Posted by: MDS | 2009-04-29

Recurrent blepharitis and meibomian cysts - at my wit' s end!

Hi there

I am new to this forum and I' m hoping you can help me or at least point me in the right direction. In June last year, I developed and eye condition, quite literally overnight. I woke up one day with my right upper eyelid red and swollen and I assumed that this was just a stye. It went away after a few days but came back with a vengeance in July when my entire eyelid swelled up and I had a discernable hard lump on the inside of my lid. It was only after a visit to an ophthalmologist that I was told that this condition had a name - blepharitis. And the lump was something called a meibomian cyst.

Several courses of treatment later (including antibiotics, prescription eye drops, hot compresses and eyelid scrubs with baby shampoo and Blephagel), there was virtually no improvement. In fact, I developed another 3 meibomian cysts during the course of last year. So I underwent a series of steroid shots (which are supposed to help eliminate these cysts) - there was some improvement, but again the lumps were still there and my eyelid remained red and inflamed.

My last resort was surgical removal of the cysts, which I had done in January 2009. Although the procedure was expensive and not entirely pleasant, my eye finally improved and I thought this nightmare was finally over.

Well, to my dismay, my eyelid has started to flare up again over the past 2 months - despite the fact that I have continued with the daily eyelid scrubs. In fact, although my eye improved after the surgery, my right eyelids remained somewhat red and my eye does not look the same as it was before I developed this condition. Now, it just appears to be getting worse. I am seriously at my wit' s end and very depressed about this situation, which has started to take over my life. I wake up every morning wondering how my eye will look and I hate the fact that I have virtually no control over this situation.

What puzzles me the most is that none of the eye doctors I visited last year (I saw 4 of them) was able to tell me what could have caused this condition and why only my right eye has been affected. Possible causes included: contact lenses (I had worn lenses for 10 years prior to the onset of the blepharitis and never had a single day' s trouble as I was always very particular about cleaning them, etc)  acne rosacea (hence the antibiotics - although these didn' t help much at all)  bacterial infection  and even diet (which seemed a bit suspect to me, e.g. caffeine - which I was told to cut out of my diet, again with no improvement whatsoever).

I was wondering whether anyone here can offer me some sort of guidance in this regard. Could the blepharitis and meibomian cysts be caused by something other than the causes listed above? I even had the removed cysts tested for malignancy (as I was told about a very rare type of eyelid cancer by one of the doctors I saw) but the test came back showing no malignancy.

Is it possible that I am allergic to something that is causing the recurrent inflammation? Is there someone I can see who would be able to do some tests in this regard (I stay in the Joburg area and work in Sandton) - i.e. an allergist? I have no idea as I have never been tested for allergies before. Also, I remain puzzled as to why only one eye has been affected - if this was an allergy, surely both eyes would be affected? My left eye has not given me any trouble at all.

Sorry for the long winded message. I am just so frustrated about this mysterious condition that has overtaken my life and ruined my confidence. I honestly don' t know who to turn to next and I' m reluctant to go back to my ophthalmologist only to be told that I need to go on more antibiotics and that I should do daily lid scrubs (which I have been doing anyway).

I' m really desperate right now and just want this ordeal to be over. It has been almost a year now and I feel like I have been going around in circles.

Many thanks in advance!


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Our expert says:
Expert ImageCyberDoc

Dear MDS
Meibom cysts or Chalazion are modified sweat glands that gets blocked by overproduction of sebum ( an oil that is made by the skin ) and can get infected. It is not caused by allergies. I can understand that you are thoroughly tired of battling with this condition but it seems as if your doctors have been doing everything according to the book to treat this and if you keep on getting repeated infections, you may need to use tetracyclines preventatively (like people with acne needs to). The only thing I think they haven't done is to test for Demodex infestation ( still controversial if this really has a role to play in chalazion) . This is a very tiny (microscopically) mite that normally lives on skin in hair follicles. Putting eye ointment on the eyelid may smother these mites and reduce infestation - it may be worth trying.
I would also try putting Bactroban ointment in your nose, to reduce the number of staphilococcus areus bacteria in the facial area (another bacteria that all of us carry and that sometimes can cause infection if it overgrows)
Dr Bets

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