Blepharitis

[maria40]

Does anyone know about the connection between autoimmune disease and blepharitis? I have had eye inflamation for about four months now and it's getting worse. It began with styes on both eyes (outer eyelid) then I developed a series of smaller styes along the inner eyelid which persist and now another stye on the outer lower lid. This is affecting my vision slightly and my eyes are constantly watering. I have hypromellose drops for dry eyes but they don 't seem to be helping. I've tried hot compresses which soothe but don't heal. I understand there can be a link between auto immune disease and blepharitis. My GP says it will clear but I feel I can't go on like this and, before I try a private consultation with an opthamologist I wonder if anyone has any advice.

[SheffieldJane]

I would be interested in any replies you get and any research articles you find. My eyes are often sore/ strained. They stream in the evenings and one eyelid is markedly swollen. My lids can itch intolerably. This has been going on for a long time. I was recommended and managed to get on prescription Thealoz Duo , preservative free, eyedrops and they seem better, than hyperpromellose drops. I have no other signs of infection like you do though. My eyes, nose , throat and even ears, seem constantly on allergic alert. This seems likely ( to me) to be associated with an autoimmune disease and long term steroid use. Like yours, my doctor is not excited about it. When I was a child, my mother used something called “ Golden Eye Ointment” for styes. It always did the trick quickly. Probably highly toxic and discontinued now.

[maria40 in reply to SheffieldJane]

Thanks Jane. Haven't had any other replies yet but expect I will. I remembered Golden Eye Ointment too. Also have a vague memory of people rubbing styes with wedding rings.

[DorsetLady PMRGCAuk volunteer in reply to maria40]

Good old fashioned wives tales - similar to cutting potato in half and rubbing on warts!

On a more serious note this might help - slightly different question, but the first reply from Kate may be useful -

healthunlocked.com/pmrgcauk...

[Purpleprimrose in reply to SheffieldJane]

I also have blepharitis that appeared after starting steroids ( for GCA ) my Dr .says it will never go completely . Could go for a while but would come back . Have tried warm eye masks , hypromellose drops and chloramphenicol 1 % 4 times a day which helped a bit but now is back as it was. Luckily I haven’t had styes ,but eyes feel sore and itchy .

Am now about to start the eye cream again .

God luck with yours , sorry you have to cope with painful styes.

Purpleprimrose

[Jampad]

I sometimes have blepharitis - not caused by GCA but following cornea transplants. My cornea surgeon gave me a spray foam to wash my eyelids and it cured the problem after a couple of weeks. I now buy a similar product from Boots called Eyelid Cleansing Foam.

[PMRpro Ambassador]

This is a really detailed article about blepharitis which might help:

aoa.org/Documents/optometri...

It is associated with some systemic a/i disorders but not usually PMR and GCA. However, dry eyes are common in a/i disorders and rosacea can lead to blepharitis - and rosacea can be caused by long term use of steroids though usually the topical variety.

Very consistent cleansing of your eyelids may help clear it up - by that I mean daily or more than daily use of warm packs to soften the oils in the glands and mechanical massaging to release them and cleaning the eyelids. I remember someone talking about a heated mask they were able to get online - maybe someone else remembers it better than I do.

amazon.co.uk/Luxury-Heated-...

which, of course, is currently not available from the Jungle company!

or this

amazon.co.uk/EyeSoothe-Blep...

or this

superdrug.com/Health/Eye-Ca...

if you prefer not to go to the jungle ...

And a really good optician should be able to advise too.

Or Dr Hilary Jones explains (hmm, looking his age ...)

youtube.com/watch?v=gBgqZsd...(Not working as expected?)

[maria40 in reply to PMRpro]

Thank you so much for this. I think I will see an opthamologist privately as I think I need something more than the compresses, etc. My problem is I'm allergic to most antibiotics , though erythromycin is ok. Sulfonamides are out so treatment options are probably limited but I have to do something.

[PMRpro Ambassador in reply to maria40]

I think you will be amazed how effective the cleansing regime can be - it is a case of unblocking the pipes first, abx only work for bacterial infections and sometimes they are fed by the gunge. Clear the gunge and they clear on their own.

[Rose54]

Hi

I get is now and again

As PMRpro advises

Heated eye pads from Optician

All I do is wash face with a facial wash pay attention to eye area rinse then use a hot cloth against eye for a few minutes this appears to work for me .

Have tried lots of eye drops but dont make much difference .

[Marijo1951]

I had quite bad and persistent blepharitis for several months mainly in my left eye. It was sometimes very sore and bloodshot. My GP prescribed some antibiotic drops and some wipes. I thought the wipes helped a bit, but I didn't think the drops did anything. I continued with Bio True eyelid wipes and Systane Ultra eye drops every day for a long while. My eyes have improved a lot, quite spontaneously evidently. I now just use the wipes and drops any morning when they feel a bit sore. I understood that this was one of the numerous possible side effects of taking pred rather than connected directly with the PMR or GCA.

[maria40 in reply to Marijo1951]

Thank you for that. I'll look up the wipes and drops you mention. My GP did say it would never go away entirely but I would like to stop looking like a horror film extra.

[Marijo1951 in reply to maria40]

I know what you mean. I was wearing sunglasses on days when they were entirely unsuitable. By the way neither product that I mention is exactly cheap, but they can be a little bit cheaper bought on eBay.

[Koalajane]

I had conjunctivitis and was told to use a hot damp eye pad to clean my eyes every morning and used a wipe called something like blephawipes to clean the eye during the day. Apparently blepharitis does not go away so you need to keep up the cleaning routine

[Thelmarina in reply to Koalajane]

Yes. I have a daily routine which seems to keep it under control. Need to use the eye compress occasionally too - I dropped it because there are only so many hours in the day !

[Orpheus82]

Blepharitis doesn’t usually need antibiotics but it does need good daily lid hygiene. Dry eyes are very common as one gets older. If you use dry eye drops you do need to use them four times a day. People often stop once the eyes feel comfortable and then it all comes back. There are two types of drops - aqueous based and oil based - and it helps to know which to use. So if you do decide to see an ophthalmologist ask which you should be using. Dry eyes are such a large problem that some of the larger eye clinics have Dry Eye Clinics specifically to cope with the numbers. Do hope you get some answers as such a simple condition can cause great discomfort.

[Joaclp]

I have very bad, chronic blepharitis secondary to the autoimmune condition, Sjögrens, and a lot else, PMR and RA included. Longer term the twice daily heated pads, massage and cleaning is the only thing that helps. This is what PMRpro is saying. This taxing procedure is what removes impurities from the glands. It also counters the stinging of the biologic Restasis that I use for Sjögrens dryness. From time to time, I have been given an antibiotic. Good luck!

[pugrescue in reply to Joaclp]

Just over a year ago, I was going thru the long process of diagnosis of Sjogrens. During the lip biopsy was complaining to ENT lady re headaches, jaw pain etc. She actually was the one who pushed the GCA as well. Anyway have severe dry eye, and same as you, restasis, warm compresses, eyelid wipes each am, any extra eyedrops have to be preservative free.... my ophthamalogist checks it all every few months, as well as any "damage" to optical nerve from the GCA. Interestingly, when on the higher doses of pred (50 thru 20) my eyes actually seemed more comfortable. Now down to 10ish the eyes are definitely worse....also the dry mouth etc from the Sjogrens much worse.

[PMRpro Ambassador in reply to pugrescue]

Funny you should say that - I had awful dry eyes before pred and it did improve a bit on pred. In the meantime I had been at lower doses (under 10mg) and now I'm back around 15mg - and my eyes feel much more "normal".

[pugrescue in reply to PMRpro]

the other thing I forgot to mention is take a double dose of Omaga3 & Flaxseed oil every day. I find the flaxseed upsets the tummy so keep it refrigerated and take with meals, eliminates most of that. Restasis, is a cyclosporin drop, which is anti-inflammatory. So I assume that a systemic drug like pred would help as well. Obviously pred can also cause more eye problems long term, but nice if we can benefit from one nice side effect since we have to take it.

[Lochy]

I used to suffer more regularly from blepharitis but that was my pre PMR days. My recommended regime was to hold my head over bowl of hot water as if steaming and then massage my eyelids, cleaning all the dry skin etc. I was recommended to use a gentle baby shampoo or similar to cleanse my eyelids. Doing this regularly definitely helped. Since I’ve been on steroids it’s dry eyes I suffer from and use drops usually twice a day. I wear my glasses when out walking so my eyes don’t stream!

Good luck.

[borednow]

Cleanse eyes morning and night with micellar water. Does the trick for me.

[maria40]

Thanks so much to everyone for their experience and advice on blepharitis. Don't know what I'd do without this forum.

[PMRnewbie2017]

I get it too and if I become complacent with my eye-toilet regime it comes back!

I have noticed if I get water in my eyes when showering this destroys my tear film and i am more susceptible to problems.

Re the gold ring curing styes. I have done it and it works. I have suggested it to patients and it has worked. Gold was used in injectible form ( as Sodium Aurothiomalate) for rheumatoid arthritis not so long ago.

[maria40 in reply to PMRnewbie2017]

Very interesting . I had wondered what the basis for using gold was. Also, I'll stop splashing warm water into my eyes which I had though was doing them good.

[PMRpro Ambassador in reply to PMRnewbie2017]

We had a lady on one of the forums a couple of years ago who claimed her RA was being managed with gold injections. I couldn't help wondering what age her rheumy was!

[Fifelassieo]

I have blepharitis, l use blephaclean wipes every day.