Hi. I'm online and happy to answer your question today.
It sounds like you are suffering from an anterior segment/tear film issue. Many times, as we get older the anterior surface of the eye starts to have difficulties. What can cause this? Well, there are a number of conditions but the most common are dry eyes (sounds like you are getting some treatment for this already) allergies and blepharitis....many times all three conditions act together to make you miserable. In order to solve your problem you need to address all of these issues at the same time.
How do I address them all at the same time?
When it comes to allergies it is almost impossible to pin down the offending agent(s) and, therefore, treatment needs to focus on controlling the symptoms. Dry eyes are very common and can be improved by a stepwise series of therapies. First, the use of natural tears 4-6+ times/day to augment your natural tear production, if this doesn’t work then you can try temporary punctal occlusion of the lower puncta, then, if needed, temporary occlusion of all 4 puncta then, if indicated, surgical ( non-reversible) closure of the puncta. The openings to your tear drainage system are called puncta and you have one opening on each lid, near your nose.
Blepharitis is a condition where glands in the eyelids are not functioning normally. They become plugged and instead of putting out their normal clear, oily secretions, they put out thick, toothpaste like gunk. You may not be able to see this “gunk” yourself, unless it is really bad, but it shows up clearly on slit lamp examination.
The best treatment for this condition daily lid scrubs combined with warm compresses. I like to use baby shampoo for lid scrubs. In the shower, place the shampoo on your index fingers, close your eyes, raise your eyebrows (to stretch the skin on your eyelids) and scrub back and forth along your eyelashes for 3 to 5 minutes. The hot water in the shower helps to soften the plugged oils in the glands while the mechanical scrubbing with your soapy fingers removes the oils.
Baby shampoo lid scrubs will also help to wash away allergens and stimulate tear production, thereby addressing all three of your issues. Remember, this is not an instant fix. While you are waiting for the lid scrubs to have affect you can use over the counter allergy pills such as Travist, dimetapp or Zyrtec.
Should your symptoms get worse, your vision become significantly affected or things just not get better in 3 weeks or so you should have a complete eye examination by your local ophthalmologist to look for other, less common, causes of your symptoms.
Does this make sense to you?
So an opthamologist would be the preferred type of eye doctor to see for this condition? Could the use of warm compresses cause any type of fungal infection on my eyelids? I've been using Zyrtec for about a week, and just started using the ketotifen drops this weekend. Would it help to do an eyewash?
No. There is no worries about fungal infections from this treatment. The lidscrubs are better then commercial eye washes. And, yes, an ophthalmologist is the doc to see for this....
I picked up some ROHTO eye astringent, lubricant and red eye relief this weekend too. I used the ketotifen then waited for a couple hours and used the ROHTO drops, should I not mix drops?
I don't think the ROHTO is adding anything.....I'd stop using it.
And any drop that is for "getting the red out" will just irritate things more in the long run....stop using those too.
How are each of these detected during an exam? I see that the eye lids can be seen with a slit lamp, but what about the tears, and the tear ducts?
All of these issues can be detected during a slit lamp exam. However, in the course of a busy clinic day many eye docs don't even look for signs of these conditions and easily overlook these issues.
Should I continue using the ketotifen which is an allergy eye drop, and add the natural tear drop. I've been rubbing my eyelids in the shower, but didn't know I could use a light soap on them, thanks for that.
If you want to go to the best trained expert for the issues I've discussed a corneal specialist is the person to see. From what you have told me, however, I don't think you need to take this step yet. Try the therapy I've outlined for a month and, then, if things are not better, and you are not happy with your current ophthalmologist, go see a cornea doc.
Yes. It would be OK to continue that drop.
Not light soap....baby shampoo. The yellow stuff.
Right, the johnson and johnson shampoo, I remember it now. When I make the appointment should I state what I would like them to check for in the slit exam?
I'm planning a two thousand mile drive in about three weeks, and am hoping to have this corrected by then, thank you for your time today.
Just tell them the problems you are having and they will know what to do at the slit lamp.
My pleasure. Have a safe trip.
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Take care and let me know if there is anything else I can do to help you in the future.