Step Ladder Approach to Burning, Itching, Foreign Body Sensation

Step Ladder Approach to Burning, Itching, Foreign Body Sensation [Blepharitis, Meibomian Gland Dysfunction (MGD), Dry Eye Syndrome, Conjunctivitis]

You should not feel eye discomfort when blinking & eye movement. You should not feel constant itching, foreign body sensation, burning, irritation, constantly tearing. If you have such symptoms, we know how to help. Let me give you some hope & urge you towards patience: a step ladder approach is the best way to help your eyes & avoid side effects of powerful medications.

1. The first thing we do is ask you questions: do you wear contact lenses (CL)? Do you have itching and is it worse than the burning or vice versa? Do you have pets? Have you travelled abroad recently? Could it be: allergy to new detergents, chemicals (ie, fingernail polish, makeup for women).
2. We then make sure you do not have: Viral Conjunctivitis (usually very itchy; were you sick recently or around someone with a cold or “Pink Eye”? We check for a pre-auricular lymph node especially); Antibiotics do not help viruses. Bacterial Conjunctivitis (usually profuse yellow or green discharge): treated with antibiotics.

3. We will look at your eye & its surfaces under the Microscope (Slit Lamp): If we see Papillae we think, Allergy or Giant Papillary Conjunctivitis (GPC) if a CL wearer; if see Follicles, we think of a virus.
4. If we see crusting on lids, we diagnosis Blepharitis. If the clogged meibomian glands, we diagnose Meibomian Gland Dysfunction. If we see a dry tear film or changes on your cornea, we suspect Dry Eye Syndrome.
TREATMENT: We start with as natural remedies as possible.

1. Lid Hygiene, Warm Compresses, diluted Baby Shampoo Scrubs (with or without prescribed Erythromycin ointment): as often as possible: 2x/day at least (see instruction sheet). This step is key. Continue periodically even if your eyes feel better.
2. Eat more Omega 3’s in Fish Oils, Cod Liver Oil. Dr. Sears & TheraTears Nutrition are good medical grade oils. Cod-liver oil: be aware of mercury level & check not rancid. Avoid sun. Stop smoking. Eat veggies for health.
3. We might measure your tear osmolarity (or/& Schirmer’s test) if symptoms severe or not improving with STEP 1, 2. We’ll recommend artificial tears: Non-preserved (NPAT) are best but more expensive. If symptoms include itchiness, we recommend putting in refrigerator to keep cool and help with itchiness. If significant allergic component present, I’ll prescribe an antihistamine drop.
4. Doxycycline 20mg (up to 50mg by mouth) helps MGD; also helps in rosacea, ocular rosacea
5, 6. If symptoms severe, and #1 is being done, we may add a low dose steroid drop for a couple of weeks. We then add Cyclosporine Restasis drops (can take weeks-months to work), and then decrease the steroid (long term use can increase risk of high eye pressure, glaucoma, cataract).
7. If all these treatments do not help but the STEP 1, 2 are being done & it looks like chronic tearing is due to rebound Dry Eye (inadequate tears do not stick on eye & dry up sending a signal to produce copious tears), we will check the drain system & consider Punctal Plugs (temporary or permanent).
8. Intense Pulsed Light (IPL) and LipiFlow: if you are tired of the warm compresses or just do not have time for this, IPL and LipiFlow work. They are not covered by insurance. Initial studies show good results in opening Meibomian Glands and relieving dry eyes.

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