red itchy swollen burning eye lids etc.

please help - I have had this eye condition on and off for what seems like years.....it used to flare up and down, and now I seem to have it very regularly.  I have been to my doctors on many occassions, and have been prescribed several different creams.  I have seen a dermatologist - which was a waste of time, and this past summer saw an allergist, who in turn sent me to an internal medicine guy.  Many allergy test later, and many more blood test, they could not find anything wrong with me.  Over the years I have changed all cleansers, moisturizers, pillows etc. etc.  My mouth is ofter dry as well.....I am a long time contact wearer, but have stopped wearing them all together over the past year.  This is very painful, and started out as an occasional irritation, which I thought was allergy related......it would go away, then  reappear......this past year has been the worst yet, and I just do not know what more to do.....and now over this past year it has spread to the lower eye area.....after I wash my face, the entire eye are is very red.....always itchy, and red spots in the under eye area. and it used to be worse in the mornings, which it still is but is aggravating all day with itchiness and redness....if anyone can help me please please respond.  This is becoming debilitating.  I rarely wear make anymore, as I can work from home several days a week.  I do not believe this from make-up.....but I just don't know what else to do.....thought I would try here, before another trek back to the drs.  sorry I have gone on and on, but I am at my wits end......thank you

[John C Hagan III, MD, FACS, FAAO]

Your symptoms are very strongly suggestive of severe dry eyes and with the dry mouth you may have Sjorgren's syndrome with is marked dry eyes, dry mouth and sometimes an inflammatory arthritis.

You should see an ophthalmologist Eye MD physician preferrably one that specializes in corneal and external eye disease. When you go in you should have the Eye MD examine your eyes before the staff puts in any drops at all. You should tell the Eye MD about the dry eye and dry mouth. Request a schirmer tear test and an evaluation of your tear break up time (BUT).

I believe it highly likely you will be found to have marked to severe dry eyes. If you are a female over 40 and on hormonal replacement therapy that is a classic problem but it does occur in younger females and some males.

If you have trouble finding one go to www.aao.org and use the Find An Eye MD and look for a corneal and/or external disease specialist.

JCH III MD

[maggiemae_06]

After having been seen by the internal medicine dr./and allergy specialist Sjorgren was mentioned, however all of my test results were good - test were all stemmed around immune system - I understand that there is no treatment for Sjorgrens .....I am over 50, not on hormonal replacement, but have completed menopause.  I just completed a bone scan to determine arthritis etc. and am awaiting results.  Dry eyes have definately been mentioned, and at this point I am looking for a treatment to keep this under control.  Seems that there is no treatment.  I do  use eye lubricant regularly....I will persue the Eye MD as suggested, all though I do have my eyes checked regularly, and other than severe dry eyes - no other issues have been mentioned - everyone seems to suggest allergies, but no allergy show on any of my tests.  Can you advise of any additional things that I can to do lessen these systems.......would hormone replacement help this condition?  Should I be taking any particular vitamins......any suggestions would be greatly appreciated......what is this cause by - am I doing anything that increases the severity - I have not worn my contacts as I said for the best part of a year........thanks for your help

[John C Hagan III, MD, FACS, FAAO]

This is from a previous post on dry eyes:
a Schirmer test of zero indicates that you have severe dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical compies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops.

If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 8 weeks of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes two months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. If you did not take for 8 weeks you need to restart therapy. Improvement often continues for up to 6 months.

If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.

Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.

In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.

If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.

If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise.

Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.

JCH III MD

[maggiemae_06]

Thank you so much for all of this info.......I do so appreciate your help.  Why do they plug tear ducts if this is a dry eye condition.....sorry perhaps I have missinterpreted this....but would it not be better to maintain tear ducts in order to keep the eye moist?

[John C Hagan III, MD, FACS, FAAO]

The plugs go in the tube that drains the tears out of the eye, not in the tear gland that produces the tears. There is a small opening on both the upper and lower inner eyelids. It works like a drain plug in a bathtub.

JCH III MD

[maggiemae_06]

oh I see......do we know what causes these tears ducts to be blocked.  I have booked an appt. with my eye doctor to get a referral to a Ophthamologist.....I am going to take this route.....I cannot remember if the immunity test that I had this summer would show anything to do with arthritis.  I am awaiting results from the bone scan which was done this past Sat., which I guess will show that....I am a healthy person, although it would sound otherwise :), but I am determined to get to the bottom of this.....do you know if Retisan is sold in Canada?  I am going to start taking flaxseed daily, and see if that helps, and be more diligent with the eye drops......I have also booked a Dr. appt. as I want to go over the past test results, in particular the hormone levels.  I had no signs of going thru menopause, although he tells me I am finished with that....had a hysterectomy about 10 years ago, so I had no tell tale systems to speak of.......but if hormones would help, should i persue the natural type?  After having travelled two summers ago, (via air) I had a severe cornea inflammation, and at that time my eye dr. told me to use eye lubricant - dry eyes are very common with contact wearers.......I guess everyone was under the assumption that this eyelid ailment was cause by allergies.....but in hind sight it appears that it is not related at all......I could rationalize the dry eyes to contacts, and the eye inflammation to something else.  I am afraid to touch my eyes in anyway, although would love too, as they are always extremely itchy......anyway any knowledge that I can acquire on my own is so very helpful......thanks again.

[maggiemae_06]

also the only meds that I take regularly are - calcium and vit D daily, and Fosamax once a week for osteoporosis......I thought at one point the fosamax was the cause.....but I am still not sure it is not a factor - seems to me all of this started about the time I started taking Fosamax on a weekly basis....thanks again

[John C Hagan III, MD, FACS, FAAO]

The ducts from the tear gland are not blocked. they dump tears on the eye, it collects in the corner nasally and is drained away. In dry eyes the tears may be low in quanity and low in quality. Tear duct plugs work very good for this. The plugs block the drainage into the nose. The other type of problem is the tears are poor quality but there is a large amount of watery tears. Plugs don't make this better and can make it worse.

I don't know if Restasis is sold in Canada. Remember a trial is 2 months of therapy one drop both eyes twice/day. If it helps (and improvement is present for up to half a year) you need to stay on it. Flaxseed may not be as helpful as Theratears dry eye formula (pills over the counter) or fish oit (get the enteric coated type).

Dry eyes and allergy often co-exist.

The allergies may need treated with a good allergy drop like Zaditor (over the counter) or Pataday (Rx required).

JCH III MD

[maggiemae_06]

thought I would follow-up in hopes this may help someone else.  After a lengthy appt. with my eye dr. he has determined that I likely have blocked pores in my eye lids (I know there is a name for this, however not sure what it is called).  In any event he felt that my tear production is fine, my bone scan showed my arthritis and he does not feel that I have Sjorgrens......I am currently using hot compresses to help open these pores and "hopefully" this will help, with alot of eye drops for the dryness and irritation.  I guess these pores release an oily substance that is required in the proper function of the eye.  I experience a great deal of what I would call a "gravel" feeling in my eyes.  Also, blinking is very important.  I am not a good "blinker" - many years of contacts, and computer work have not worked in my favor.  He also encouraged Omega 3.  Also he felt there may be a thyroid problem, and has asked me to chart my temp in the mornings before getting up.  I will be referred to an "eyelid spec" as well. Anyway this is a very condensed overview of where I am now with this ailment, and as I said perhaps it will help someone else.  Again thanks for all your assistance and wish me luck!  (sorry about these lonnnnnggg posts)

[John C Hagan III, MD, FACS, FAAO]

Sounds like at least part of your problem is blepharitis or Meibomeian Gland Disease (MGD).

Good luck. Merry Christmas.

JCH III MD

[crankdatKellyAnne]

My eyes are itchy. It starts in the top corner closest to the middle of my face, and then the entire eye gets itchy. This happens to both of my eyes. I really want to go see a doctor, but, I can't afford to see one. :( On my right eye, there's this weird bump on it. First it was on the top lid, then I woke up this morning and it was on the bottom. It kind of burns, and it hurts everytime I blink. Any idea what's going on with me?

please e-mail me:
crankdat.***@****

[John C Hagan]

Itch usually indicates allergy. Try Zaditor allergy eye drops available over the counter. If it continues see and Eye MD ophthalmologist. Find one at www.aao.org

JCH III MD

[Judes1223]

Hi, I'm wondering if anyone could help me with an ongoing problem.  About 4 weeks ago I woke up with eyes very swollen as well as underneath the eyes.   It's very red , inflamed and itchy too.  I thought it was possibly an allergy, but found out it wasn't .  I started with all new makeup so I know that isn't the problem, in fact I haven't been able to even wear it because it burns to have anything go near it.  I take a generic form of synthroid .88 mcg. .  I'm wondering if that may be the cause?  I did notice that this all started after being on zithromax for my lyme disease.  I have been put on high doses of prednisone, but it only comes back again.  This is the 3rd time in about a month this has happened.  I can't even go out in public because I look like "elephant" woman.  (very wrinkly, swollen red skin)  My Dr. is not sure what it could be and is ordering some tests for me . She prescribed some augmentin , but I'm leary to try it since it seemed to happen after being on z-pack. HELP Please!!! I can't live like in isolation, I have 3 children that need me!!

[ColleenDD]

My button right eye lid is red and it burns, even the skin directly beneath the eye burns at times. What causes this, is it very serious.

[bamagirl218]

Over the past 2 months, I have had red, itchy, swollen eyelids.  Sometimes itchy near tear ducts.  Nothing seemed to help, moisturers, vaseline, it would just burn.  The right one worse than the left, and the right one started scaling over.  Once the scales were gone, it almost looks like a sunburn.  I have drier eyes too.  Finally went to the family dr and he gave me a script for Elecon, and advised to use very sparingly.  It helped but was right back if I didn't use it.  Because I didn't want to keep using steroid ointment, I went to the dermatologist, to which she just advised it was probably allergy, to keep using the Elecon cream and Vaseline.  With that, I switched all my makeup to Hypoallergenic since she thought it was allergy related to product.  My eyes continue to be dry and itchy like and my eyelids about the same state.  The drier my eyes are, the itchier my lids are.  Is this related?  I just want my eyelids back, please help!  

[bsavage1]

I have to thank you so very very much Dr Hagan.  I have been to the general physician whom said I had fungus, to the opthalmologist, to the dermatologist...inidicating eczema and allergic reation.  I have cut out all scented products in my home (laundry detergent, dish soap, using dove uscented, etc)...and it has helped.  I have tried every over the counter fungus creme, antibioitic eye drops, to Protopic, and nothing has helped 100%.  I have red, itchy (scaling, feels like thorns sticking in my eyelids), swolen eyes.  This has gone on for 3 years now.  I read your posting about tried Zaditor....I slept so good last night without itchy eyes...and they are clearing up tremendously, just with a 2nd drop.  Thank you so very much !  I wish this would get out to others...because I have searched the internet so much for this condition over the past years and your advice was the best ever !!!!  Thank you again.    

[decotch]

Was wondering how you are doing now...I have had all the same similiar symptoms but my Dr. is afraid for me to try Restasis because he swears this is also eye allery and doesn't know what I am allergic to...I am currently undergoing patch testing and will find out in 3 days if this shows anything. I have been worse in winter than in summer months but episodic. Mostly my lower lids feel itchy and burning right where the lashes attach. I asked my opthamologist about MGD (oil gland disease) and blepharitis but he feels mine is brought on by allergy. I have stopped using all makeup, nail polish, and have been using a natural type shampoo and conditioner. I am starting to feel I am allergic to my house as I have been staying at a friends for a month and when I visit my own home I get eye symptoms a few hours later...I uses Systane Ultra in the preservative free vials. It feels better when the drops are cold and I feel better in a cooler environment such as the grocery store.  Worse at night especially when trying to sleep...I have tryied flax oil and now may switch to fish oil...just wondering if you had any success.