Allergic Blepharitis?

[Neonglow]

Hello, and thank you in advanced.
I'm a 24 years old female. I live in Virginia. My left eye's problems began in 2008. The problem began with watering of my left eye only out of the inner corner. This water wouldn't leak don my cheeks, it would collect on the top of my eyelid. This made just the corner red and irritated. Then the skin started cracking in the corners. I was given Pataday and antibotic ointment to put on these cuts and was told it was allergy related. This didn't help the problem.

I waited a while to see if the eye would clear on it's own. It didn't. It got WORSE AND WORSE AND WORSE. It is now swollen all the time. The swelling varies in severity throughout the day. It is very unpredictable how "big" my eye will be at any given time. Upon waking it is closed with yellow crusts. cracked cornes bleed. Always always always watering. I look like I've been beaten.  I decide to seek out more help.

I went to my second eye doctor in hopes of more help. This doctor told me I had dry eye and Blepharitis. She
prescribes me with Tobradex and tells me to use it 3x a day for 3 days, 2x a day for 2 days, then 1 time a day for 3 days. First, the problem went away! (surprise surprise...steroid) No watering, no crusting, no redness. I go in for a follow up and she tells me my eye looks normal again! And to just use the artificial tears. 2 days later my left eye is back to how it used to be! It's PAINFUL at this point. Burning, stinging, light sensitivity, miserable.

I decide to make an emergency appointment with the first doctor I saw. She examines my eye and tells me to go back on the Tobradex and follow the same regimen as before. Again, it works. I go back to follow up and she tells me my eye looks normal again, but the top tear duct looks a little narrowed. She thinks this is all allergies and that I should see an Allergist.

[Houman Vosoghi, MD]

Sounds good.  He/She should be able to help.  Immunology deals with allergies and immune system problems in the eye.  They deal with conditions that respond to steroids so may be a good choice.

HV

[Neonglow]

I made an appointment with a Corneal special at Johns Hopkins Wilmer Eye Institute in Baltimore MD. Deff. worth the hour drive.
Even the receptionist/Nurse have been more helpful than any doctor I've seen.

They told me they know how scary it must be to not know where to turn, but that if the doctor they made the appt, with isn't the right one, he'll deff. know where to send me.

Have you heard of an Ocular Immunologist? If so, what is it? What do they do?

Thank you for your help!

[Neonglow]

I made an appointment with a Corneal special at Johns Hopkins Wilmer Eye Institute in Baltimore MD. Deff. worth the hour drive.
Even the receptionist/Nurse have been more helpful than any doctor I've seen.

They told me they know how scary it must be to not know where to turn, but that if the doctor they made the appt, with isn't the right one, he'll deff. know where to send me.

Have you heard of an Ocular Immunologist? If so, what is it? What do they do?

Thank you for your help!

[Houman Vosoghi, MD]

Johns Hopkins is the best in the country if you could get in.  Ignore what I said about the cancer, I missed your age which pretty much makes it impossible.

HV

[Neonglow]

Do you recommend any in the Northern VA/DC area?
I know there is Georgetown and John Hopkins nearbyish.

Do you know any specific doctors???

[Houman Vosoghi, MD]

Wow!  That sounds terrible.  I don't know what I would add to all of that.  I also get concerned with someone potentially needing steroids for a prolonged period of time or indefinitely because you are asking for glaucoma and cataracts to develop.  Consider going to an academic center and consulting with both a cornea specialist and an oculoplastic specialist for the eyelid and see if between the two of them they could figure out what to do.  Try to cut out any sources of allergy in the meanwhile.  You may also need a biopsy of your eyelid depending on what it looks like as there is a rare form of cancer that can present as chronic blepharoconjunctivitis called Sebaceous Gland Carcinoma (highly unlikely).  But do see both specialists.

HV

[Neonglow]

I go to an Allergist in all this time and she tells me what I know. I'm allergic to dogs, cats,pollen,mold,dust and Lentils. I should say at this point I knew about the food allergy, and have been avoiding said food since day 1. She added Xyzal allergy pill to my regime.

It's follow up number 2 with the Eye Surgeon. The DAY I wake up for this appointment (I'm on Pred Forte 1x a day for the past week) my left eye is swollen,red and has white discharge....I go into the appointment and she tells me I'm all puffy and I have to go back up to 2-3x a day for 2-3 days, then Lotemax 2-3x a days for 2 weeks. She said I have to remain on steroids, but it has to be a less intense steroid than Pred Forte. I'm also supposed to use a SMALL amount of Tobradex 1-2x a day. I'm also supposed to continue Preservative Free artificial tears. I'm so scared to be on a steroid eye drop indefinitely. All she told me was steroid would help and I would remain on them. I don't like this at all. I'm so afraid of what is going to happen when I come off these drops again. It's painful and for the past month and a half I've looked normal I got used to not being in pain, and I'm afraid of it coming back.
I've been to 4 different Optometrists/ Ophthalmologists about this chronic problem and I still have yet to get a definitive answer to what is going on with my left eye.

Any suggestions are welcome. Please help.

OVERVIEW:

I've been told this problem is Dry Eye, Allergies, Blepharitis, MGD, and the newest one: Eczema.

I've been treated with the following: Antibiotic ointment(no luck), Pataday(no luck, was only on for a month, though), Vigomox more times than I can even begin to count, Azasite, Pred Forte, Tobradex.

I'm always on the following meds for my Asthma/Eczema: Singulair 10MG 1x a day, Advair 250/50, Elidel for facial eczema on cheeks(controlled now), Nasonex, and the newest Xyxal.

I've always used unscented detergent/dryer sheets. I haven't worn makeup since this whole thing started. I don't use scented anything. I used Aveeno on my face and Vanicream on my body(makes face break out)

[Neonglow]

Last month I decide to visit the Eye Surgeon in the same Ophthalmologic practice since I convinced myself that I had a narrowed tear duct and it needed to be dialated. THIS doctor tells me as soon as she walks into the room (she still has yet to examine my eye through anything...she always just stands across from me) she tells me immediately that I have severe allergies and that all of this is Eczema. She tries to put me on Tobradex and I tell her what I went through before and that all it does it make things better, and then much much worse. She tells me I must be allergic to the Preservative in it. (BC) and that THAT is the reason steroids haven't been working for me. I tell her I'm not comfortable with the steroid drops( Pred Forte) and that all I wanted was to have my tear duct irrigated. She  disagrees but does it anyway. Then she tells me that it is not blocked and that the only reason the duct is narrowed is because of inflammation.
I cave and give into her suggestion.  I used nothing but Pred Forte 4x a day for 2 weeks, 3x a day for 1 week, 2x a day for 2 weeks, then 1x a day for 2 weeks. I go in for a follow up 3 weeks later. Everything is great. My eye is becoming less swollen each day. No more stringy discharge, nothing. I tell her I added putting Elidel that I have for my Eczema on my eyelids. She said this was OK. She also told me to ad Preservative Free artificial tears.

[Neonglow]

My eye stays normal for 2 days-again. I make an emergency appointment with the Opthamologist she has referred me to. He tells me I have Blepharitis Posterior and Anterior,MGD,and eye infection and that I'm allergic to Tobradex. He wants to put me on Restasis, but my insurance doesn't pay for brand name meds. He puts me on Azasite saying this would probably clear everything. I got it ($150) and used it for about 2 weeks. It didn't do anything. It just stung. A lot.

Giving up, I decide to just let my eye be. It goes on like normal. Nothing gets better. My eye looks horrible. I'm very depressed. I try not to leave the house. I'm constantly calling out of work on the days I wake up to an eye that looks VERY infected. I use Tobradex again on my own at this point. 3x a day. A week after going on like this I wake up to an eye that is COMPLETELY CLOSED. Oh my gosh, I FREAK OUT and make an appointment with the Ophthalmologist I went to before. He tells me this is a normal reaction to using Tobradex for a long time. He prescribed me Vigomox and Keflex tablets. It takes a week for my eye to go back to "normal" i.e slightly swollen and watery.  I give up.

I used organic baby shampoo (free of dyes, perfume, ect.) diluted in water 2-3x a day. I use artificial tears all day, I use Refresh PM preservative free every night, which started to help with waking up free of debris on my eyelashes.. I do warm compresses for 10 min. at a time 2-4x A DAY. Nothing helps. Some days it looks infected, some days it only looks slightly swollen. Some days the redness on my eyelids looks slightly pink,some days its BRIGHT red and scary looking, and that's when I put steroid cream on it. I know I'm not supposed to do it without doctors permission, but I give up. It's steroid ointment used for my Eczema. I put a small amount on with a Q-Tip.