Current issue for me - overproduction of oil from sebaceous glands

[dijon84]

Hi

In the past month I've had appointments with an ophthamologist, dermatologist and optometrist. Some key points to come out of those appointments:
- Ophthamologist: my tear film is very oily, my meibomian glands are 'working overtime'. Use fish oil supplements only (no need for me to take flaxseed oil too). Supplement my routine (2x daily warm compress with eyebag plus eyelid cleaning with blephasol) with eye drops 4x daily.
- Dermatologist: I have mild seborrheic eczema and mild rosaceaa (I already knew I had seborrheic blepharitis and MGD). Take Tetralysal antibiotics 1x day.
- Optometrist: TBUT is normal. Try reducing the compresses and lid cleaning to 1x day, as lids look quite clean now.

I've been mulling things over and I think a key thing that has to happen before I get better / feel better is for my sebaceous glands to decrease oil production. This could be related to the dandruff problems I've been having (I'm currently cycling between medical shampoos to treat it). Also, I've had mild acne since I was a teenager (I'm 27 now). Most of the skin on my face doesn't feel greasy, but the area surrounding my eyes feels a bit more greasy, and the skin on my eyelids feels really greasy. It makes sense to me that my meibomian glands would be overactive at the same time as the sebaceous glands in my facial skin (especially the eyelids).

I read somewhere that using jojoba oil can help to decrease production in sebaceous glands - the jojoba oil 'tricks' the skin into thinking that enough oil is already produced, so the glands decrease production. Has anyone had any success with using jojoba oil on their skin / eyelids? Has anyone had similar problems to me, and managed to reduce the greasiness of their skin, in particular the eyelids? If so, how did you do it?

I'm beginning to understand how everything is related - oil production, bacteria / yeast, inflammation, MGD, tear film quality.

Finally, I realise now that this forum may not be the best place to discuss these skin issues. Are there any other forums that people are aware of that may be better for me to go to?

Thanks
Dave

[HYPERHEAD]

I used jojoba a while back and it made my eyes burn

Try this forum ..its great:

http://rosaceagroup.org/The_Rosacea_Forum/

We will meet as arranged and look forward to obsessing and over analysing

[Joseph]

HYPERHEAD I am not sure if that was helpfull or if you were being mean. I hope it was the first. Dijon, I think you should read and investigate other sites because they might be helpfull and knowledge is power. I would hope that you stay with us here at Dry Eye Talk and keep us posted if for nothing else to let us know how you are doing. Skin issues and eye problems kind of go hand in hand. Believe me I KNOW.....

[HYPERHEAD]

Dont worry joseph we are friends and live near each other

From my experience my skin is very very sensitive and easily reacts to anything near my eyes, i have tried many different solutions but in the long run have always made my eyes worse hence why i have now booked a dermatologist who hopefully wont just chuck gut damaging antibiotics and steroids at me !

For example i have tried:

1.Baby shampoo !! After a few days of use very inflamed red eyeballs and very red lids obviously due to detergents and perfumes compromising the already weak tear film and irritating the inner lids skin. I still cant believe optholomogists and GPs advise this as standard treatment to help with blepharitis/MGD!!

2.Jojoba oil! Oh boy !! Read this: Known also to burn eyes and further irritation!

http://www.rosaceagroup.org/The_Rosa...eic-dermatitis

3.Castor oil ...Worst side effects ever..suffered severe burning and swelling and could barely see!

Although some may not have the same reactions its also helpful to inform others of my journey into the blepharitis sensitivity zone,im almost scared to try anything now but my increased sebum production is increasing crusts and scales 10 fold!!

[littlemermaid]

Dave,

We are hanging out in http://rosacea-support.org/ too and there is a good email alert for news from Mr David Pascoe. http://rosaceagroup.org/new/ is a news aggregator by 'Warren' to give you a start. Rosacea includes sebaceous dermatitis, hypersensitivities, allergies, eczema etc these days, many people have eye involvement.

On PubMed and Google Scholar Alert, I'm following: Frank Powell, Richard Gallo, James Del Rosso. They're looking for the markers and prompts for rosacea, seb derm, acne etc - sebum production, inflammation pathways. There's an androgen issue, but how. We know these things are inter-related, but how do we fix it. And, as you say, how do we improve the face skin so the eyes work again?

It's great that everyone has forums for their different aetiologies for the eye problems, but it's so useful to everyone here, and also lurking medics, if we feed back and discuss what we've discovered. This has been the most useful thing for us, finding out about other people's medical treatments and thinking. This lack of joined-up thinking and team work is holding back research and treatments, especially on the systemic and 'autoimmune' conditions, let it not be so for us.

[dijon84]

Joseph - don't worry, I know HYPERHEAD, it's fine . HYPERHEAD - thanks for that mate! It is interesting how you get reactions to things like Blephasol, and annoying for you I'm sure. While I don't get any reaction to Blephasol. I will check out that forum for sure.
Littlemermaid - thanks for the link and information on that forum. I will look into it very soon. Joined-up thinking is a problem I'm sure - agree with you there. When I went to see the ophthamologist, I asked her about the skin around my eyelids and she said my skin looked great (admittedly I knew at the time that the dermatologist was the best person to ask about this). Yet at the dermatologist appointment 4 days later, he says I have mild seborrheic eczema and mild rosacea.....at that time I was frustrated at the ophthamologist. She should either have said 'I don't know enough about this area, so ask the dermatologist' or she should learn more about skin conditions so that she can comment. If I hadn't already had the dermatologist appointment booked, I might not have then arranged one (the ophth implied I didn't need one).
Also with the dermatologist appointment, I basically had to push this through myself. I went to the GP and said I want to see a dermatologist privately, so need a referral letter. If I hadn't done that, I don't think I would have got a referral on the NHS at that time! At a previous GP visit, I had said I want to see a dermatologist and the GP said the NHS is very busy, so prescribed some Nizoral cream. Frustrations....

[HYPERHEAD]

Hey littlemermaid how are you

Need some advice off you if you dont mind...Basically these horrible scaly yellow blobs of crust on my lower lids wont go..all im treating them with is lids scrub by ocusoft but even then they keep growing and doing the scrubs every day is leaving red lines but nt sore below the crusts probably caused by too much friction of the cotton swabs.

I have these things to try:

Bicarbonate of soda
Sterild
OCusoft Plus
Olive oil
Head and shoulders Zinc

What is making these crust grow so quick ? is it the over active sebum glands?
Also how would you apply H@S to eyelids ..should i just wash face and head with it and just let the suds quickly go over my face, as im sure this is related to sebbourheic dermatitis as i get scales of skin in my ears and brows which i scratch off!

Also would the olive oil dissolve these sebacious crusts and how would i apply that, i was thinking leave the olive oil on for an hour and then wash off with shampoo or lidcrub.

[littlemermaid]

Hello Hypes, I had a crack at this on your other thread but TBH I don't know what's happening with this sebaceous overproduction. LM has been getting these yellow crusts, particularly forehead, since this mgd started in puberty, so presumably it's this tendency towards seb derm that rosacea types also have.

She also continued 'cradle cap' from baby-age on/off until she was 7/8yo. This was easily fixed on the scalp with TGel or Head & Shoulders shampoo although now her eyes and skin are so sensitive to chemicals, we're even laying off H&S and using natural honey-based shampoos and moisturisers (Medihoney, Dr Organic, Nature's Gift UK). We have seen A Lot of derms and they don't know what the aetiology of seb derm or sebaceous blepharitis is yet, although the general view is that it's prone to colonisation (fungal, esp naturally occurring yeast). I wouldn't be surprised if it turns out to be a steroid hormone/lipid metabolism thing.

We are experimenting derm-wise with more gentle interventions, and everyone's sensitive to different things, so maybe have a go. LM can't use any of your options - they would all make her eyes sore. So I'm thinking, gently see what makes it better/worse - no one else can tell you. We don't poke about with the cotton bud at first. We use warm water cotton wool gently under the eyelash line, then if there's anything left, in there with a cotton bud, or leave it. Is your magnifying mirror making you over-fussy?

Are you sure you can't do this just with warm water like we can? And do you necessarily need to remove all the crusts if the intervention's making it worse? The main concern is the state of your meibomian glands - what are they actually like?

In case it's useful, if LM has sebaceous crusting, I'm finding she's secretly scoffed a low-quality pizza with that revolting 'cheese' in town with her friends. Or a milkshake. The dairy/sugar/fake fat combo is definitely related - are you dairy-free? Food intolerance and skin can be related.

Also, if the derm wants to use steroid for small signs of seb derm, I wouldn't. There's other options. Maybe post up first what s/he says. And don't use any of their prescriptions round the eyes without an ophth.

Good luck!

I basically had to push this through myself. I went to the GP and said I want to see a dermatologist privately, so need a referral letter. If I hadn't done that, I don't think I would have got a referral on the NHS at that time!

Dijon84: Good to hear you're kicking *, ain't that just the way it is. We try to remain goal-orientated. Docs are just not getting the eye/skin relationship yet, are they?

[dijon84]

Hi
I just posted alot of detail about myself on the rosacea forum, which I will repost here. Here are some additional photos that I didn't post on there
Inside lower lid - left eye

Inside upper lid - left eye


Rosacea forum post
http://www.rosaceagroup.org/The_Rosa...865#post269865

"Hi there

Hope that someone will be able to help with this and would be grateful for any help at all. To cut a long story short:
- 27 year old male. I’ve had mild acne since I was a teenager. Controlled it with Clean & Clear twice each day. Dec 10 – went to Australia (during their summer) for 4 weeks and had fewer problems. When I came back to the UK winter in January, the acne came back with a vengeance.
- Had mild dandruff since I was a teenager also. I didn’t use shampoos for a few years until Feb 11, then I started using the regular medical anti-dandruff shampoos (Nizoral, Selsun, T-Gel, H&S) and started cycling between them.
- Feb 11: think I picked up conjunctivitis from someone else’s towel, then blepharitis started shortly after.
- May 11: established with my GP that it was seborrheic blepharitis
- Later in 2011: diagnosed with meibomian gland dysfunction
- April 2012: my dermatologist diagnosed me with mild seborrheic eczema and mild rosacea. Prescribed Tetralysal antibiotics to take once a day. Stop taking them a month after ‘symptoms’ subside.
- Worth mentioning that my mother has rosacea. She has quite bad veininess on her cheeks, but she says the rosacea isn’t something she thinks about much any more (I assume it doesn’t cause her much discomfort).
To treat the blepharitis / MGD each day, I’ve been using heat bags for 10 minutes (making sure not too hot) on the eyelids, followed by massage then cleaning with Blephasol / Blephagel. In the shower in the mornings, I also let the foam from the shampoos sit on my closed eyelids for a minute or two – the dermatologist thought it would be alright to let the shampoos I get the gritty sensations in my eyes most days. I also take fish oil supplements. Here is a recent picture of my left eyelid (my left eye is my worst for eye sensations):


Points to note:
- The skin on most of my face doesn’t feel particularly greasy . But the skin around my eyes feels a little bit greasy, and the skin on my eyelids feels extremely greasy. A month ago my ophthalmologist told me that my tear film in my eyes is very oily and my meibomian glands are ‘working overtime’. I think this overproduction of oil inside the eye and on the skin around the eyes is related somehow.
- You can see the base of my eyelashes are depigmented due to blepharitis. I don’t think this is really a problem now – the bases of my eyelashes are pretty clean now.
- The eyelashes have a tendency to stick together.
- Red ‘veins’ on the eyelid due to blepharitis. There are also some more of these just below the eyebrows.
- Small white pimples on the eyelid, near the inner corner of the eye and below the eye (nearer the inner corner of the eye)
- Yellow blotches on the skin just below the eye.
- Something that I believe may be exacerbating my problems – I have quite deep set eyes so alot of the eyelid skin is hidden for virtually all the time. If I shut my eyes, there is still a fold of skin there. To get my eyelids fully stretched out (as in the picture), I have to raise my skin by using the muscles around my eyebrows. I am thinking that the oiliness of the eyelid and the fact that it doesn’t get exposed very often means it is an ideal place for bacteria / yeast to thrive.

Anything additional that you can tell me about the descriptions just above would be very useful:
- Do you think anything I am doing could be aggravating the skin around my eyes – heat bags for 10 minutes, massage, Blephasol, Blephagel, suds from medical shampoos?
- Anything you would recommend me stop doing?
- Is there anything else I can do for the skin around my eyes to help it, such as other products? In particular, is there anything I can do to reduce the oiliness of the skin around this area?

Thanks – please let me know if you need more detail to be able to help. I have more pictures of my eyelids if that would be helpful.
Dave"

[littlemermaid]

Assuming that rosacea is a sensitivity disorder, maybe try eliminating chemicals? We are doing well on saline eyedrops in frequent use + Hyloforte.

We minimised medical shampoos to only when really needed - in our case, small amount of H&S if necessary + using the mildest possible hypoallergenic no preservatives etc shampoos rest of time, currently Nature's Gift Honey Shampoo in frequent use + Avalon tea tree shampoo maybe 1/week.

This is the problem isn't it. We need seb derm control but then we are hypersensitive to detergents and chemical additives.

Your inside lids look a bit sore to me, maybe it's the shampoo chemicals, as you suspect. But it's finding a gentle cleaning regime that works for you rather than anybody else. I'm still liking honey + beeswax products but we are experimenting. I'm wondering if we necessarily need detergents for cleaning round the eyes but you're doing well on Blephasol so that's good for you. We are doing OK on warm water cotton wool although in Thames we even have to filter the water, hopefully Cardiff's better.

Assuming you've got a really healthy diet now, eg snacking on veg + seeds + nuts, drinking lots of water? We're taking a multivitamin + mineral but only occasionally particularly post-viral, just in case there's some unidentified eg micronutrient deficiency (Vitabiotics).

Dave, I'm thinking as you're doing well on oral antibiotics, could you reduce chemical eye interventions to minimum like we are, and aim for normality with saline tear sub?

[HYPERHEAD]

Hows it going dave and littlemermaid..

Its good to see you dont have much crustation on the lids dave and i noticed depigmentation when i saw you last ...i wonder what causes this

Your eyelid margins are looking very good no me with no noticable blocked oil gland orifices.. How are your eyes lately ?

My eyes have been feeling better in the hot sun, but since the sun has obviously been helping in melting the oil glands im now noticing tiny white heads appearing on the oil gland exits on the upper lid margins..they look like whiteheads...i hope these go as i dont want chalazia Maybe i should try to pop it using a cotton bud ?

Dave and Littlemermaid have you had the whiteheads forming and are they capped glands..it looks like the gland orifices are possible clogged or something?

Also i have laid off a bit with the lid hygiene due to bad redness forming on even the lower llids now..but now the yellow crusts are growing again..damn you cant win..

Littlemermaid please could you advise on the following:

1:Would olive oil or unrefined coconut oil left on the margins for an hour once a day and then washed off with ocusoft help remove these damn yellow crusts.

2:How do i apply head and shoulders zincy stuff to the eyelids? Do i lather it on my head and then just let the suds run over my face and lids or do i leave the suds on my face scalp eyelids for a few minutes then wash off? Also wouldnt this really dry out the skin if left on a few minutes?

3:Should i use a moisturiser like coconut oil or jojoba on my eyelids after a shower to combat dryness and possible sebum gland irritation, also wouldnt that help reduce crusts..trouble is when i use oils near the lids they end up migrating into the eye and burning

I really would appreciate your help again master mermaid..

[dijon84]

Hi LM and Mario

Thanks for your replies. My inner eyelids have looked like that probably since the middle of last year. I don't really put anything 'in' my eyes any more - I have very poor compliance at putting eyedrops in, despite being told to many times. I probably use a few drops every two weeks or so, and only when my eyes feel very gritty. It's rare that the shampoo foam on my lids gets into my eyes. So not exactly sure why the inner lids look so bad. What I would say is that I often feel friction in my lower lids - if I look down, then back to level again I do feel this 'friction'.

To be honest, I don't know if my MGs look normal in that shot. I don't know if they are expressing clear or not - I have tried the techniques suggested here to test but can't really tell. Sometimes I do get a white bump appearing on a MG. The photos were taken on Saturday. I've felt a bit better the past few days in this warm weather - I think it is what you were saying about the sun melting the MG oil. But it could also be related to my acne - in my post I said that I had very little acne in the Australian summer but it came back with a vengeance when I flew back to the UK winter.

Perhaps it is ok to use medical shampoos on the scalp but not so on the lids. Anyway I think I may try toning down the medical shampoos and using the tea tree or honey shampoos that you are using.

I saw an ENT doctor today about the crushing sensations behind my nose and forehead. After looking up my nose, he says it all looks good so nothing medically wrong that he can tell.

I have discussed with Mario about my diet. I always start the day with a big bowl of cereal and semi-skimmed milk. I do get through a reasonable amount of dairy each week, perhaps should try cutting down (although I did try this last year for a few weeks and it didn't really do much). I do find that if I eat strong cheeses, it feels like my cheeks are sweating and this happens almost immediately after. Otherwise my diet is mostly good. I eat a big salad for lunch in work each day (peppers, celery, spring onions, carrots, tomatoes, cucumber, lettuce, tinned sweetcorn, salmon/tuna/chicken). I chop all the veg up at the start of the week. I also eat alot of wholemeal stuff - pasta and bread. I do drink too much alcohol, it averages over the 21 units per week guidelines. It's mostly ale that I drink - probably not too good for me with yeast / sugar etc. For snacks, I eat quite alot of nuts (cashews, almonds, walnuts, brazil nuts etc). I also eat alot of fruit - in a work day I will usually have something like an apple, clementine, banana, plum, blueberries, grapes). Sometimes I feel a bit of heaviness in my eyes after this. Do you think I am overdoing it with the fruit and the sugars? Any suggestions for snacks I could replace some of the fruit with?

I'm going for a GP visit this Wednesday and will ask him how I'm getting on with the rosacea. Doing a bit of internet research, I think that possibly those whitish bumps on my eyelid skin and below are milia - blocked pores. Possibly nothing to worry about, just unsightly.

Bit of a rambling post here! Cheers, Dave

[littlemermaid]

Hi Dijon, Great job! Look where you were and where you are now. Sounds like MGD people are enjoying the heat and sun, clearing acne, getting the oils flowing. Same for us. Some people think vit D3 deficiency is an issue.

Do you think you need eg saline eyedrops? We are using saline Minims regularly + Hylotear occasionally to keep the surface good whether she feels dry or not, but don't know what your tear film or surface is like. I suppose the danger of not using drops would be if the eye surface deteriorated without a decent tear film and you didn't realise because it was a bit desensitised. Whereas if you did use bland drops and protect the surface a bit more with wraparounds then healing might be better. Maybe drops would help with the pH, which seems to be another problem if it's seb bleph. Just speculating.

That tea tree shampoo is not so good near the eyes, feels like it's stripping the tear film off, although I'm thinking for us, letting it wash over very very dilute is more good than harm. LM and I are both sensitive to it eg on arms and legs - I think it must be a bit under-formulated - but a small amount is good for the scalp once in a while if you're oily and feels like a great bug-killer - eg no sign of seb crusting on the scalp or behind ears like we used to get. The honey one feels harmless and gentle to us, plus it's got a bit more compatibility with eg dry scalp and, I'm hoping, gentle antibacterial action (yeh, I am completely making this up). Everyone's different. I just bought more from Holland & Barrett Manuka Honey range (plus the Rescue Repair moisturiser but that's for rosacea).

Healthy chap! We've cut out gluten, yeast, dairy, hoping for relief on the overproduction of sebum, maybe rebalance the hormones. But this is total guesswork. We are snacking on nuts, seeds, dried fruit too, and rice cakes. A quick internet search reveals that many people lose the ability to digest dairy. But we do have probiotic yoghurt occasionally in case that improves the digestion (no idea if LM is lipase or hydrochloric acid deficient). The key for us has been cutting to minimum. If the kid wants icecream or chocolate she gets it, but it's the best quality, and it's just once in a while. No point in making our lives a misery. I love this approach and it suits us perfectly, it feels like true luxury - you could upgrade to the finest ale! Balance seems to be the key, not too much of one thing.

Not sure which salad oils to use yet so we're sticking to olive oil. But I think good salad oils are helpful, like walnut oil. It's the fake fats that cause problems - the clue's in the word 'emulsifier'. Just felt angry in the aisles of Walmart/Asda looking at all that *; to me now it seems the processed 'food' giants are poisoning us and our kids.

I think we forget what's normal - can you ask family/friends if you can see their inner eyelids? Yours look a bit affected by something to me but not inflamed all red like we get on flare-up. One super-ophth said if there's a whitish colour right at the bottom of the inner eyelid then you're not reacting in an allergic way. Maybe it is friction you're not aware of, as you say. Have you never seen clear meibom? (2 fingers gently pressing upwards under lower eyelash line, look along eyelid margin)

Hyperhead, I don't know what to say - it's so personal what helps, what doesn't. I always take my makeup off with eg Johnsons baby oil and cotton wool, close the eyes, swipe - then hot water and cotton wool swipe to clean off excess oil - then swipe under lower eyelash line - but whether that would work for you with an oil you like, I don't know. Our ophth tapers as things start to work to get the eyes to recover rather than carry on blitzing, which shows how a maintenance routine is a personal thing. For sure, we can make things worse on other people's advice and everyone's different on allergy/sensitivity.

It's a joy to hear about you guys supporting each other through this.