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wieyedoc
wieyedoc, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 11110
Experience:  I have over two decades of clinical experience and am also a retina specialist.
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For the last 2-3 weeks I have had extremely dry, flaky,

Resolved Question:

For the last 2-3 weeks I have had extremely dry, flaky, tight eyelids especially in the inner corner of the eye. I have a red irratible patch just below my right outer eye.
I usually use Epaderm ointment to wash with, dab eyes very carefully, then put another very thin smear or Epaderm back on affected areas. When I wake up in the morning my left eyelid in the inner corner is always very tight and pulled downwards towards my tear duct, I have problem opening that eye properly... I also have dry eyes drops - but it has still not gone away... There is no discharge from eyes, but iam constantly having to blink in the day as my vision is blurred with Epaderm. But if I don't use the Epaderm the skin immediately around my eyes would go very tight..... What is this?????
Submitted: 6 months ago.
Category: Eye
Expert:  wieyedoc replied 5 months ago.

Hi. I'm Dr. Rick and I have two decades of ophthalmology and retina surgery experience. I'm online and happy to answer your question today.

Expert:  wieyedoc replied 5 months ago.

can you upload a picture?

Do you have any other medical problems or take any medications?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.

Customer: replied 5 months ago.
I was diagnosed in 2011 with "fibromyalgia & coccygodinia" . I am now on 60mg daily if duloxetine for depression and do take gabapentin for pain in back and joints. I have attached a photo of both my eyes I hope it is a good enough shot...
Customer: replied 5 months ago.
Iam now post menopausal, does it have anything to do with that?? And I have had at least 5 corticosteroid injections into my tail bone over the last 6 years..
Customer: replied 5 months ago.
Hi Dr. Rick
What do you think this is??
Customer: replied 5 months ago.
Iam sorry but, I cannot rate any advise regarding the eye problem, as I am still awaiting the diagnosis and outcomes from the information I have given.... You cannot rate something that you haven't had....!!!
Expert:  wieyedoc replied 5 months ago.

Sorry for the delay. I was on call this weekend and it was crazybusy :(

Thank you for the photographs and additional information.

Yes. Being post menopausal can make these sorts of eye problems much worse.

It sounds like you are suffering from a combination of dry eyes, allergies, medicine side effects and blepharitis. The good news? There is a home treatment you can do that should help. Please allow me to explain:

Dry eyes can be due to many different factors. Different medicines such as psychiatric medicines, antihistamines, cold medicines and others can contribute to dry eyes. Allergies in the eyes can also contribute (make dry eyes worse). Some people have an innate deficiency in making their own tears (these people may also have other dry mucus membranes, such as their mouth, nasal passages, or genitalia). Many people have an inflammation in the eyelids called blepharitis which causes the tear film that is supposed to coat the front of the eye to not function as well, and then the eyes dry out. People with blepharitis have morning tearing, burning, and often eyelash mattering. Their symptoms get better as the day progresses, but then they get intermittent blurring when they use their eyes heavily in activities such as reading, watching TV, computer use or driving.

Because blepharitis is so under-diagnosed and the treatment for it is relatively benign, you might consider starting this treatment, while concurrently continuing artificial tears. In order to treat blepharitis, everyday in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are called Ocusoft or Sterilid which are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water), you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done.

It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working. Also the eyes are still significantly dry during this 3-4 weeks so use the artificial tears you bought 4x/day in both eyes (one drop per application). After 4 weeks you should be able to start tapering off of the tears to as you need them.

Just doing the artificial tears, hot compresses and eyelid scrubs alone would likely start to help you after three or 4 weeks--but remember it could take this long of doing it everyday before you see a significant effect, so don't stop it thinking it's not working.

If you are a person that doesn't make their own tears very well, then you may also benefit from a prescription drop called Restasis, which actually modulates a person's immune system to help them make more of their own tears. This drop actually requires constant usage on a daily basis for up to 10-12 weeks before its effect kicks in (takes awhile to change the immune response in the body).

Because there are numerous reasons for dry eye, if not all the reasons that exist in one patient are treated, it can seem as though the ones that are being treated are providing no benefit. If you've tried these recommendations and still don't feel better then you should consider seeing an ophthalmologist for a dry eye evaluation.

Does that help address your concerns?

I am happy to be able to help you today. If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter. I would also be happy to continue to answer any more questions you have until we have resolved your concern.

wieyedoc, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 11110
Experience: I have over two decades of clinical experience and am also a retina specialist.
wieyedoc and other Eye Specialists are ready to help you
Customer: replied 5 months ago.
Thank you for replying. I did get told by my own gp a couple of weeks ago that she thought it looked like periocular dermatitis... She gave me some 0.01% hydrocortisone cream, I tried it very sparingly over the left eyelid - but it seemed to make it worse, and it stung like heck...
Expert:  wieyedoc replied 5 months ago.

That is a very mild steroid cream and would be safe to use....

Try the home therapy I discussed above....it bet it will work, although it can take up to 3 weeks to really "kick in" :(

Have a good week.

Customer: replied 5 months ago.
Thank you for your help. I do have some Ocusoft eyelid foam - so I will give that a go. I might ask my gp if she could prescribe the eye drops for dry eyes that also modulate the immune response.... Thank-you....
Expert:  wieyedoc replied 5 months ago.

yes, she could give you an Rx for restasis...but she would not have the training or equipment to evaluate how it was working...

Customer: replied 5 months ago.
Hi Dr.Rick
I have just told customer support to give you full credit/payment for your very excellent advice ... Many Thanks... Get some rest, and have a good evening...
Expert:  wieyedoc replied 5 months ago.

I've got clinic all day and then Grandchild duty this evening......rest is not, unfortunately, an option ;)

Glad I could help you. Take care.

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