Guide to Alternative Blepharitis and Meibomian Gland Dysfunction Treatments
Note: I originally wrote this for the Dry Eye Talk Forum. In addition to Blepharitis/MGD, I've also had doctors tell me that my condition is Seborrheic Dermatitis and Ocular Rosacea. I suspect that all of these conditions are related and so I'm posting this article to the Rosacea forum. I hope you'll consider these options and see if they help you, and post if they do!
If youíre like me, youíve been suffering from Blepharitis and Meibomian Gland Dysfunction (ďMGDĒ), seen several doctors, and been unable to find relief. Some of you may be long-time sufferers and some of you may be recent sufferers. Iíve been suffering from Blepharitis/MGD for about five years. Iíve spent a lot of time reading these forums and trying various treatments, and Iíve decided to make a comprehensive list of treatment options, and to ask each of you to consider trying my approach and to report back here on your results. Iíll also include my comments about what worked for me and what didnít.
At the outset, however, I want to disclose my biases and where Iím coming from. First, I am absolutely convinced that the mainstream medical philosophy on the causes and treatment for Blepharitis and MGD are wrong. I believe this both because the traditional treatment methods did not work for me (and often made my condition worse), and because there are many others who are just like me who are searching for relief. If youíre reading this forum, it is probably because you have not found relief from your doctors.
Second, I am almost certain that my Blepharitis is caused by an allergic or irritant response to something in the air. I reached this conclusion very early on, when I was taking a course of steroids and I found that when I was in certain locations, the steroids would work better than when I was in other locations. My belief was confirmed by the fact that allergy treatments have worked wonders for my condition, while the traditional treatment methods did almost nothing. Today, I am 95% better than I was when I first sought treatment. And I really, really believe that if other people try what I did, some of them can find relief also. I suspect that some of you out there may even be able to help refine my theories further.
Hereís what you need to know about allergies. The air around you is filled with millions of little particles that you cannot see. These particles include mold/fungi spores, dust mites and their fecal matter, pollen, animal dander, skin cells, particulate emissions from automobiles and industry, pollutants like Ozone, and many others. As you walk around, these particles are constantly bombarding your eyes. As you sit down on a sofa or chair, or roll over in bed, these particles rise up out of the foam. They are the very reason that we have eyelids, tear films, and a blink mechanism, i.e. so that the accumulation of these particles can be swept away.
These particles can be measured using a particle scanner. If you contact the company that makes the IQAir Perfect 16 while house air cleaner, theyíll be happy to send someone out to your home to measure those particles. Theyíll also try to sell you a very expensive air cleaner, which I am not entirely certain is necessary (more on that later). When I tested the air outside my home, I found measurements as high as 2,500,000 particles per unit of measure (I canít remember what the unit was, but I think it was per cubic foot of air).
Mold/fungi spores, dust mites, pollen, animal dander, etc. are well-known allergens which can provoke an allergic response in certain areas of your body. Ozone, which is a principal component of smog, is a well-known eye, nose, throat and lung irritant. Allergies do not only cause runny nose and sneezing. Rather, you can have allergies that only affect your skin. Also, instead of having a massive allergic response that causes hay fever symptoms, you can have a low level allergic response that keeps your sinuses inflamed. An allergist will tell you that allergies can even cause red eyes and irritated eyelids.
In my case, my lower eyelid is much worse than my upper eyelid. I suspect that is because gravity and the blinking motion of my eye pushes the allergens down, and the allergens build up under my lower eyelid. Those allergens then irritate my Meibomian Glands, causing them to produce a white, cottage cheese like substance instead of the natural oils that Iím supposed to have. These allergens also cause the edge of my eyelids to become inflamed and to appear serrated, and, at times, my eyelashes to fall out.
Unfortunately for me (and maybe you), when we have problems with our eyes, we often seek treatment from an ophthalmologist or an optometrist, rather than an allergist. These eye doctors are not trained in allergy like allergists are. Rather, they are trained in diseases of the eyes. As a result, Iíve found that eye doctors are far less likely to ďseeĒ allergy than an allergist is. This phenomenon reminds me of the old adage: ďWhen youíre holding a hammer, every problem looks like a nail.Ē When you see an allergist, every problem looks like allergy. When you see an eye doctor, every problem looks like an eye disease.
Also, many eye doctors discount allergy unless you report itchiness. At least for me itchiness only occurs when Iím right on the border between good and bad. When my eyes start to hurt, the itchiness goes away. Many eye doctors also incorrectly believe that antihistamines will dry your eyes out. They will, at first, but once your glands start working correctly again, your tears will return to normal as well.
Things Your Might Try
Having said all that, here is my comprehensive guide to treatments that Iíve tried, with my comments. Because Iím writing the guide, Iíll start with what has worked for me and finish with what hasnít worked, but might work for you.
1. Close your windows- The vast majority of sources of allergen (including molds, pollens, etc.) and chemical irritants come from outside your home. When my problems started, I always kept my windows open, because I enjoy fresh air. I had no clue that the polluted southern California air was irritating my eyes. Closing my windows and filtering my air improved my symptoms dramatically, overnight. Now, I open the windows for 15 minutes once every week or so, around midnight, when the levels of outside air pollution are lowest.
2. Clean your environment- This is really the easiest thing to do and was the most effective thing for me, because I am allergic to dust mites and molds. Dust mites and molds are everywhere, but they are also relatively easy to remove by cleaning.
Start by cleaning EVERYTHING where you spend significant time. Clean under, over, behind, and on top of EVERYTHING.
Your Bed- You spend at least 8 hours a day there, and your mattress and bedding is filled with dust mites. Strip your bed and wash EVERYTHING on it (pillows, blankets, sheets, duvets, mattress covers, allergy covers, etc.) in hot water once a week. I found that my bedspread was too large to regularly wash, and so I replaced it with a quilt and a cotton blanket. Now I can wash both every week in separate loads.
While everything is off your mattress, vacuum it using a HEPA filtered vacuum. My favorite vacuum is made by Miele, with the optional HEPA filter. Miele is VERY expensive, and if you canít afford one, the Electrolux Oxygen models also work well. Donít forget to clean under and behind your bed.
Even more importantly, buy and use allergy covers on your mattresses, box springs, and pillows. This made a huge difference for me, since you canít really wash your mattress or box springs.
A lot of different companies sell covers that supposedly block dust mites, but Iíve found that very few of them actually work. The only covers that I trust (and that Iíve found work) are ones that are also waterproof. National Allergy Supply sells a series called ďBedcare ClassicĒ which have a cotton outerliner and a rubber inside liner. Theyíre also one of the cheapest versions that National Allergy Supply sells.
Remember that you MUST wash your allergy covers, or dust mites will colonize them as well. Most mattress covers fully enclose the mattress and they are hard to remove. Again, National Allergy Supply sells a travel cover which goes on like a fitted sheet, and it makes it much easier to remove, wash, and put the cover back on. If you go to National Allergyís web-site and search for ďBedcase Classic TravelĒ you can find it easily.
Your Carpet- Your carpet is like a huge sponge. It absorbs all the particles that are in the air until it fills up. When you walk on it, your carpet releases them back into the air in a plume. Try beating on the carpet while you shine a flashlight at it (at night, in the dark), and watch the plume. Remember that you canít see most of what is being brought up. Vacuum your carpet at least twice a week using a HEPA filtered vacuum.
Your hard floors- mop/vacuum them at least once a week.
Your furniture- Cloth furniture harbors dust mites and absorbs particulates just like carpets. Try beating on the furniture while you shine a flashlight at it (at night, in the dark), and watch the plume. Vacuum any cloth furniture. This applies to your office chair, sofa, easy chair, and any other cloth furniture. Better yet, replace it with something in leather.
Your computer and other electronic equipment- take them outside along with a bottle of canned air. Open the computer if possible. Use the canner air to blow out all the dust. Youíll be amazed at how much stuff is in there, especially in your computer and its power supply. You probably only need to do this once every six months.
Your washing machine- Front loading, high efficiency washing machines are notorious for harboring and growing mold. Search Google for ďFront Loader MoldĒ and you can read all about it. Carefully inspect the seal around your front loader for mold growth. Pull it back and look up inside. Get rid of your front loader. If you canít, clean it (see the aforementioned Google search results for instructions), and then leave the door open whenever you arenít using it to allow it to dry. Spores from that mold are in all of your clothing and bedding, so go wash them all again.
Framed pictures- my wife had a bunch of old framed pictures stored behind our bed. Cleaning these improved my eyes by 50% overnight.
Window Coverings- clean your shades/blinds/shutters/drapes. Clean the top of the rail that they are hanging from.
Light fixtures- clean inside and outside all light fixtures. Clean the bulbs. Turn it OFF and wait an hour first because bulbs can get very hot.
Your bathroom- clean any mold in your shower. Clean your hairbrush and comb because it is a breeding ground for dust mites.
Consider buying a Haan steam mop and using that, along with the carpet attachment to sanitize your carpet and furniture using steam. Steam can kill dust mites.
3. Clean yourself. Shower and rinse your hair twice a day. Your hair, like carpet, can harbor allergens. If you sleep with a partner, make sure he/she rinses his/her hair at night before going to bed. Consider Nasal irrigation- as your breath, the hairs in your nose and sinuses harbor allergens. I have used the Neil-Med Sinus Rinse in the past and found it to be relatively easy to use.
4. Antihistamines- There are a million ocular antihistamines, but the most popular is a prescription drug called Patanol and Pataday (Pataday is just a higher concentration of Patanol that is dosed once daily Ė it seems to work better). Zaditor is over the counter and cheaper, but I donít think that it works quite as well. If you use these ocular drugs, read the instructions and follow them. Donít just drop the drops into your eye. Pull down your lower lid, create a pouch, put the drop in, blink twice, close your eye, and block the drain duct for as long as you can so that your eye will absorb the medicine.
There are also several oral antihistamines, but my favorite is prescription only Allegra, because it doesnít make you drowsy. Demand the 180 mg once daily dosing, and not the 60 mg dosing. Zyrtec used to be prescription, but it is now over the counter. Although they say it doesnít make you drowsy, it makes me drowsy. Benadryl is the most effective oral antihistamine, but it makes me very drowsy (and it is also used as the ingredient in most over the counter sleeping pills).
Iíve found that antihistamines are only marginally effective at reducing allergy symptoms. They work best when Iím in the marginal area where my eyes actually itch, but are not painful. In addition, antihistamines have an immediate effect, but they also have a cumulative effect. The longer you take them consistently, the more they work.
5. Ocular Antibiotics- Iíve tried these several times with different results. Before I realized that my problem was allergy, I found that antibiotic ointments made things worse. I usually put them on before bedtime and then got in bed. I suspect that all the allergens from my mattress, pillows, and the dust covered framed pictures stored behind the bed then attached themselves to my sticky eyelids, making things much, much worse.
More recently, however, I started using ocular antibiotics again and Iím finding that they may be helping. Recently, Iíve tried by Erythromycin Ointment and then later Azithromycin Gel (sold as Azasite). However, I do not follow my doctorís directions. Instead of putting a huge amount into my eyes and messing up my vision, I wash my hands, apply a small amount to my finger tip, and then rub the ointment onto the surface of my lower eyelid between the lashes and my eyes. Then I close my eyes and apply a little more to the outside surface of my eyelids. I do one eye at a time, and keep my eyes closed for as long as possible after applying the medicine so that my tears donít wash it away before it can be absorbed. It certainly hasnít been making things worse, but since Iím doing this in combination with other treatments, itís hard to tell how much it is helping.
Be aware that there are risks to using antibiotics. Bacteria and mold compete for resources in your tissues. If you eliminate some bacteria, you eliminate a natural rival which suppresses the mold and other bacteria that wouldnít normally take hold. This is why some women get yeast infections and some people get nasty gut infections (called colitis) after taking antibiotics.
Antibiotics may also offer some relief because most antibiotics have an anti-inflammatory effect.
6. Get some sun- Sunlight kills mold and fungi, and helps your body produce Vitamin D. Obviously, you donít want to get too much, but too little sunlight is unhealthy as well. Iíve found that 15-30 minutes of direct sunlight every day was very helpful. I usually walk around in the sun one day and then lay-out in the sun another day. Recent research suggests that most people are deficient in Vitamin D, and sun exposure is the easiest way to get the right amount.
Obviously, you want to avoid the sun if you have a medical condition that would be worsened by sun exposure. You should also avoid sunlight if youíre taking Doxycycline or any other medication whose directions tell you to avoid sunlight.
7. Moisturize- Iíve found that moisturizing my face and eyelids using OTC moisturizers like Eucerin has been very helpful.
8. Cold compresses- most eye doctors will tell you to use warm compresses. This didnít work for me at all. And why should it? If you have inflammation on any other part of your body, your doctor will tell you to use cold compresses or ice to reduce the inflammation. Heat promotes inflammation. If your eyelids are red and irritated, use cold compresses. This is the most effective immediate remedy, but its effect is short-lived.
Your eye doctor will tell you that your glands are plugged. I believe that they arenít plugged; rather, they are swollen and producing a thick substance. Although it is thick, it still comes out whenever I rinse with saline, and thus, the glands are NOT plugged.
Iíve found that my eyes feel best when Iím outside during a cold winter. The cold soothes my eyes, and there is very little mold spores, pollen, and dust mites during cold winter months. If my problem were plugged ducts, I would expect just the opposite.
9. Steroids- Many eye doctors will recommend short courses of ocular steroids. They have risks, however. Steroids can cause an increase in intraocular pressure and can cause serious retina damage. Thatís why, whenever you take ocular steroids, your doctor should check your eye pressure at least once every two weeks. Steroids can also cause cateracts later in life. There are several weaker steroids which doctors regard as ďsafer,Ē including Alrex (which has been approved for long-term use to treat allergies).
10. Eye drops- if you must use any kind of ocular eyedrops, try to avoid using ones with preservatives. Iíve found that the use of too many drops that contain preservatives can make my eyes significantly worse, and it can take several days for the effect to go away. Eye drops work best if you follow the instructions: Form a pouch, insert drop, blink twice, and close your eyes for as long as possible. Several formulations of lubricating eye drops are available in single-use vials, with no preservatives.
Unisol 4 is a preservative free saline. I use it to rinse out my eyes at least once a day, on the theory that rinsing out the allergens is a good thing.
11. See an allergist and get tested. Because of restrictions imposed by insurance companies, your allergist my not offer you the best testing method.
Ask for prick testing for every antigen that is available. Ask your allergist to follow-up any negative prick test with an ďintradermal skin test,Ē which involves using a syringe to inject a small amount of antigen into your skin. Offer to pay cash if your insurance wonít cover it, and ask if he offers a cash discount. Blood tests are not effective at detecting allergies.
Ask your allergist to give you allergy injections for any positive results, ESPECIALLY mold. Some allergists wonít test for mold and wonít treat for mold, so make sure that the doctor you see will.
Ask your allergist if you have any signs of allergy in you nasal passages. If you do, treat them with prescription Patanase (a nasal antihistamine that contains the same ingredient as Pataday) and Veramyst (a nasal steroid that has also been shown to offer relief for ocular allergy sufferers.
12. Exercise- Exercise 30 minutes a day. Exercise is proven to reduce almost every kind of inflammatory condition. Itís also good for your heart and will help you to lose weight and probably live longer.
13. Change your soap, your shampoo, your laundry detergent, and all your personal care products- Several readers have reported finding that a certain soap or detergent was the cause of their irritated eyes. This didnít help me, but it certainly makes sense to try it.
14. If you have a central furnace, install the best media (non-electronic) filter you can. Remember to change your filters regularly. Run your furnace 24/7 if you can and let your furnace filter clean the air in your house.
Consider upgrading your furnace filter to the IQAir 16 (which is very expensive) or the Lennox HC16 (which is very inexpensive and is rated to work just as well).
Consider hiring an AC contractor to install UV lights over your AC Coil. Your AC coil is a breeding ground for mold, because it is often moist and always dark. Whenever your AC is on, spores are probably coming out of your HVAC vents. UV lights kill mold and prevent it from growing. It is not sufficient to put a UV light in your air filter, the light must shine where the water collects on the AC cool, as water promotes mold growth. I did this at first, but ultimately removed the UV lights because they added a funky smell to my furnace.
Avoid electronic filters. Every ten years, it turns out that the electronic filter they used 10 years ago did something that was harmful to your health. Media based filters are proven safe and effective.
15. Buy a room HEPA filter. IQAir is the most expensive and claims to be the best. The Honeywell 50xxx models are much cheaper, and work just as well according to the particulate counter that I used to test them. 3M makes a model called the Filtrete Room Air cleaner with is NOT a HEPA filter, but which cleans the air much faster and quieter than a HEPA filter. Remember to change your filters regularly. Avoid electronic filters for the reasons I discussed above. If you have a central furnace and you run it regularly to heat or cool your house, you should add filtration to it as well.
Iíve used filters in various areas of my house, and Iíve learned the following: The vast majority of the dust in a house comes from the laundry room. If you place a filter in your laundry room, it will collect massive amounts of laundry dust and need new filters very often. For that reason, I settled on a non-HEPA filter called the 3M Filtrete for my laundry room. The bathrooms are the second most dusty places. And downstairs is usually dustier than upstairs.
16. Antifungals- Diflucan is a prescription antifungal. Some people in the Blepharitis Forum have reported that Diflucan cured their Blepharitis. Diflucan kills molds and fungi throughout your body. It has a long half-life in your body. I suspect that it works, at least in the short term, because we are allergic to fungi. Killing them removes them from our body and thus alleviates the allergic reaction. But, because fungi and molds are everywhere, they are likely to return once the Diflucan leaves your body. Diflucan has serious risks and drug interactions, so talk to your doctor about this therapy, even if you live in a country where it is available over the counter. I tested this theory and it did not work for me.
Antifungal shampoos- Some Blepharitis Forum users have reported success using anti-dandruff shampoos which contain antifungals to clean their eyelids followed by a 60 seconds of soaking on the eyelids before rinsing. This might work, because they would kill any mold and fungi, to which we may be allergic. Nizoral, Head and Shoulders, and others are available over the counter. Iíve tried it and found it inconclusive Ė Iím pretty sure that the irritation caused by the shampoo outweighed any benefit.
17. Over the Counter Eyelid Scrubs- Theratears Sterilid is an over the counter eyelid foam. Iíve used it and found that it helps sometimes, but it also irritates my eyelids. Interestingly, it contains natural ingredients which have anti-bacterial and antifungal properties. It is expensive, however.
18. Warm compresses, lid expression, lid scrubs, baby shampoo- If youíre reading this, youíve probably tried all of these. They didnít work for me, and they actually made my condition worse. As I mentioned before, heat provokes inflammation. Scrubbing irritated tissue just irritates it even more.
Iíve been posting my theories off and on for some time, but most people just seem to ignore them. If youíre suffering, please consider treating your condition like an allergy, and reply to this message to report whether any of these things worked for you.