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My eyes have become very dry due to an accutane treatment

I'm currently on, and I...
My eyes have become very dry due to an accutane treatment I'm currently on, and I hadn't been moisturizing them enough recently (not for 6 days) with eye drops and then one morning it suddenly got terrible, my eyes got swollen, were constantly crying and red and painful, and it took a lot of eye drops to bring this down. My left eyelid seems to be doing better and is now almost back to normal, but the right one is still red and swollen and sometimes a little painful (though a lot less than when my eyes were at the peak of their dryness). There is no discharge, and my vision is perfect with my left eye (the OK one), but slightly blurry for the right one. How can I know if this puffiness/redness/painfulness in my right eyelid is just due to the current dryness of my eyes and the irritation still going on from the other morning when it got very bad, or if it's actually blepharitis? Also, what should I do except for the moisturizing eye drops? Should I consult right away (it's been almost two days since I got this 'dryness attack')? Thank you so much for your help!
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Answered in 2 hours by:
2/4/2013
Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2,451
Experience: MS Ophthalmology with 13 years of surgical expereince
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Hello,
Welcome to Pearl.com
Dry eyes can cause watering and some amount of redness too but not lid swelling as such. Looks like more of blepharitis as the cause of lid swelling. Apart from lubricating eye drops you can try some of these home remedies which are quite effective in the treatment of blepharitis.
1. Gentle lid scrub at the margin only with 50:50 diluted baby shampoo everyday.
2. Warm compresses to be continued for 5-10 minutes each time, thrice a day.
3. Antibiotic steroid combination eye ointment at bedtime if he above two measures do not help (prescription medicine).
Please feel free to ask follow up questions if any.
If you are satisfied with the answer, do give a positive rating.
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Hello Alice,

I guess you can give the above measures a try before you consider visiting your ophthalmologist. Here is a detailed explanation of the same measures, just in case you are looking for an elaborate answer-

First, application of heat to warm the eyelid gland secretions and to promote evacuation and cleansing of the secretory passages is essential. Individuals are directed to use soaked warm compresses and to apply them to the lids repeatedly. Warm water in a washcloth, soaked gauze pads, or microwaved, soaked cloths can be used. However extreme heat should be avoided.

•Second, the eyelid margin is scrubbed mechanically to remove adherent material, such as crusting, and to clean the gland orifices. This can be completed with a warm washcloth or with gauze pads. Water often is used, although some clinicians prefer that a few drops of baby shampoo be mixed in one bottle cap full of warm water to form a cleaning solution. Attention must be directed to gentle mechanical jostling or scrubbing of the eyelid margin itself, not the skin of the lids or of the bulbar conjunctival surface. Vigorous scrubbing should be avoided as it may be harmful.

•Third, an antibiotic ointment is applied to the eyelid margin after it has been soaked and scrubbed. Antibiotic-corticosteroid ointment combinations can be used for short courses, although their use is less appropriate for long-term management and should be used strictly on the advise of the ophthalmologist.


Please feel free to ask follow up questions if any.


Thank you and best wishes.


It was a pleasure to have answered this question.

Experts are credited only if a positive rating is given and not otherwise. So do remember to give your rating. A positive rating is what I aim for and we can continue to interact till you get a satisfactory response. An excellent feedback and /or bonus are most welcome and appreciated.


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Customer reply replied 4 years ago

Thank you for this detailed answer it is of great help, but I was just wondering what you meant by "Attention must be directed to gentle mechanical jostling or scrubbing of the eyelid margin itself, not the skin of the lids or of the bulbar conjunctival surface." My guess is you are referring to the skin above the eyelashes, and advising me not to scrub the 'lid' that usually sits on the eye itself?

Also, if I do have blepharitis due to accutane (I am scheduled to see an ophthalmologist Wednesday), will this mean that it is something that settles in permanently? I seem to see a lot of internet talk about it being something you can control but not get rid off and this worries me a lot, getting me to think my right eye will always be irritated and I won't ever be able to wear makeup again or such without triggering more irritation... What do you think?

Thank you Alice for the reply and additional information.

You are right that we must not rub the part of the eyelid that actually touches the surface of the eye. We need to scrub only its outer most part just where the tiny sebaceous glands have their openings.

No, blepharitis is not a permanent thing but recurrances are common. If there are contributory factors such as co-existing acne/dandruff, then they need to be tackled first. If all these measures fail and the lid continues to be red, swollen and painful, then a short course of oral Doxycycline, 100 mg , 1 tablet twice a day for 2 weeks would be very beneficial.

Please feel free to ask follow up questions if any.


Thank you and best wishes.


It was a pleasure to have answered this question.

Experts are credited only if a positive rating is given and not otherwise. So do remember to give your rating. A positive rating is what I aim for and we can continue to interact till you get a satisfactory response. An excellent feedback and /or bonus are most welcome and appreciated.

Views expressed are for information purpose only and cannot substitute a visit to an ophthalmologist

Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2,451
Experience: MS Ophthalmology with 13 years of surgical expereince
Verified
Dr. A.S. Desai and 87 other Eye Specialists are ready to help you
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Customer reply replied 4 years ago

Thank you Dr., I will follow your sound advice and it's great to know this won't be a permanent affliction.

Best,

Alice

You are most welcome.

Have a good day!
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Customer reply replied 4 years ago

Hello Dr. ! So I saw my ophthalmologist and he said I had keratitis actually. Since it's not viral but only from the dry eye irritating the cornea, he gave me no antibiotic eye-drops but only hydrating/lubricating and 'eye-proctecting' ones. So my eyes don't feel dry anymore, but i do still wake up with them being almost glued together and a little puffy (which eventually goes away la), and I am worried because lately I have been seeing double for the past 24 hours and it isn't going away. From far away and close up, my vision is blurred and while it isn't painful in itself, the fact that I have to focus and concentrate constantly is exhausting. I've been doing a lot of research and I wondered, could this mean that I have been misdiagnosed and actually do have bacterial keratitis which would explain the blurred vision? Or could it be that my cornea is 'healing', because I read somewhere that when the cornea is healing from it's 'scars', the vision can become temporarily blurred... So what do you think this could mean?

Hello Alice,

Thank you for the follow up and the additional informatiom.

I am glad that you got your eyes examined by an ophthalmologist. Double vision and blurring of vision can occur when there is pooling of tears from reflex tearing of dry eyes. If the symptoms disappear with blinking then it shows that lubricating eye drops would help to overcome the symtoms. I don't think you have been misdiagnosed or that you could be having bacterial keratitis as the latter is very painful and it would never get missed on an eye exam. So do continue with the lubricating eye drops and lubricating eye ointment such as lacrilube at bedtime. Once the cornea heals completely, the double vision and blurring of vision would disappear.

Thank and best wishes. Take care.
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Customer reply replied 4 years ago

Thank you Dr., but my eyes actually feel less dry now that I have the powerful hydrating and lubricating eye drops and they aren't painful anymore. The blurriness is just occurring now though, even though all the dry eye symptoms have gotten better... And it's going to be the third day today that I have been seeing blurry. I don't feel like blinking makes any difference, but when I squint my eyes I see perfectly. Do you think it could be the cornea healing over it's scars, almost 'reconstructing', because like I said I read somewhere (but then again it was on one site and these sites are never 100% sure) that eye vision can become blurry when keratitis is healing... What do you think?

the cornea while healing can cause blurring . I guess it should improve once the cornea heals completely. The eye has a natural reflex to produce tears whenever there are dry spots occuring in the eyes . This can sometimes cause pooling of tears and blurring too. But it is good to know that you feel better symptomatically with the use of lubricating eye drops.
Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2,451
Experience: MS Ophthalmology with 13 years of surgical expereince
Verified
Dr. A.S. Desai and 87 other Eye Specialists are ready to help you
Ask your own question now
Customer reply replied 4 years ago

Thank you Dr! Well I think the cornea has healed, because I have no more blurred vision now. But I have a bigger problem I think, and this is so frustrating because I feel like my ophthalmologist has misdiagnosed me and that if he had seen my problem I could've treated it and avoided it. The problem is that I think I have blepharitis. I'm pretty sure I have posterior blepharitis because the meibomian glands appear to be clogged, some of them look like very tiny whiteheads on my lower lids (I can't see the upper lid ones). And also, I now have crusting of the eyelids, mostly in the morning when I wake up, and they don't seem too attached because I can easily remove them and when I wake up sometimes they are all over my eyelashes- not all of them stick to the base of the eyelashes. Sometimes, I will have what looks like a dot of floating mucus in one of my eyes when I wake up... And one of my eyes feels like it is puffy, like there is pressure on it, though the puffiness can only be seen when I wake up and later on goes down. So do you think that this could be just a benign irritation? Or do you think that I have posterior blepharitis, or would this be odd since I am on accutane and that accutane stops oil gland production? And does the crusting when I wake up mean that it is also anterior blepharitis, or does crusting happen with both anterior and posterior blepharitis? And lastly, do you think it could be a demodex infection?

I am seeing the ophthalmologist next thursday, but since it's a long time I would like to have someone else's opinion too as I am very worried. Thank you again for you time Dr.

Customer reply replied 4 years ago
Relist: Other.
I am still waiting for my question to be answered
Hello Alice,

It is good to know that the cornea has healed very well and that the vision is clear now.

Your detailed list of symptoms does point towards a possibility of blepharitis ( posterior blepharitis is where the meibomian glands get affected). As for the treatment of blepharitis is concerned, we had discussed it the last time we interacted. However I would like to send the remedies once again here-

First, application of heat to warm the eyelid gland secretions and to promote evacuation and cleansing of the secretory passages is essential. Individuals are directed to use soaked warm compresses and to apply them to the lids repeatedly. Warm water in a washcloth, soaked gauze pads, or microwaved, soaked cloths can be used. However extreme heat should be avoided.


•Second, the eyelid margin is scrubbed mechanically to remove adherent material, such as crusting, and to clean the gland orifices. This can be completed with a warm washcloth or with gauze pads. Water often is used, although some clinicians prefer that a few drops of baby shampoo be mixed in one bottle cap full of warm water to form a cleaning solution. Attention must be directed to gentle mechanical jostling or scrubbing of the eyelid margin itself, not the skin of the lids or of the bulbar conjunctival surface. Vigorous scrubbing should be avoided as it may be harmful.


•Third, an antibiotic ointment is applied to the eyelid margin after it has been soaked and scrubbed. Antibiotic-corticosteroid ointment combinations can be used for short courses, although their use is less appropriate for long-term management and should be used strictly on the advise of the ophthalmologist.


Anterior blepharitis is nothing but formation of scaly flakes all along the lid margin as seen in case of squamous blepharitis.

As for the possibility of demodex infection, very unlikely as it is caused by a rare crab louse ( which otherwise is seen in pubic area ). The only way to confirm is to get the eye examined by the ophthalmologist under the slit lamp ( equipment with magnification and focal light). But I guess you can just keep this possibility aside for the moment.

Please feel free to ask follow up questions if any.

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Just wanted to add a few points-

Squamous blepharitis would have been associated with flakes all along the lid margin and not just crusting in the mornings. It is more likely that you have meibomitis ( could be possible even if you are on accutane treatment). Hope the above measures would help you give symptomatic relief from crusting and puffiness.
Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2,451
Experience: MS Ophthalmology with 13 years of surgical expereince
Verified
Dr. A.S. Desai and 87 other Eye Specialists are ready to help you
Ask your own question now
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