Thick ointments such as lacrilube - useful?

[brd888]

Anyone using ointments such as Lacrilube?
I've just read that there is a strong possibility that ointments interfere with the wettability of the ocular surface and lid lubrication.
I've been using lacrilube at nights due to recent problems with dry eye but maybe this is perpetuating the current problem. I've only been given lacrilube by one of my GPs and the opthalmologist I saw almost a year ago, neither of which were very concerned about dry eye. Maybe it is time to bin the stuff.
Regards,
Bruce.

[Rebecca Petris]

I've just read that there is a strong possibility that ointments interfere with the wettability of the ocular surface and lid lubrication.

In addition to that the residue may clog up the meibomian glands.

Ointment can be useful in some situations but IMHO daily use can pose some problems.

[Eli]

If you're going to use Lacrilube, why not use Refresh PM instead? It's preservative free. However, I have also seen the speculation about ocular surface wettability and meibomian clogging, and it certainly seems possible. It's a shame, because the stuff really does work.

[stella]

I have never dared use this directly in the eyes -despite being told to by an optician. I did use it on the lids for a while as i felt they were soo dry(being careful not to get it on the lashes - so as not to block the already blocked glands)
Interestingly my daughter works in ITU as a nurse and tells me they routinely apply lacrilube into the eyes of all unconcious patients in her hospital as protectionI spent a life time in ITU as a nurse and our protocol for protecting the eyes of unconcious patients was to apply folded gauze swabs dipped in normal saline - then directive come from the eye- dept that we were to use sterile water insead [B]There was also an interesting substance called " jellyperm" It come in protected sheets and was cut slightly larger than the eye and we wet it with sterile H2O]and placed it over the patients eyes To me at that time it seemed a great protective solution- Then it was withdrawn due to costs (it was see- through, and resembled thick plastc)also was permiable
I wish I had some now - I would try it at night
After all, the unconcious patient often has the eyes only half closed and never blinks - if unconciousness is drug- induced for their condition and in most cases it is
I thought that info might add to the discussion
I just stick to celluvisc (carmellose sodium) both day and night - I must find out what carmellose sodium is ?
You dont seem to have it in the USA?
Anyone throw any light on that one?
Stella

[Rebecca Petris]

I'm chemistry challenged but just from having seen these over and over, I believe...

Carmellose = carboxymethylcellulose

(similarly, hypromellose = hydroxypropylmethylcellulose)

These polymers are both used in various artificial tear products available in most western countries. Check our lubricant listings and look for CMC and HPMC.

CMC is in most of the Allergan products and in Theratears.

[stella]

Thanks for that info Rebecca !
Stella

[tiggy]

Hi- Interesting conversation!

I have MGD and find that applying a mineral oil based ointment like Refresh PM once a week actually helps. I also have found that washing my face with castor oil and steaming it helps unclog my pores. Maybe occasional use of an oil based product my have the same effect on the eyes?

I think it would interfer with moisture content of the cornea with daily use.
My .02-
tigs

[Kevin]

Hi everyone...i have recenltly moved to london, england from the USA and have been using oitnments at night..the problem is im having a hard time finding sterlid and occusoft etc here. Does anyone know where i can get these here...rebecca can i order from the dry eye store for international shipping? Also, I have long eye lashes and when i put my glasses on in the morning (even after cleaning) i have left over mineral oil residu build on my glass lenses.....its sooo annoying...does anyone know of a good way to clean the gunk out of our lashes in the morning? I appreciate anyones input! thanks

[irish eyes]

Hi Kevin

Welcome to the cold UK.

I am surprised you are having difficulty getting hold of Sterilid and Ocusoft. I got mine from my local optometrist here in the North of England. Some good chemists might stock it. I imagine several internet companies would supply it. This company (below) is OK to do business with. They have a range of products called Blephaclean / Blephasol which do the same job. I find most of these products rather harsh on the poor lids. I used to have the same problem as you have - long lashes causing my glasses to get smeared!

www.dry-eyes.co.uk/

[thistledown]

If you're going to use Lacrilube, why not use Refresh PM instead? It's preservative free. However, I have also seen the speculation about ocular surface wettability and meibomian clogging, and it certainly seems possible. It's a shame, because the stuff really does work.

for the first time last night i used Lacri-lube, because i'd been having to get up two and three times in the night to re-apply my Refresh Plus drops.

Here in the UK Lacri-Lube comes without preservatives. (i wonder if there are other differences, too, in the ingredients?)

i haven't tried Refresh PM but might in the future. anyway, although i had to reapply the Lacri-Lube once more in the night, today my eyes are more comfortable than they've been for quite a while, and i'm going to use it again tonight. a good night's sleep seems to help more than anything else - i'd like to get to the point where i can put the Lacri-Lube drops in and sleep right through!

i take on board what's been said about blocking the glands, and will keep an open mind on that. but just the relief of not having a very sore eye on waking (and the accompanying depression) seems worth a bit of gland-unblocking afterwards!

and this morning, before putting in the Refresh Plus drops, i carefully cleaned the remaining gunk out of my eyes with a cotton wool pad soaked in hot water. hopefully this might stop build-up?

so far, anyway, i'd recommend the goo.

[thistledown]

for the first time last night i used Lacri-lube, because i'd been having to get up two and three times in the night to re-apply my Refresh Plus drops. ... so far, anyway, i'd recommend the goo.

oh boy. why don't these things work consistently? last night i put in the Lacri-Lube goo (and what a business that is! stuff keeps spooling out of the tube even when i'm not squeezing it, and by the time i've managed to get some in one eye without poking my eye out, it's too blurred to see what i'm doing to the other eye. consequently i end up with about a teaspoonful of the stuff all over my face. there doesn't seem an easy way to use this stuff... ) - anyway, i then woke up at about 3 am, eyes dry and sore, struggled to put more of the thankless gunk in them (by torchlight) - cleaning up my eyes, face, etc woke me up thoroughly, so i didn't go back to sleep for about an hour and a half. when i woke up at about 7, my eyes felt like a gremlin had been in there, rubbing them down with sand paper.

so it was back to Refresh Plus, which works ok, but not for long enough. and i just don't know what to do tonight! do i give the beastly goo another chance? or drink lots of water and wake up every two hours to put in the Refresh Plus? which at least is easy to apply, but it means i get another interrupted night...

i do want to try Celluvisc - which i'm hoping to get my doctor to prescribe - but i don't see him till tuesday. perhaps also Refresh PM - though i have a feeling this is just more oily goo, isn't it? the same as Lacri-Lube?

please could someone tell me whether i can use all this stuff together, and if so in what order, and if not - which one to ditch? i'm having a really down day today, and i was feeling so good yesterday, thinking i'd got it sussed!

rats rats rats!!!

[calli66]

Bear with me and read this little narrative:

A close friend of mine with Sjogren's ---with severe dry eye---was literally "hooked" on the ointment for over a year. With 0 Schirmer's score and corneal
'points' (I don't know the name for it---caused by the dry eye), she HAD to use something strong at night. The "lube" helped heal the "points," gave relief, and she even noticed that the greasy lubrication lasted into the next morning, giving her relief until almost noon.

But after noon, and for the rest of the day, her dry eye was awful, making her desperate. I tried to encourage her to use the gel at night instead, but she couldn't get used to the sticky lashes and the need to wake up and re-apply several times----difficult for her because she took sleep medication. Eventually, she had to use the CPAP machine at night and couldn't use petroleum jelly products with that, so was more or less forced into trying several nights with gel only.

I had been suggesting Genteal Gel (available in US), and this product was too harsh---really burned---but she finally found a different gel--I think it was Refresh Liqui-Gel, and was finally able to quit using ointment. After that, her eyes improved rapidly---they didn't get more tears, but they felt much better.

Each person has to find what works best for them, but it's my opinion and my experience that the ointments interfere with the wetability of the eye surface, and while they help in the moment, they are not good to use long term.

I've read articles about people with "chapstick addition"---it's kind of a joke, really, but I think the effect is similar. The more you use, the more you have to use. If you don't apply if, your lips seem to be drier than ever. I don't think petroleum jelly is an evil substance----I use it in my nose at night and am pretty dependent on it---but for the eyes? Doesn't seem right to me.

With the eye, we're not talking about lubricating ball bearings, we're talking about a delicately balanced lubricating system of tears/lipids/mucous that's spread by blinking. Petroleum ointments can function to prevent gross damage to the cornea (like erosions). But as a barrier to air exposure, there are better ways. Some type of gel and TranquilEyes goggles at night works for me---not perfect---but I've learned to live with it, and generally get pretty decent sleep.

Calli

[thistledown]

Bear with me and read this little narrative:..... Petroleum ointments can function to prevent gross damage to the cornea (like erosions). But as a barrier to air exposure, there are better ways. Some type of gel and TranquilEyes goggles at night works for me---not perfect---but I've learned to live with it, and generally get pretty decent sleep. Calli

thank you, Calli. that's useful information.

i'd like to stop using the Lacri-Lube as soon as i can get hold of an alternative, perhaps Celluvisc.

last night was slightly better, maybe because this time i didn't overload my eyes with the goo. i still had to put it in again in the middle of the night. i've given up trying to apply it with the tube nozzle - i put a little bit on a well-washed fingertip, and smooth it onto my lower eyelid. some gets inside! maybe, like facial moisturizer, the less you use the better it works?

[calli66]

Do you have to get a prescription for Celluvisc in the UK?

Sounds like you're doing better since you're minimizing the quantity of ointment. I do much the same thing when I have to use medicated ointment---just put a tiny amount on my finger and apply it to my lower lids. That way, it doesn't overwhelm the eyes.

C

[Lucy]

i put a little bit on a well-washed fingertip, and smooth it onto my lower eyelid. some gets inside! maybe, like facial moisturizer, the less you use the better it works?

That's exactly how I use either gel or ointment to apply before bed. I even Pull out my upper lid and scrape the finger with the gel on it so some gets up under the upper lid too. Lucy

[thistledown]

Do you have to get a prescription for Celluvisc in the UK? Sounds like you're doing better since you're minimizing the quantity of ointment. I do much the same thing when I have to use medicated ointment---just put a tiny amount on my finger and apply it to my lower lids. That way, it doesn't overwhelm the eyes. C

i did the same thing last night, and then woke at 4 am, not sore but a bit dry, so instead of reapplying the gunk, i used my Refresh Plus drops - a full vial. and this morning - eyes not too bad at all. i guess less is more!

which makes me wonder - do the eyes become dependent on all this stuff, so that the more you use, the more you need to use?

anyway - today i'm going to my doc to ask for prescription for Celluvisc, not because it's only available on prescription here, but because - being over 60 now - i get my prescriptions free. if i can at least get the Celluvisc on the National Health, it'll make a major difference to what i'm spending on the ol' peepers.

[SallyP]

I don't get on with any of the gel/oils. Last one I used, Lacrilube made my eyes stick even more in the morning, and as I have MGD I don''t want to take the risk. I use Systane drops and have found them to be the best so far.

[calli66]

Thistledown wrote:

"which makes me wonder - do the eyes become dependent on all this stuff, so that the more you use, the more you need to use? "

Just my opinion, but I believe that might be the case. It makes your eyes feel better by creating a barrier to air---not in the same way that tears do, though. When it wears off, you have to apply more. Liquid drops provide a barrier too, and have to be reapplied often---but at least they sort of work with your natural tears. Petrolatum ointments have the added effect of repelling your own natural tears----so they don't have a chance to work.

And too, natural tears carry nutrients and chemical signals to the eye surface---they're part of a feedback loop that moderates the eyes' secretions. Ointment or drops, applied too often, interfere with all this, leaving you dependent on the product. You have to work toward a goal where the eyes can start taking care of themselves most of the time, with a smaller amount of help from gels, drops, meds, etc.

"anyway - today i'm going to my doc to ask for prescription for Celluvisc, not because it's only available on prescription here, but because - being over 60 now - i get my prescriptions free."

I hope it works for you.

C

[msienkiewicz]

I have to say I agree with the less is more theory.

I started simplifying my routine over vacation up north, partly out of exhaustion and laziness.

I am now using restasis three times a day and that's it. I was told to only use it twice, but three times seems to be the charm.

I have not been wearing the lacriserts lately or using any other drop.

Overall, I have been fairly comfortable and happier with the simpler routine.

Hope my eyes are happy at the next check up.


Melissa

[thistledown]

..... natural tears carry nutrients and chemical signals to the eye surface---they're part of a feedback loop that moderates the eyes' secretions. Ointment or drops, applied too often, interfere with all this, leaving you dependent on the product. You have to work toward a goal where the eyes can start taking care of themselves most of the time, with a smaller amount of help from gels, drops, meds, etc. ... C

yes, i think that's the way: to have a definite motivation towards using less stuff, and letting the eyes recover. although, one has to balance that against the danger of tearing the cornea at night, if the eye surface is too dry. i'd like to reduce my daytime use to almost nothing - other than to moisturise after over-use of the computer, or watching a movie etc. but i'll keep up the night time regime until there are definite signs that i can ease off there, too. it's all a bit of a juggling act, isn't it?

anyway - i am pleased to report that the doc has given me a prescription for Celluvisc - hooray! although they didn't have any at the dispensary yesterday, so i'm going to have to cycle the mile or two back there today... however, i've discovered that if i wear my wrap around eye protector plastic goggles (over my glasses) - the kind you get at a DIY store, and which i use for carpentry etc - it keeps the wind and dust out of your eyes whilst cycling. i got a few odd looks on my way there, yesterday - but who cares! i'd rather be eccentric and comfortable than cool and stressed out! aaahh, the joys of being an older woman!

[calli66]

Yes, definitely--to all you said!

I still goop up my eyes all night long, but only have to use drops 2-3 times during the day.

And as for the freedom you get as an older woman---I understand that. I realized in my early 50's that I was almost "invisible" to the unwanted or critical attention of the younger generation. Older guys still check me out now and then, but goggles, bad clothes, and dirty shoes keep them away.

Now, if only I could get the street people and pan-handlers to leave me alone....

C

[mary kenny badami]

. . . i got a few odd looks on my way there, yesterday - but who cares! i'd rather be eccentric and comfortable than cool and stressed out! aaahh, the joys of being an older woman!

Oh, calli and thistledown, how very much I do relate to what you are saying.
I realize that there are posters whose careers or age or personal expectations require a certain standard of appearance, (even if it may conflict with their own best health choices)!
I don't mean just about eye issues, either . . .
I mean, for instance, wearing shoes that hurt one's feet (but are fashionable), or hair treatments that look nice (but carry potential physical harm).

Me, personally, after I had Lasik eye surgery, I never wore "eye makeup" again. Yep. No eyeliner, mascara, eyeshadow, ever; not ever again.
My choice was to accept such a "loss" of whatever "glamor" I had left, in favor of keeping my eye area as free from foreign substances as possible.
One less variable, one less potential contaminent. My eyes are no longer made-up, but I accept that I have improved their chances to look clear and feel healthy.
(Also, I don't spend as much as I did on cosmetics, and my purse and travel kits aren't as heavy as they used to be!)

Now, that doesn't make me unsympathetic to the folks who are trading ideas on various threads here about makeup brands and eye makeup strategies.
I figure that each person does their own personal cost/benefit analysis, and in the process takes into account their life circumstances and priorities.

I started rehearsals for a community play last night. There are 25 of us with speaking parts. One of our "warm-up" exercises was to arrange ourselves in a line, from youngest (age 9) to oldest (age 90 -- no kidding)! We were asked to caucus with those near us about what's good and not-so-good about being our current ages . . . and yes, I (third-from-the-extreme-old-age-end) and my mates agreed: within the limits of the law, our finances, and our personal moral and ethical values, we LOVE being relatively free to look however we want and to do whatever we want!

aaahh, the joys of being an older woman!

[Lucy]

Me, personally, after I had Lasik eye surgery, I never wore "eye makeup" again. Yep. No eyeliner, mascara, eyeshadow, ever; not ever again.

Totally agree with what Mary says (with a few exceptiions), but after Lasik, I thought I would be able to "paint my eyes up with eyeliner and mascara" for the first time in my life. Always the owner of -10 glasses, I never bothered as the look would have been quite garish. I thought this would my entry into the world of glamour.

Like H it was. I, too, have never worn mascara, eyeliner or the such since Lasik. I don't want anything near my sore eyes, or anything that might irritate them. Although I want to wear the spikey, pointy toed shoes that I did earlier in my life, I just can't. I can't see too well and fall too easily.
Taint' worth it.
Lucy
Lucy

[thistledown]

... And as for the freedom you get as an older woman---I understand that. I realized in my early 50's that I was almost "invisible" to the unwanted or critical attention of the younger generation. Older guys still check me out now and then, but goggles, bad clothes, and dirty shoes keep them away. ... C

love it! me, i'm usually in paint-stained jeans, and very old and 'distressed' green flash plimsolls (trainers to you younger ones) and on the rare occasions i clean up, the difference is so considerable i get lots of attention (wanted and unwanted)!

so i guess, you just set the bar a bit lower, then you have more scope for raising it now and then!

i've posted an urgent request for info about Celluvisc - new post - please, anyone who knows, could they answer my question about PF or not Pf, in the Carmellose Sodium form (0.5%) single use vials. it doesn't say whether there are preservatives or not - anywhere! guess they reckon, once your doctor has prescribed it, you, as the meekly obedient patient, shouldn't enquire further. well - that's something else that, as an older woman, i'm learning: ask questions, be annoyingly well informed, and don't let yourself be brushed off with anything less than a proper answer!

... and Mary, i do love your description of your rehearsals for your community play.

[SallyP]

I would also agree. I was using Celluvisc, and I realised taking it 4 x a day wasn't doing anything, andwhen I get worse in the evenings it was giving immediate relief, but within 10-15 mins, my eyes got even worse. I just use Systane (the best drops so far) when I get up, 2pm, then again at 6pm.

[thistledown]

... I just use Systane (the best drops so far) when I get up, 2pm, then again at 6pm.

Sally - could you tell me more about Systane, please? is it PF? in single-use vials? and where do you get it?

[irish eyes]

My optician stocks Systane and it can be obtained from some of the small pharmacies. I don't think Boots stock it.

You can buy it in single dose vials.


http://www.systane.co.uk/

[SallyP]

Hi, yes sure - I get it on perscription, but I know Tescos do it It is PF, and is in single dose units, and I've found it to be the best one so far. Do try it and see how you get on. Trouble is, it's such a personal thing, what works for one, doesn't for somebody else.

Good luck!

[irish eyes]

Sorry Sally - I answered a question that was addressed to you. You are right to point out that what works for one may not work for another person.

The strange thing I found with Systane is that I am better able to tolerate it now than I was a few years ago - but even so, I need a break from it every so often.

Thistledown, if I had a few spare vials I would send them to you but I'm back to using Vismed for a while - that is one of my back ups. Which reminds me that I must get some more Systane. The Systane website can direct you to stockists by postcode but it's worth giving your local opticians a ring to see if they have some.

[thistledown]

Sorry Sally - I answered a question that was addressed to you. You are right to point out that what works for one may not work for another person.

The strange thing I found with Systane is that I am better able to tolerate it now than I was a few years ago - but even so, I need a break from it every so often.

Thistledown, if I had a few spare vials I would send them to you but I'm back to using Vismed for a while - that is one of my back ups. Which reminds me that I must get some more Systane. The Systane website can direct you to stockists by postcode but it's worth giving your local opticians a ring to see if they have some.

thank you so much - both of you. Systane seems to be an entirely different composition to others - it isn't sodium carmellose, nor is it hyaluronate. i might get some to try, because the Celluvisc, soothing as it seems to be temporarily, doesn't seem to last very long. (and i was surprised - expecting a thicker formula to Refresh Plus, it actually seems very much the same).

they sell Systane here http://www.dry-eyes.co.uk/acatalog/Systane.html which might be easier for me than tracking it down OTC - especially as a local optician i rang, whose name was given by Systane as one of their UK stockists, said they didn't do it!

ohhhh..... why is it all so difficult??? i hate putting stuff in my eyes anyway - and i'm sure the natural balance is being disturbed by these drops. but what else can one do?