Treating Blepharitis

[BigMonk]

I've had what I believe to be blepharitis for almost 9 months now; crusting of the eye lids, loss of eyelashes, stys and most recently inflammation of the eye lids (I've started to look like a frog).

Unfortunately its definitely chronic and I'm really struggling to shift it. I do the hot compresses and cleaning of the eye lids twice a day with baby shampoo and a terry towel flannel and it feels great, but it doesn't return any long term results.

The GP's at my local practice have been next to useless and keep writing me prescriptions for ointments and drops that do nothing other than irritate my eyes.

I requested to be referred to a specialist yet again but my GP wants me to try two further treatments, fusidic acid 2% cream and olopatdine 0.1% eye drops – I told her with all due respect, every other past ointment and drop has poisoned my eyes.

So does anyone have knowledge of either drug? I’m now very conscious about anything my GP recommends.

Thanks in advance.

Edited by BigMonk on Monday 9th January 19:33

[968]

BigMonk said:

I've had what I believe to be blepharitis for almost 9 months now; crusting of the eye lids, stys and most recently inflammation of the eye lids (I've started to look like a frog).

Unfortunately its definitely chronic and I'm really struggling to shift it. I do the hot compresses and cleaning of the eye lids twice a day with baby shampoo and a terry towel flannel and it feels great, but it doesn't return any long term results.

The GP's at my local practice have been next to useless and keep writing me prescriptions for ointments and drops that do nothing other than irritate my eyes.

I requested to be referred to a specialist yet again but my GP wants me to try two further treatments, fusidic acid 2% cream and olopatdine 0.1% eye drops – I told her with all due respect, every other past ointment and drop has poisoned my eyes.

So does anyone have knowledge of either drug? I’m now very conscious about anything my GP recommends.

Thanks in advance.

Get referred to an Ophthalmologist.

It sounds like you need treatment with oral antibiotics, doxycycline to be precise, 100mg once a day for 3 months. It'll clear it right up. You might need some steroid ointment too. With respect to the GP, this is not her area of expertise and she should refer.

As you perceptively say, fusidic acid will simply irritate your eyes and olpatidine is an antihistamine and will do bugger all to help, but will poison your eyes more. Stop all drops, get referred to your local eye hospital, to see an ophthalmologist. Let me know where you are and I might be able to recommend someone.

Edited by 968 on Monday 9th January 19:38

[BigMonk]

Thanks for your feedback - its exactly what I wanted to hear.

I am in the Liverpool area.

Thanks kindly.

[968]

BigMonk said:

Thanks for your feedback - its exactly what I wanted to hear.

I am in the Liverpool area.

Thanks kindly.

No probs. In Liverpool, I think the best person might be Stephen Kaye, for front of the eye problems. In Wirral there's a guy called Austin McCormick who might be able to help too and is a fantastic doctor. I'm in Manchester and there are good people here. A great guy in Bolton is Jeff Kwartz.

[Superbad]

Have you had a swab done? GP should have done one if you've had the issue for 9 months.

Basically they'll take a swab of the stuff in and around your eyes and grow it. Once they now exactly what it is they'll give you an oral antibiotic the stuff is sensitive to.

[968]

Superbad said:

Have you had a swab done? GP should have done one if you've had the issue for 9 months.

Basically they'll take a swab of the stuff in and around your eyes and grow it. Once they now exactly what it is they'll give you an oral antibiotic the stuff is sensitive to.

It's not really that important as it's not an active infection that causes blepharitis, it's an inflammatory reaction to the presence of skin flora, in people that produce more oil in the skin.

The oral antibiotics he needs is doxycycline or tetracycline. The others will not help as it's not the antibacterial aspect of the drug that helps blepharitis in particular, it's that the chemical has an affect to neutralise harmful inflammatory proteins that attack the front of the eye and eyelid.

He needs referral to a specialist and proper examination.

[BigMonk]

Thanks gents.

[PaulHogan]

Do you wear glasses (sunglasses as well)? Make sure these are sterilised regularly. Also change your pillowcases daily and your bedding every three days or so until the infection retreats.

[968]

PaulHogan said:

Do you wear glasses (sunglasses as well)? Make sure these are sterilised regularly. Also change your pillowcases daily and your bedding every three days or so until the infection retreats.

Arrggghhh it's not an infection!

[PaulHogan]

968 said:

Arrggghhh it's not an infection!

http://en.wikipedia.org/wiki/Blepharitis

[968]

PaulHogan said:

http://en.wikipedia.org/wiki/Blepharitis

Thanks, I'm a Consultant Ophthalmic surgeon by the way and no it's not an active infection in this chaps case. If you read wiki (not that reliable source) it'll tell you it's an inflammatory reaction to the presence of skin flora, specifically staphylococcal organisms. Even in anterior blepharitis, it is still not an active infection as such, rather an exaggerated inflammatory response to the bacterial materials that exist on the lashes and eye surface. I treat this condition very regularly, and believe me, changing the bedding etc makes no difference. He needs proper assessment and management as I've described above.

[Cheib]

Not saying I advocate it but there are plenty of people that short circuit the system by going to A&E in a case like yours....it's not what your supposed to do but people do it.

It's unbelievable that your GP won't refer you...I'd be on to the local NHS Trust making a complaint.

[968]

Cheib said:

Not saying I advocate it but there are plenty of people that short circuit the system by going to A&E in a case like yours....it's not what your supposed to do but people do it.

It's unbelievable that your GP won't refer you...I'd be on to the local NHS Trust making a complaint.

It is quite poor that the GP won't consider referral given the length of symptoms, however going to A&E might not be the best idea as unless there is a walk in eye casualty (I'm not sure if Royal Liverpool is a walk in eye casualty) you will be seen by an A&E doctor who will have about as much knowledge as the GP in this situation. If there is a walk in eye casualty, you could get seen though given your symptoms are chronic I think it would be more appropriate to be referred to outpatients.

At the end of the day, it's not actually the GPs decision whether to refer you or not, it's yours as the patient. I would explain to her that you do not want to try anything else, and would like to be referred for a specialist opinion. The alternative is to be seen privately, then you can be seen by who you like, when you like.

[PaulHogan]

968 said:

Thanks, I'm a Consultant Ophthalmic surgeon by the way

Why didn't you say so in your first post?

968 said:

and no it's not an active infection in this chaps case

Amazing! You can diagnose a person without seeing them.

968 said:

...and believe me, changing the bedding etc makes no difference.

Without wishing to call into question the OP's hygeine, how do you know it won't help?

[968]

PaulHogan said:

968 said:

Thanks, I'm a Consultant Ophthalmic surgeon by the way

Why didn't you say so in your first post?

968 said:

and no it's not an active infection in this chaps case

Amazing! You can diagnose a person without seeing them.

968 said:

...and believe me, changing the bedding etc makes no difference.

Without wishing to call into question the OP's hygeine, how do you know it won't help?

I'm very sorry for not declaring my interests at the outset.

I can't diagnose him online, which is why I've repeated that he needs specialist assessment and management and have recommended him colleagues in his area who can help him. They can also ensure that it's not something else that can cause similar symptoms.

However, his description of his symptoms are classical of blepharitis, of which I have treated many many cases. I know changing his bedding won't help because it's not a hygiene or a transferable infective problem. As I've said before, his problem is related to the composition of his skin flora and the oils produced by his skin. The inflammation caused by a hypersensitivity reaction to these natural organisms which live on all our skins, cause inflammation, which in turn can result in blockages to the glands which produce oils which appear as lumps on the eyelid, which can come and go, and are generally self-limiting but can be recurrent.

What he probably needs are topical steroid drops, oral doxycycline and possibly some topical antibiotics (not the ones given by the GP).

[croyde]

PaulHogan said:

968 said:

Thanks, I'm a Consultant Ophthalmic surgeon by the way

Why didn't you say so in your first post?

968 said:

and no it's not an active infection in this chaps case

Amazing! You can diagnose a person without seeing them.

968 said:

...and believe me, changing the bedding etc makes no difference.

Without wishing to call into question the OP's hygeine, how do you know it won't help?

968 is PH's resident eye doctor and has been helpful on many threads about eye problems.

[Cheib]

968 said:

Cheib said:

Not saying I advocate it but there are plenty of people that short circuit the system by going to A&E in a case like yours....it's not what your supposed to do but people do it.

It's unbelievable that your GP won't refer you...I'd be on to the local NHS Trust making a complaint.

It is quite poor that the GP won't consider referral given the length of symptoms, however going to A&E might not be the best idea as unless there is a walk in eye casualty (I'm not sure if Royal Liverpool is a walk in eye casualty) you will be seen by an A&E doctor who will have about as much knowledge as the GP in this situation. If there is a walk in eye casualty, you could get seen though given your symptoms are chronic I think it would be more appropriate to be referred to outpatients.

At the end of the day, it's not actually the GPs decision whether to refer you or not, it's yours as the patient. I would explain to her that you do not want to try anything else, and would like to be referred for a specialist opinion. The alternative is to be seen privately, then you can be seen by who you like, when you like.

Not advocating it but people do it....I've been to A&E a coupel of times in the past year with my young family. UCH has a specialist Paed A&E so people seem to use it to self refer to bypass their GP's!

Get on a train to London and go here http://www.imperial.nhs.uk/westerneye

It's a 5 min walk from Euston station!

Seriously though the expert knowledge you bring to this forum is brilliant....the PH massive really is an amazing resource.

[BigMonk]

968, I find there’s not much debris to remove on the outside of my eyelids but there’s chunks of it if I pull the outside edge of my eyelid up – is this of any relevance?

I'll arrange for the GP to call me back tomorrow and I'll politely demand a referral to see an ophthalmologist.

[968]

BigMonk said:

968, I find there’s not much debris to remove on the outside of my eyelids but there’s chunks of it if I pull the outside edge of my eyelid up – is this of any relevance?

I'll arrange for the GP to call me back tomorrow and I'll politely demand a referral to see an ophthalmologist.

Difficult to be sure. I would advise that you continue bathing with cooled down boiled water, mixed with baby shampoo, use a hot flannel on your eye before that, to encourage the production and expression of oil. Massage any lumps in the eye lid. Don't use any further drops for the moment, until you are seen by the ophthalmologist.

[BigMonk]

Thanks very much.

For anyone elses curiosity I will update this thread with the outcome in due course.