What is the treatment done for ocular rosacea, blepharitis, and MGD?

Question

Hi doctor,

I am a 22-year-old girl. I have had eye problems for around nine months and have seen several eye doctors and ophthalmologists who all have told me different things and tried a lot of different treatments that have not worked. I am a contact lens wearer with extremely bad eyesight and first had eye problems eight months back. It started after a plane ride and assumed it was an eye infection from being on a dirty plane and touching my eyes.My eyes were stinging and crying and red and I could not bear to put contacts in. Nine months later I am still having this problem. I was first treated with antibacterial drops by a normal doctor then referred to an eye doctor when this did not fix it. The eye doctors diagnosed me with ocular rosacea, blepharitis, and MGD. I have rosacea on my face too. I have done eye compresses, gotten a liposcan (meibomian glands were not clogged enough to need lipoflow), I have punctal plugs in both eyes and I took Doxycycline for over three months which did nothing but destroy my digestion. I have been prescribed Restasis and Lotemax which I use multiple times a day. I use lid scrubs and a tea tree oil eye and face cleanser. But my symptoms are still severe, I have extremely dry eyes, my eyes are bloodshot 24/7. I have red lower lid margins and cannot bear to wear contacts which is extremely upsetting because I am an athlete and this is really impacting my athletic ability and quality of life. I just really hope someone has an answer and treatment that will work.

Answer 1

Hi,

Welcome to icliniq.com.

I can imagine the situation you are going through. MGD (meibomian gland dysfunction) with dry eyes related to rosacea is a disturbing problem. Your doctor is treating it very well but in spite of all, you are still having problems. You have done warm compresses, taken oral and topical antibiotics and steroid drops too with artificial tears and punctal plugs. Most of the people respond to this therapy. A contact lens is not advised in cases with severe dry eyes and MGD (but as you told you are an athlete and glasses are not suitable for you). And you are not an ideal case for refractive surgery too with such condition. So considering all these factors I would suggest that discontinue contact lens for some time or minimize duration as much as you can (better to discontinue) until your eyes get better. Secondly, clean your lid margins regularly with wet cotton or baby shampoo to remove crusts (if any). You are already using steroid drops (Lotemax) but I would advise you to use eye ointment at night like Blephamide (has steroid) or plain antibiotic ointments like Fusithalmic (Fusic acid) or Tobramycin. Apply this ointment at lid margins, eyelash roots at night after properly cleansing eyelids (as it is a disease of lid margins). Topical drops have limited effect on lid margins diseases but topical drops are necessary for conjunctival redness. So continue Lotemax (I hope your doctor is monitoring intraocular pressure IOP as steroid drops can cause secondary glaucoma) and Restasis (Cyclosporine). Restasis can be used as many times as you feel the need. As they are preservative free and have no side effects. Punctal plugs are good. So, in short, continue all the medication you are using. Discontinue contact lenses for some time. Continue warm compresses. Try Blephamide ointment (if IOP is normal) or some antibiotic eye ointment. Keep follow up to your doctor they are doing a great job.

What is the treatment done for ocular rosacea, blepharitis, and MGD?

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