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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7746
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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DUE TO A CHRONIC DRY EYE CONDITION AND A RECURRING PROBLEM

Resolved Question:

DUE TO A CHRONIC DRY EYE CONDITION AND A RECURRING PROBLEM WITH BLEPHARITIS
I RECENLTY WENT THROUGH ANOTHER BOUT WITH THAT. I USED THE RX'S I KEEP ON HAND AS DIRECTED BY MY EYE DR BUT SHE IS AWAY AT A CONFERENCE THIS WEEK. THE WIPING WITH TISSUES AT THE EXCESSIVE TEARING AND USE OF MY DROPS HAS DRIED THE SKIN AROUND THE BOTTOM LASHES AND I WANT TO KNOW IF THERE IS ANYTHING SAFE AND NATURAL TO APPLY - OTC- TO MOISTURIZE AND HEAL THAT DELICATE AREA.
I HAVE BEEN TOLD NOT TO USE WHITE PETROLEUM PRODUCTS. COULD YOU RECOMMEND ANYTHING? THANK YOU.
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Actually, yes. I would suggest you get some johnsons and johnsons baby shampoo.

Dr. Rick :

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

Dr. Rick :

You can also apply a commercial skin cream in the affected area to soothe it. This should take care of things until you can get back home.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)


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Expert:  Dr. Rick replied 2 years ago.
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Expert:  Dr. Rick replied 2 years ago.
Let me know if there is anything else you would like to discuss pertaining to this issue.
Customer: replied 2 years ago.
Relist: Other.
Sorry. I needed my answer from an opthamologist not a general medical doctor. A general answer from an MD would not be as specialized and focused on this situation that built on the layers of info given. PLEASE FORWARD TO AN OPTHAMOLOGIST.
Expert:  Dr. Rick replied 2 years ago.
Actually, I am an ophthalmologist with two decades of experience as a retinal surgeon....you just caught me on the medical site :)
Expert:  Dr. Rick replied 2 years ago.
That is a slit lamp I'm leaning on in the picture from my office :o)
Customer: replied 2 years ago.

I am sorrry! I sent additional info after your first answer and it doesn't appear to be included in the scripts of my questions today. I am not sure where it went but is not the

info shown sent [-time-stamped at 1:50] by me above your new answer.

Expert:  Dr. Rick replied 2 years ago.
No. And it doesn't show here on my screen either.....looks like the computer is infested with Gremlins. Again :(

But don't worry, I've been called much worse then an internal medicine doctor lol!
Customer: replied 2 years ago.

ok, I will try again to give the info that looks like it never got to you.

I was told not to use J&J baby shampoo and never ever to rub or scrub but to pat

STERI-LID [only] and splash with lukewarm water until fully rinsed. Then to only use soft tissue and no washclothes or anything that might allow me to start rubbing the extremely itchy site and cause more irritation. I haqve extremely sensitive skin.

 

There is nothing wrong and a lot extremely right about being a internal medical dr. I just wanted an answer from a specialist. I am sure you can see why. Thank you again and please do not be offended.

Expert:  Dr. Rick replied 2 years ago.
I am not offended in the least.

J&J shampoo, especially the clear hypoallergenic kind is the best and not even the most sensitive skin will be irritated by it. I would think it is safe for you use.

The steri lid and gentle treatment isn't aggressive enough to treat the underlying blepharitis that I'm almost 100% sure you have.

The lotemax, which is a steroid, will of course make you feel better, but like a bandaid on a machine gun wound it does nothing to address the more important underlying issues.

Here is a little blurb that I like to give out. Seeing as you have already been dealing with dry eyes and blepharitis for quiet some time I'm sure most of this you know....but...this does work for a majority of patients with your issues:

It sounds like you are suffering from an anterior segment/tear film issue. Many times, as we get older, and especially after eye surgery, 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, 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.

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.

In your case, if things don't improve and you haven't already done so, you might consider being evaluated by an cornea/external disease specialist.

Sorry about the mixup and your post getting lost....
Expert:  Dr. Rick replied 2 years ago.
Also, the ciloxan ointment is not effective in this condition. If you kill off the normal bacteria the only thing that happens is resistant bacteria, many time they are worse then your normal flora, take over.

The FML ointment is a steroid and we are back to our bandaid/machine gun analogy.....plus using steroids, even in low doses, long term is not a good idea

Does this make sense to you?
Customer: replied 2 years ago.

Does this mean you don't think Restasis has value?

I also do use a drop made by Alcon and Optive for sensitive eyes which is

a tear replacement. I have trusted my eye specialist but may show her your

recommendations. She only has me use the FML for very limited times and

only when skin has cracked open.

The Ciloxan is once a week and not on a daily basis.

Expert:  Dr. Rick replied 2 years ago.
No. I do believe restasis is a very good drop. As you know it takes about 3 weeks of daily use for it to "kick in" but other then this delay it works great for many patients.

I do not believe that using ciloxan once a week has any value at all. Using that schedule it will not kill any bacteria and the chronic low level exposure will quickly lead to colonization by resistant organisms.

FML, in my opinion, is not the correct drug to use to speed healing of cracked skin. As a matter of fact a steroid would be expected to slow healing. It would be better to use a gentle cream to soothe the skin as long as there is no evidence of infection.

I don't mean to be negative....just giving you the same advice I have been giving my own patients for many years.

I hope this information is of value to you. Have a good evening and feel free to give me positive feedback and/or accept if I've been helpful.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7746
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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