eyelid swelling!

[koki]

Guys, I would greatly appreciate any tips on ocular rosacea/ eyelid swelling. Im on 250mg of tetracycline. Do cold compresses once in a while. What has helped you guys??

Im getting wrinkles from the constant swelling and is really bringing me down, my self-esteem is nonexistent because of this, im only 21.

=(

[Melissa W]

Hi Koki,
I'm so sorry you are dealing with this. Do you have allergies by any chance? That would increase eyelid swelling and if so you might want to take an antihistamine for some relief. That will dry out your tear film as well so make sure to instill some preservative free rewetting drops. Cool compresses on a more regular basis should help as well and you might want to try cool tea bags as I believe that could help with swelling also.

Do you have any other eye symptoms besides lid swelling?

Best wishes,
Melissa

[koki]

Yup, I recently tested allergic to absolutely everything. I took zyrtec yesterday and my eyes got really dry, so I dont really know what to do. I have meibomian gland dysfunction because of the rosacea but the swelling of the eyelids started recently.
Whenever my eyelids swell my inner cheeks also feel swollen.. I dont know if there is a connection? Do u know if antibiotics help with the rosacea swelling?

Melissa you are a sweetheart, thank you for helping everyone!

[Melissa W]

Hi Koki,

Antibiotics (topical as well as oral if necessary) will be helpful for MGD as will doing warm compresses, lid massages,cleansing your lids/lashes with warm water and a soft washcloth or lid scrubs and adding omega 3's to your diet.

There is also another treatment that may prove beneficial using azithromycin in a topical preparation where it is acting as an anti-inflammatory.

Here is a great explanation about MGD and how to treat it from the Dry Eye Zone and an explanation about the topical azithromycin from Dr Eric Donnenfeld who is also a really nice guy who knows his stuff btw.

http://www.dryeyezone.com/encyclopedia/mgd.html

Meibomian gland dysfunction (MGD)
also called... MGD, meibomitis, meibomianitis, lid margin disease
WHAT IT IS Your oil glands have gone on strike!
The meibomian glands are located in the eyelids. Secretions from these glands comprise the lipid (oily) layer of the tear film which is so crucial in preventing rapid evaporation of the tears. Failure of these glands to produce or secrete oil - due to chronic blockage, thickening of the meibum, etc. will affect the quality and stability of the tear film, which in turn will produce classic dry eye symptoms even in people whose dry eye test results appear normal. A TBUT should show whether the oil layer of the tear film is adequate or not.
Meibomian gland dysfunction is quite common and unfortunately it often goes undiagnosed. Even when diagnosed is often not treated or is not treated effectively until it has become chronic or severe.
MGD may be inflammatory (often as a result of blepharitis) or atrophic.
For more non-technical background to put MGD in context, please read Dry Eye for Dummies.
CAREFUL! MAY BE CONFUSED WITH... "Dry eye" (in the aqueous deficiency sense): Many people who have dry eye symptoms are treated as though the cause is aqueous deficiency, e.g. with artificial tear supplementation and punctal plugs, when in fact their primary problem is meibomian gland dysfunction. Some researchers believe that up to 70% of chronic dry eye may actually be MGD, not "classic" dry eye.
Blepharitis: Blepharitis is related because chronic blepharitis will cause chronic meibomian gland dysfunction, which in turn will cause dry eye symptoms. But blepharitis should not be confused with meibomian gland dysfunction. Keep in mind that you may clear up the bleph and still have MGD.
TREATMENT Typical treatments for MGD may include, depending on specifics of the condition:

• warm compresses (to liquefy any secretions that have solidified and are clogging the glands)
• lid scrubs
• oral antibiotics (such as doxycycline)
• Omega 3 supplementation
• topical antibiotic ointments

and
http://www.eyecareeducators.com/site...ysfunction.htm

New Treatment for Meibomian Gland Dysfunction
Eric D. Donnenfeld, MD, FACS
A new medication and treatment algorithm promise greater efficacy for the treatment of meibomian gland dysfunction.
Meibomian gland dysfunction (MGD), also known as posterior blepharitis, is one of the most common physical findings in primary eyecare patients. MGD is important to treat for several reasons. While MGD may not be sight threatening, it undermines patients’ quality of life enough that they often come to us for relief. Second, the abnormal lipids produced by MGD patients have a negative effect on the quality of the tear film, which produces both discomfort and visual acuity problems (Figure 1). Third, MGD can lead to chalazia, which can be painful and unsightly for the patient. MGD is also very highly associated with infections of the lid margins, so it may contribute to bacterial growth in the lids, which can increase the risk of infection following any kind of ocular surgery. Lastly, for so many of our patients, it can make wearing contact lenses very difficult.
Providers have historically considered MGD one of the most difficult diseases to treat because we have lacked a simple, effective therapy. The challenge with “mechanical” therapies (cleansing, hot compresses, massage) is adherence; the challenge with topical antibiotic drops and ointments is efficacy—they do not penetrate the lid margin well, and most lack the needed antiinflammatory effect. While more effective, oral tetracyclines often have unpleasant gastrointestinal side effects.
A New Approach
All this may be about to change, however. The topical preparation of the macrolide antibiotic azithromycin (AzaSite®; Inspire Pharmaceuticals) in a mucoadhesive vehicle (DuraSite®) promises us an agent that is easy to administer and truly effective. Unlike fluoro*quinolones, macrolide antibiotics have antiinflammatory as well as antibacterial properties.
In addition, the vehicle in the new azithromycin preparation is mucoadhesive that adheres the antibiotic to the lid margins long enough for it to penetrate tissue. Azithromycin itself has high affinity for tissue and tends to reside there for long periods, offering a reservoir of drug for a lasting effect. Research in rabbit eyes shows that AzaSite can achieve tissue levels very substantially higher than can be achieved with any of our other ocular antibiotics.
Like the tetracyclines, azithromycin has antiinflammatory effects that are independent of its antibiotic effect. But, unlike the tetracyclines, which must be taken orally, we can now give azithromycin topically, so that there are no unpleasant systemic side effects. In addition, properties of both the drug and its vehicle make it possible to achieve and maintain effective tissue concentrations, even when the drug is taken just once a day. In fact, the tissue concentrations when azithromycin is given topically are such that effective levels are maintained for days or weeks after the drug is stopped.
Currently, AzaSite is approved only for the treatment of conjunctivitis, so its use for MGD is off-label. However, we have been using it to treat MGD very successfully in our practice and in open-label studies, and we’re initiating a double-masked controlled trial.
A New Regimen
We currently have patients take topical azithromycin as an integral part of a comprehensive lid disease treatment regimen. This includes lid cleansing with a commercial lid cleanser followed by hyperthermia (warm compresses—as warm as the patient can tolerate—for 3 to 5 minutes). The azithromycin drop is then applied to the lid margin and the lid massaged for about 10 seconds.
This regimen is performed twice a day (morning and evening) for 2 days, and then once a day in the evening for 28 days. After one month of treatment, azithromycin can be used on a month-on/month-off basis to control the inflammation. The cleansing, hyperthermia, and massage routine is continued as long as the patient is symptomatic.
Topical azithromycin plus lid hygiene comprises our first-line therapy. If additional therapy is needed, an oral tetracycline (minocycline or doxyclycline) can be added. If additional antiinflammatory effect is needed, topical cylcosporine (Restasis®; Allergan) and/or a topical corticosteroid can be added.
THE BOTTOM LINE
MGD affects many of our patients, and treatment options traditionally have been notorious for low efficacy and poor adherence. While the treatment still includes mechanical measures (lid cleansing, hyperthermia, and massage), the new topical azithromycin preparation promises to greatly improve our ability to help patients with this very unpleasant, chronic condition.













Eric D. Donnenfeld, MD, FACS, is a founding partner of ophthalmic consultants of Long Island and Connecticut and a clinical professor of ophthalmology at New York University Medical Center. Dr. Donnenfeld is a consultant for Allergan, AMO, Alcon, Bausch & Lomb, Inspire Pharmaceuticals, and InSite Vision. He received assistance with this article from medical writer Mary Gabb, MS.

I hope this is helpful Koki. Let us know how it is going.

Best wishes,
Melissa

[findingaway]

Has this new drug been approved in the UK do you know Melissa?

[Melissa W]

Hi Moore,
I did a search and I believe it is available in the UK. Why don't you call your local pharmacy to find out for sure.

Best,
Melissa

[queta]

Hi
My derm told me I can put a very thin layer of Metrogel on my eyelids to reduce the swelling. BE VERY CAREFUL and don't get in your eyes. It has really reduced the eyelid swelling.
Cheers
Queta

[Fee]

I've had eyelid swelling since puberty and now wonder if it was an initial presenter of ocular rosacea. I have wrinkling too and fat atrophy around the eyes. This is my history. Does it sound similar to yours?



I've dealt with moderate to severe swelling around my eyes since I was 12 (puberty). I always woke up to the swelling, it was painless and never affected my eyes directly, just the tissue around. The swelling could affect the upper and/or lower lid in one or both eyes. The swelling could take up to 4 days to go down. In my teens I could have severe swelling (like I'd been stung by a bee) 3-4 times every six months. Throughout my 20s the swellings became less frequent in intensity and number. Now, in my mid 30s I have a moderate swelling that I wake up to maybe 1-2 times every six months. I was told growing up that the swellings were due to "allergies," so I just accepted that I would get them sometimes. Though I was never diagnosed with being allergic to anything. :/

To add another piece to the puzzle, in my mid 20s I developed the first skin symptoms of rosacea—papules and pustules—and I was later diagnosed with rosacea. Around the same time a doctor diagnosed the eyelid swelling as blepharochalasis, a condition of unknown origin that causes eyelid swelling starting in puberty. But I still feel like there could be some type of rosacea link since I know some of us suffer from different types of facial swelling. I've noticed that some of my rosacea triggers, particularly getting hot, like from exercise, can result in swellings the next day, but not always. Sometimes I can't pin point a cause and I fill like my eyelids are almost always a little puffier than they should be, though the rest of my face never is. I've never had nose swelling, though I did wake up to slightly noticeable upper lip swelling maybe like 4-5 that I can remember in my life.