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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3147
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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My eyes are a problem. Off and on they are red, itchy, watery

Resolved Question:

My eyes are a problem. Off and on they are red, itchy, watery etc. and I've tried everything.
' Bathing them with hot soapy water, liquid baby soap.'
' Dry eye drops.'
' Allergy drops.'
' Ointment prescribed by an opthomologist.' and so on.

My question is, should I have a complete allergy test by an allergist?

I even feel the right eye is slightly aching. Can you suggest something?

Thank you!
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 3 years ago.

Doctor DanB :

Hello and thanks for your question. Are you available to chat?

Doctor DanB :

It sounds like you have already tried the treatment for blepharitis, which is an inflammation of the eyelids that can lead to itchy/watery eyes and also dry eyes. It also sounds as though you've tried using allergy drops. Now depending on what drops you've tried, there may be other options. Unless you've tried prescription allergy drops like Pataday, Bepreve, Lastacaft, or Elestat (you may have just been using over-the-counter allergy drops), then what you used may not have been strong enough. If you did use one of these drops, but it wasn't enough of an effect then there may be other things you need to do, in addition to these allergy drops, to treat your allergies.

Doctor DanB :

I have some patients who need much more allergy treatment to help their eyes other than just allergy drops. The next step I would recommend is taking an OTC allergy pill like Claritin, Zyrtec, or Allegra every day, in addition to using a drop like Pataday. If this helps, but is still not enough, then I would recommend also taking a different kind of allergy pill like Singulair (Accolate is another one of this type), which can help augment how the Claritin or Zyrtec works.

Customer:

The optomologist said I had blepharitis, but nothing is helping.

Doctor DanB :

If these help but you still need more effect, then adding a nasal steroid spray can sometimes help (such as Flonase or Nasonex). However, I wouldn't expect these to have a tremendous effect on additional allergy symptoms. If you need more help beyond this, then yes, seeing an allergist and possibly having allergy shots on a regular basis is probably the best thing to do.

Doctor DanB :

Ah, okay blepharitis. Let me address that.. Hold while I type my answer.

Doctor DanB :

Please accept this information as baseline treatment for blepharitis for you to review, but I will also be typing some more advanced treatments for blepharitis that you may need to try in addition to this: In order to treat blepharitis, everyday in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are called Ocusoft or Sterilid which are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water), you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done.

It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working. Also the eyes are still significantly dry during this 3-4 weeks so use the artificial tears you bought 4x/day in both eyes (one drop per application). After 4 weeks you should be able to start tapering off of the tears to as you need them.

Just doing the artificial tears, hot compresses and eyelid scrubs alone would likely start to help you after three or 4 weeks--but remember it could take this long of doing it everyday before you see a significant effect, so don't stop it thinking it's not working.

If you are a person that doesn't make their own tears very well, then you may also benefit from a prescription drop called Restasis, which actually modulates a person's immune system to help them make more of their own tears. This drop actually requires constant usage on a daily basis for up to 10-12 weeks before its effect kicks in (takes awhile to change the immune response in the body).

Customer:

Thank you. I think your suggestions will be helpful, and I agree that I should have allergy tests.

Doctor DanB :

For persons who are doing all of the above treatments for blepharitis, you may also need a pulse treatment of a low-concentration antibiotic such as doxycycline that can help those people with blepharitis.

Doctor DanB :

In addition, taking a fish-oil supplement on a daily basis can also work well for persons with blepharitis. Lastly, you may need a pulse treatment with an antibiotic / steroid combination drop that helps calm down inflammation while killing the bacteria that llike to pool in your tear film because of the inflammation from blepharitis. It is not a true infection, but the bacteria can work a number on your eyelids.

Customer:

You have suggested things that I have not heard befor, and that is helpful.

Doctor DanB :

Do you have any other questions I can help you with?

Customer:

I do take Omega 3 tablets.

Doctor DanB :

That's good, I would continue using those.

Customer:

Some of your suggestions are most interesting. Hope the doctor here will agree.

Doctor DanB :

I hope so, too.


I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need.


 


If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter; this allows part of the funds that you have deposited to the website to be released for my efforts to assist you. This does not end our conversation, however-we can continue to discuss any of your concerns without further charges until you are satisfied.


 


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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

Customer:

I have seen an optomologist and family doctor, but not recently. Will try them again.

Doctor DanB :

I think seeing an ophthalmologist is your best bet. If you don't have success with a comprehensive ophthalmologist then you should consider seeing a corneal specialist who is an subspecialist ophthalmologist.

Customer:

You have mentioned a number of things that make sence to me, so will see a specialist about them, and also see an allergist. Thanks again.

Doctor DanB :

You're welcome.


If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter; this allows part of the funds that you have deposited to the website to be released for my efforts to assist you. This does not end our conversation, however-we can continue to discuss any of your concerns without further charges until you are satisfied.


 


Any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. Thanks for your inquiry!


 


My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

Customer:

There is a retinal specialist here, but have never heard of a corneal specialist.

Doctor DanB :

You can find one in most major academic medical centers and also in major cities as well.

Customer:

Your information is all very interesting and helpful.

Doctor DanB :

I'm glad to hear it. Is there anything else I can help you with?

Customer:

No, I think that is all for now.

Customer:

Thanks.

Doctor DanB :

You're welcome. Good luck to you, then.


 


If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter; this allows part of the funds that you have deposited to the website to be released for my efforts to assist you. This does not end our conversation, however-we can continue to discuss any of your concerns without further charges until you are satisfied.


 


Any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. Thanks for your inquiry!

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3147
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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