Sanjeev Sabhlok – for specialist visit on 30 September 2011

HISTORY

·  Started in October 2010 – possibly as a result of extensive use of anti-histamines for hayfever, coupled with extensive computer work

·  Pain and burning BEYOND BELIEF for a very long time (October 10– April 11).

Doctors

·  Have seen three doctors so far – two GPs and one specialist

·  Specialist DID NOT conduct tests. Prescribed anti-inflammatories. Solution was ineffective.

Self-diagnosis

·  Forced me more and more self-diagnosis and self-treatment since doctors were ineffective.

·  Have studied extensively and tried a range of solutions.

·  Not as bad now as it had been earlier because of extensive self-diagnosis and self-treatment.

Self-diagnosis – logic

Sudden onset. Closely following hayfever. No change in diet, no change in food habits:

·  UNLIKELY TO BE RELATED TO DEFICIENCY since onset was sudden and severe.

Antibacterial seems to help. Possible bacterial relationships.

Some inflammation. Possible auto-immune effects from hayfever medicine.

Self-diagnosis – logic

Meibomian gland dysfunction (low delivery/ low secretion – see chart p. 1924) – to be tested

Tests needed (see p.2021)

a)  tear breakup test

b)  Rose bengal staining test

c)  Meibography (particularly to check how many glands have dropped out/died, if any) (p.2014)

Is there any nutritional deficiency? (p.1958)

Main symptoms

·  Virtually no moment in a day when I am not aware of the problem

·  Only time when I have no pain or awareness of this is when I am asleep.

·  I’ve (almost) forgotten what it was to have eyes that “don’t exist”.

·  On the best day I can expect a sense of exhaustion from chronic irritation, stickiness and slight burning

·  On the worst day life can be absolutely horrible (strong sensation of dryness, irritation, astringent, burning of eyelid margins, massive headache) – but these have reduced somewhat after my recent analysis and self-treatment package.

·  Often very bad days –variable during the day

·  Cornea is one of the most nerve rich parts of body. When exposed to air it causes significant acute symptoms

Significant impacts on lifestyle

·  Difficult to drive a car even for 30 minutes

·  Psychological impacts:

SUGGESTED PRESCRIPTION AT THIS STAGE (IN ADDITION TO TESTS)

·  Doxycycline in lower dose for a longer time

·  Erythromycin ointment

·  Topical administration of DEHA (p.1958)

Eyedrops tried so far:

Anti-inflammatory: Flarex, Albalon, Antistine Privine + (Zaditen , Visine, from pharmacist)

Anti-biotic: Chlorsig from pharmacist

Preventative for hayfever: Opticrom

Ordinary artificial tears: Thera Tears (don’t like the gel; ordinary preservative free seems to work best), Systane Balance (seems to work better than others), And all others (including gels)

Evidence of what works, so far, and why

Cause/ treatment / Steroid eye drops
FLAREX / Antibiotics
Doxycycline 100 mg/ Neosporin ointment / Non-prescription anti-inflammatory eye drops / Hot compress (with towel) and massage / Lid cleaning with medicated soap/ Lidcare / Nutrients (omega 3, flax seed oil, etc.)
Inflammation / Helped in the first week (in February) but had virtually no effect the second time round (in August) / Did not work at all – hence dropped. / Apparently helps. Nutrients seemed to have helped initially, but no longer sure.
Mebomian gland blockage / Helps if done for a long time, particularly with pulsing massage
Bacterial infection / Tried doxycyline for one week. Seems to have had a positive effect.
(Manuka honey might have helped by killing bacteria, as well) / Seems to help for the next hour or so
Insufficient production of lipids / Seems to help but effect is limited.
Mebomian gland atrophy? – need to check

What else helps

·  Eye bath with Optrex/ lemon

·  Cleaning eyelid with medicated soap/ baby soap

·  Manuka honey (antibiotic properties)

·  Aloe vera (fresh gel from actual plant) – anti-inflammatory properties