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  • I don't get it. Thinking of doing lipiflow,but the consensus here seems to be don't bother unless you have mild mgd. How do you tell if you have mild,moderate or severe?

    Comment


    • Nightbird
      Nightbird commented
      Editing a comment
      Originally posted by DocwithDryEye View Post
      Good Afternoon all,

      I recognize many of the screen names in this post, but for those who are not aware, I recently posted two extremely long posts in the MD Advanced Treatment section on the main page of this forum. Hopefully that can answer a few questions.

      Thanks for sharing your experiences

      DocwithDryEye
      Hi DocwithDryEye,

      First of all thanks for all your time and help, it's nice to have a pro on the site that is willing to answer questions. This is a off-topic, but I am wondering if you've seen this study about Diquafosol from Japan:

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664386/

      As far as I can tell from researching, this drug was not approved in the USA, not because of adverse affects but because the pharmaceutical company didn't achieve the results they were aiming for in clinical trials, but they were testing it's use for AD. The Japanese tested for MGD, and it's the first time I've seen anyone report that they were able to reverse gland atrophy. Just curious if you have any comment, or know of any renewed interest in this drug in the US. Thanks.

    • DocwithDryEye
      DocwithDryEye commented
      Editing a comment
      Originally posted by Nightbird View Post
      Hi DocwithDryEye,

      First of all thanks for all your time and help, it's nice to have a pro on the site that is willing to answer questions. This is a off-topic, but I am wondering if you've seen this study about Diquafosol from Japan:

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664386/

      As far as I can tell from researching, this drug was not approved in the USA, not because of adverse affects but because the pharmaceutical company didn't achieve the results they were aiming for in clinical trials, but they were testing it's use for AD. The Japanese tested for MGD, and it's the first time I've seen anyone report that they were able to reverse gland atrophy. Just curious if you have any comment, or know of any renewed interest in this drug in the US. Thanks.
      Thanks for posting Nightbird

      I have heard the name Diquafosol on a few posts on this site, but I don't know much about it. It would be great to see if doctors and patients outside the US start to use it, and to see what they think. If the drug does indeed reverse gland atrophy, this could be something big! Let's continue to watch and see what happens. New meds/technology always comes out OUTSIDE of the US, and then it can take months to years before making its was to us.

      Thanks again for sharing!

      DWDE

    • Nightbird
      Nightbird commented
      Editing a comment
      Originally posted by DocwithDryEye View Post
      Thanks for posting Nightbird

      I have heard the name Diquafosol on a few posts on this site, but I don't know much about it. It would be great to see if doctors and patients outside the US start to use it, and to see what they think. If the drug does indeed reverse gland atrophy, this could be something big! Let's continue to watch and see what happens. New meds/technology always comes out OUTSIDE of the US, and then it can take months to years before making its was to us.

      Thanks again for sharing!

      DWDE
      Thanks for responding. Yes, it could be something really big! The really interesting thing is that the Japanese think it’s so safe, they don’t even require a prescription for it. And there are online pharmacies there that will ship it anywhere. I agree with your cautious approach however. One study isn’t definitive. Let’s hope there is more good news from abroad, and that it takes months instead of years.

  • If after lipiflow your MGD's are hopefully unblocked, why would would it take 2-4 weeks to see improvement? I don't get that.I would expect to feel a difference immediately. Does anyone have an answer?...thanks

    Comment


    • Spoon
      Spoon commented
      Editing a comment
      Hi Max,

      Meibomian glands produce lipids through a holocrine system, which means that the secretions are produced in cells which eventually disintegrate to release the secretions. Therefore if you successfully evacuate all contents from the meibomian glands it takes some time to produce these lipid producing cells called meibocytes, and enough of them to fully mature and disintegrate to actually push the secretions up to the lid margin. From the international MGD workshop:

      ''The constant production of new meibocytes in the secretory
      acini and their disintegration into the final secretory product
      generates a continuous secretory force that drives the
      meibomian oils within the ductal system of the gland toward
      the orifice at the free lid margin''

      There are other things going on but this somewhat explains the time lag. I have read a study conducted by Dr Donald Korb which measured the time between expression of the meibomian glands and resumption of secretion to the baseline rate in normal subjects.

      The problem is that getting the blockages out of the glands may not be enough - you still need to produce normal lipids once the bad stuff is out.

    • cathy8889
      cathy8889 commented
      Editing a comment
      I'd really like to have lipiflow but im not sure if my mgd is bad enough for me to be a candidate, my tear break up time is 3 seconds. It would be really great if everyone who has had lipiflow could post their experience as to have the procedure done costs quite a lot. Is there any way it can do more damage than good does anyone know? Those glands look so delicate!!

      Thanks

    • Max52
      Max52 commented
      Editing a comment
      Thanks Spoon. Would you know if there was anything one could to produce healthy lipids or help keep them healthy?

  • This post is the second part of two parts describing how our Dry Eye Clinic uses the LipiFlow system to manage evaporative dry eye. Thanks again for taking the time to read


    Post LipiFlow Treatment

    1. Steroid use. We use Lotemax gel three times daily for two weeks. This mild steroid has long been used to lower ocular inflammation. It is quite mild, and rarely causes any increased intraocular pressure.

    2. Fish oil - There has been recent research indicating that fish oil, specifically omega 3's, and the increased risk of prostate cancer. If the patient has prostate issues, we may not recommend Omega 3 treatment, but for everyone else, it's a no brainer. From lowering stress hormones, to improving good cholesterol to lowering bad cholesterol, Omega 3 is a great supplement to be on. I always say that since MGD is a oil issue, it makes sense to supplement with a healthy oil to promote a more regular meibum production in the body.

    It is important to note that not all fish oils are created equal. First, you want a product that is Omega 3 and DHA, EPA only. You do NOT want Omega 6 or 9, which have been shown to INCREASE inflammation.

    Also, there are two main ways fish oil is processed. There is the ethyl ester form, and the natural triglyceride form. The ethyl ester form is a more processed, less bio-available form that the body has a harder time absorbing, and actually degrades in the system to some nasty chemicals. Unfortunately, this is the form that most fish oils from Target, Walmart, Kroger, Costco, etc chain stores use. It's cheaper for them this way, and that's why you can buy 600 capsules for 10 dollars. You want to see the word "Triglyceride" on your bottle of fish oil. Many health food stores have this product. Two good examples are FortifEye and Nordic Naturals.

    A simple way to test your fish oil is to use a stick pin to pop a hole in the capsule, and squeeze it in a Styrofoam cup. Leave it in the cup for ten minutes, and then take a look at the cup. If after ten minutes the cup has started to dissolve or be eaten away by the oil, you know you have a ethyl ester fish oil, or a lower quality fish oil. If it eats through Styrofoam, imaging what it's doing to your insides!

    We recommend two capsules daily, with food, one in the morning and one in the evening. The goal is close to 3000mg of omega 3.

    3. Warm compress - Once again, before the LipiFlow system, this was what we recommended most. The idea is to liquefy the oil in the glands to promote better oil release. However, this method has limited clinical effectively on its own. The glands themselves are deep within the lid in a structure called the tarsal plate, a thick collagen like tissue that protects the glands. In front of this tarsal plate are blood vessels that whisk away heat to protect the eye. Think of when you sweat. Your body recognizes that the body is hot, and to help regulate itself, it releases sweat to cool you down. Simple homeostasis. The eyelid is no different. Heat is recognized by the eye, and the blood vessels pump heat away from the lid. The method of warm compress is nowhere near the amount and placement of direct heat that is needed to tag thick clogged glands, and liquefy the oil. However, we have found that AFTER the LipiFlow procedure, when heat is directed to the BACK of the eyelid (right where the glands are), and that the glands have been purged of thick pasty oil, the use of the warm compress is much more beneficial at MAINTAINING a liquefied meibum. I continue to use the warm compress each morning, and my eyes feel GREAT after using it. We use the Bruder Mask, which contains little beads that heat up in the microwave and remain warm for 2-5 minutes, rather then a washcloth that stays warm for 10 seconds. The Bruder Mask is machine washable (cold water), and has worked very well for us. I know other people on the forum have used other masks, all of which I have heard good things.

    4. Blinking exercises - When I first heard about blink exercises, I dismissed it. I thought it sounded ridiculous. The steroid, fish oil, and warm compress made sense, but I didn't think I wanted to discuss blinking with my patients. I didn't think it was going to be something the patient wanted to hear. "You need to blink more often". Of course, this is the quick answer, and leaves the patient wanting more. At least I wanted to hear more then just "blink more".

    However, as time went on, and I started doing blinking exercises myself, and heard back from other patients following a good blinking regiment, I have come to believe that this is the most important part of having a good success with the LipiFlow system, ESPECIALLY IF YOU ARE A PARTIAL BLINKER.

    A quick repeat from an earlier post about evaporative dry eye:

    Our eyes feel dry because of decreased tears on our eyes, and the inflammation that results. There are decreased tears because these tears have evaporated. Tears have evaporated because there is a decreased lipid/oil component to the tears. There is a decreased oil component because the meibomian gland is not excreting oil. These glands are not working because the oil has solidified and become stuck under a fibrotic/collagen like tissue that grows over the orifice of these clogged glands. And what we are finding is the cause of this growth, rather then clean open glands in lid hygiene issues, are impartial blinks.

    Full blinks cause a release of this oil. If you have the LipiFlow performed, but do not make a conscious change to improve your blinking habits, you may feel a little better from the procedure for a short while, but will then be right back where you started. I'm wondering if this is where many people have failed. Patients have the procedure, and make no changes. I think it boils down to we want immediate results, without doing anything different. It would be amazing if dry eye was simply cured by taking a tablet three times a day for a week, and living life the same way we had been. THIS IS NOT THE CASE WITH EVAPORATIVE DRY EYE.

    What is a "blink exercise?" It's simply taking the time to stop and consciously think about your blinking. It takes 1.5 seconds to do it. Here is what I tell the patient:

    "Take a second to stop whatever you are doing and think 'I'm going to close my eyes, and close them completely. I'm going to think about my eyelids shutting all the way and making contact. Stay this way for half a second, and then simply squeeze down for another half of a second, and open. That's one repetition. It's like lifting weights. Multiple reps."

    "Now you need to find something that you do multiple times throughout the day, and link blinking exercises to these activities. Everytime you take a sip of water, or send an email, or walk from one room to the next, or turn the page of a book, and so on and so forth, you do a blinking exercise".

    I've found that after doing them myself, my eye feels more moist, and I can often feel the tears on my eyes.

    I had one patient back recently who said "Things have been going GREAT since the procedure!" While I've noted that almost all of my patients have returned 3 months post procedure doing better, this woman seemed very excited. So of course, I said "I'm glad that you are are doing better, and that you are so excited! Tell me, what have you been doing that you're so excited about the outcome?!?"

    The patient reminded me that she works for Fed Ex. She drives a truck all day around town delivering mail and packages. We had talked about blinking exercises, as she was a partial blinker, and she had started doing three blinking exercises every time she came to red light while driving around town. Naturally, shes at a stop light many times throughout the day, and always does the blinking exercises.

    NOTE: SHE HAS LINKED THE BLINKING EXERCISES TO SOMETHING SHE DOES MULTIPLE TIMES THROUGHOUT THE DAY. It made me realize even more how important this behavioral modification is to our schedules. If we don't think about improving our blinks, we are not going to be feel better. Our glands our going to clog again, and we are going to be right back where we started.

    So, steroid use for two weeks, fish oil, warm compress, and blinking exercises are what I call the Big Four.

    One last thing that we recently began recommending:

    5. Manual lid debridement. Use one hand to pull the lid down and press in slightly so the lid margin becomes easily accessible. Looking in a mirror, take a Q-Tip, wet it slightly, and run it up and down along the lower lid, along the lid margin that makes contact with the eye. Do not use a cheap generic brand of Q-Tip. I know of some patients who have seen the professional grade cotton swabs we use in the office and purchase these online, as the cotton is of higher quality and doesn't dissolve on contact like some cheap brands. We have patients doing this once a week.

    We now recommend these 5 things to all patients post operative LipiFlow. We have patients return in 3 months for a first follow up, and then again another 3 months for a second follow up.

    A few extra things:

    Some patients with ocular rosecia or other inflammed lid margin issues may already be on Doxy, or need to start a Doxy regiment, Azasite regiment, or something similar to address the inflammed glands.

    As noted in an earlier post. It is thought that close to 30% of patients with evaporative dry eye also have an aqueous component. We often look at the patient 6 months post op LipiFlow to see if Restasis may be beneficial. Some patients are very happy, and we don't pursue Restasis at that point. Others who may not have tried Restasis in the past may be a better candidate now that the evaporative component has been addressed. The old battery of tested used for checking for aqueous deficiency are so variable that it's best to treat the MGD component if there is one, as it is so much easier to see and diagnose. I'll put in here that if the patient has the dry eye workup, and everything looks good from a evaporative dry eye component (no partial blinks, good gland structure, healthy oil secretion), we will most likely start with Restasis if the patient has not tried this option before doing the LipiFlow.

    Noctural Lagophthalmus - I found about a year ago that I have this issue myself. My wife noticed on the few occasions that I fell asleep before her that my eyelids stay open a little when I'm asleep. I can be completely asleep, and she can see the whites of my eyes, and even the very bottom of my blue iris while asleep. This is obviously an issue, as all night long air is blowing across my eye if we have the overhead fan on, or the heater on, or the window open. I always recommend that if the patient lives with someone, and they don't mind being watched in their sleep, that they have someone check if this is going on. Chances are very high if you wake up with dry cracked eyes.

    Alright, after reading all that, take the time to do some blinking exercises. Your eyes are probably pretty dry from looking at the screen so long! Take a break. I know I need one!!

    TAKE HOME MESSAGE:

    1. DRY EYE IS A CHRONIC ISSUE. Most people are on this forum because they are miserable, and they have been for a long time. We want an easy out. We want to take something for a week, and then be done with dry eye. IF THE BEHAVIOR MODIFICATION (linked blinking to daily tasks) DOES NOT OCCUR IN EVAPORATIVE DRY EYE, NO SIGNIFICANT CHANGE IS EXPECTED. I preach this to patients all day long, and I forget to do blinking exercises myself occasionally. In writing this tomb of a post, I've worked intently for over an hour, and hardly blinked. But as soon as I look away from the computer, I do my exercises. ALSO: It's important to note that if you only do your blinking exercises when your eyes are dry, you are always playing "catch-up". The evaporation has already occurred, and you're not making a change. The best thing to be doing is blinking exercises when your eyes are NOT dry (which for some of us is never, I realize).

    Thanks for your time.

    DocwithDryEye

    Comment


    • Almondiyz
      Almondiyz commented
      Editing a comment
      Originally posted by DocwithDryEye View Post
      Almondiz,

      Once again, I firmly believe that some doctors are not taking the time to educate the patient on expectations and treatment plans. I have seen a handful of patients who have already had the procedure once, that informed me MOST of what I said, they were hearing for the first time. When I had the treatment done myself for the first time, the ophthalmologist simply thanked me for having the procedure, and there was ZERO discussion of expectations and post op treatment. How many patients have had a negative experience with LipiFlow, because they were not good candidates in the first place?

      Please private message me the name of your opthalmologist and I may be able to look into it.

      Thanks

      DWDE
      I asked you to private message me with your contact information. I will be happy to relay your practice information. Also, he and his colleagues have already read your posts. Therefore, simply provide me in private message your practice contact information and I will make sure he and his colleagues are able to contact your practice.

    • lizlou29
      lizlou29 commented
      Editing a comment
      Originally posted by littlemermaid View Post
      The Review of Optometry always makes interesting reading for doctor-shopping http://www.revoptom.com/content/d/pr...i/2856/c/48319. Some Optometrists sound very disorganised, dishonest and exploitative. And some sound professional. I wonder why they don't explain things clearly to patients and maybe do a leaflet about expectations and what medical records to bring to include in the appointment confirmation letter.
      Not to try and move away from the subject too much but I note this article doesn't have a "what to do when the patient knows more than you and you are out of your depth" section. Most of us have probably been there!

    • carocross
      carocross commented
      Editing a comment
      Very informative!! This explains why some love Lipiflow and some get nothing from it. I recently had this done by ophthalmologist in Durham, NC. Nothing really explained. Very expensive. The doc is medical advisor to company that provides Lipiflow. Wish I could print both threads. Thank you so much for taking the time to write all this.

  • I had lipiflow 5 weeks ago but no results. My doctor said it may take up to several months for someone like me to see improvement and will not prescribe me any other treatments until i give lipiflow more time. Does anyone have experience with this or had sucess with other treatments such as doxy?

    Comment


    • Max52
      Max52 commented
      Editing a comment
      Did lipiflow once 4 months ago. Doctor said things looked better, but I feel the same. With doxy it's been hard to tell. I don't think it's made me feel any better, but I might be worse without it.

    • Max52
      Max52 commented
      Editing a comment
      Originally posted by Katewest View Post
      I had no success with either. I did lipiflow 3 times and nothing. The doxy I did for about 5 months and it didn't help at all.
      Did you have lipiview all three times as well? Did those results show any improvement?

    • Murphy321
      Murphy321 commented
      Editing a comment
      This is very discouraging

  • This was almost a success story... After several years of dry eye syndrome with no relief from any treatment (and I tried them all!) I learned about Lipiflow in this forum. I found a doctor in my area who had the equipment and after ascertaining that I was, indeed, a candidate, I had the lipiflow treatment. The results were almost instantaneous and miraculous. Within a week, the redness, which had been a constant for years, was almost entirely gone and so was the constant irritation. With daily compresses using a Bruder mask, Alrex drops once a day, and Retaine MGD as needed, I was able to maintain my eyes in excellent condition for many months. Then, because of a spike in the pressure in my eyes, my doctor advised me to try to stop using the Alrex. Within a week, my eyes became red and irritated again. I went back on the Alrex but to no avail. I tried a combination of Bepreve and Prolensa -- also didn't work. I've been checked for uveitis and been told my inner eye is healthy. My ocular surface is also moist and shows no damage. I don't have herpes or rosacea. I've been on Tobramycin but it's made no difference, so obviously, I don't have a bacterial infection. My eyes keep getting redder and more painful but none of the doctors I've seen can seem to figure out what's wrong or what to do about it. Has anyone else had a similar experience? Does anyone have any suggestions about what it might be? Any and all advice would be greatly appreciated. Thanks!
    Last edited by Leah; 20-Dec-2014, 23:22.

    Comment


    • Jelena Ristic
      Jelena Ristic commented
      Editing a comment
      Hi Leah,

      It seems to me that the blockages of your meibomian glands are your main problem if Lipiflow worked at all and well. The problem is finding out why your glands are getting blocked up in the first place. You mentioned menopause as a trigger. Have you considered bioidentical hormone replacement therapy? Your problem may actually be lowered TESTOSTERONE. It exists both in men and women and declines in both as we age. There is also diet. Food allergies... I had them without any clue I did. They were a major cause of inflammation in my body and my eyes. The thing with Lipiflow or MGP is that it can clear glands, but it doesn't address the underlying causes of why they are being blocked in the first place. Once you find the causes and then have the treatments, you have a much greater chance of prolonged success. Have you tried taking fish oil or flax oil to help improve the quality of the oil in your meibomian glands? Have you actually seen a DRY EYE SPECIALIST who might be able to help you isolate causes and tell you exactly what type of Dry Eye you have? I'd try all these routes to see if they might help.

    • Leah
      Leah commented
      Editing a comment
      Hi Jelena,

      I'm sure you're right that I need to find the underlying cause of my blocked glands. I have considered food allergies and even went gluten-free, dairy-free, etc. for a period of time, to no real effect. I have not tried testosterone and I will bring that up at my next appointment. I have seen a number of dry eye specialists who haven't found the answer yet. In fact, my eyes got so bad during Xmas vacation in Miami (I'm from NYC) that I ended up in the ER of Bascom Palmer Eye Institute. They gave me a thorough examination, took a culture, and gave me a course of antibiotics both oral and eye ointment just in case. The culture turned out negative for all manner of things including chlamydia so of course the antibiotics had no effect. They mentioned that lymphoma was a low differential and I should have a biopsy done on my eye (without being specific about what kind of lymphoma or biopsy on which part of my eye -- but I assume conjunctiva?). However, other doctors I've consulted are all less alarmist, pointing out lymphoma of the eye is VERY rare. I have zero other symptoms and recent blood tests show nothing systemic, but I've read that lymphoma sometimes appears in the eye months or years before appearing elsewhere in the body, and that because it is so rare and masquerades as many different ailments, it often takes up to two years to diagnose. Needless to say, I'm approaching panic. I am seeing a top doctor in NYC this week, then go back to Miami for a follow up at Bascom Palmer, then come back to NY for a 3rd opinion. Hopefully, I'll get some answers. But thanks for your suggestions. I'll definitely check into the testosterone possibility. What a relief it would be if that were the problem!

    • Jelena Ristic
      Jelena Ristic commented
      Editing a comment
      You never know. If you have the insurance to cover testing for lymphoma...why not to get it off of you mind. Rare as it may be...it's scary. I know. I had a chalazion that turned really messy years ago and looked just like a cancerous one. It turned out to be nothing...but, it's hard to take it off of your mind unless you know for sure. As for food allergies...gluten and dairy are big ones, but it could be others too. I had no CLUE I was very allergic to pineapple, garlic and ginger for example. I used to use garlic and ginger in cooking a lot. It's really hard to get to the bottom of, but all you can do is keep trying which is a pain for sure.

  • Can anyone explain to me where Manual Lid Expression (by a doctor) falls in the grand scheme of things when comparing this procedure to some of the other meibomian gland treatments such as probing and Lipiflow? Would Lid Expression be a better first choice/first try when it comes to addressing blocked glands? Is it effective? I'd love to hear some of your experiences with this and whether or not it helped you. It's not as inexpensive as I thought, so I'm carefully weighing my options at this point and would much appreciate your input.

    Comment


    • Minni
      Minni commented
      Editing a comment
      Some points:

      (1) I find a flax-seed pack the most moisturizing & lasting. More than thermalon, or therabeads, or ThermiPAQ etc.
      The best form of flaxseed-pack is cotton-jersey (such as Walmart Mainstays pillowcase), with dimensions approx. 10" x 3"
      Also good to sew a cover for it out of the same cloth.
      (Strategic opening at center of cover - to insert pack in & out.)
      The Mainstays jersey was easy to sew onto, unlike other jerseys.
      Here's a sample sheet-set. Mine was Made In Pakistan http://www.walmart.com/ip/Mainstays-...t-Set/16783608

      (2) Didn't see any comments above re: Mibiflow, whereas I see mention of mibiflow elsewhere on drytalk.

      (3) Thinking that a Silicone-type of tip (similar to silicone spatula's) would be gentler than either cotton Qtip (or metal paddles).
      A quick-search yielded these, but I had in mind more a Qtip-shaped tip.
      http://dowelldentalproducts.com/othe...ips-p-809.html
      http://www.accessoreyes.co.uk/silico...tips-547-p.asp

      (4) Granted that mechanical/invasive probing may be effective BUT its important to allow oneself sufficient recuperation post-surgery by avoiding stress AND ALL U.V. AND OTHER RADIATION. That includes LCD-monitors, LED-monitors & cellphones & DECT-phones & WIFI.
      All those frequencies cause stress - i.e. dirty-electricity. You can test for dirty electricity by tuning a portable radio to white-noise on AM (not FM), and pointing the receiver to your sundry electronics.
      Even suppose LEDs don't radiate, yet they still have phosphors - which is UV.
      ...and bright LEDs can cause stress. I know from having read peoples' complaints.

      (5) I didn't understand Sandra Brown's terminology, nor the term trashed-glands.
      Last edited by Minni; 04-Feb-2015, 01:36.

    • LaDiva
      LaDiva commented
      Editing a comment
      When the oil in my glands becomes insipid, I can see it (it looks white) after doing compresses even after no expression and just blinking my eyes a few times. It comes to the surface of the eyelid rim. You can see the oil, even when it isn't in gross condition. All you need is some light and a magnifying makeup mirror. I know some people say they cannot see the oil, but I can, and when it is white, I can really see it.

    • Minni
      Minni commented
      Editing a comment
      Originally posted by LaDiva View Post
      When the oil in my glands becomes insipid, I can see it (it looks white) after doing compresses even after no expression and just blinking my eyes a few times. It comes to the surface of the eyelid rim. You can see the oil, even when it isn't in gross condition. All you need is some light and a magnifying makeup mirror. I know some people say they cannot see the oil, but I can, and when it is white, I can really see it.
      I tried once using a Qtip on my lower lid (pressing all along) - but I didn't see anything. I just went to the Ophtho yesterday, and his P.A. said my near & far vision with 1.25 glasses is 20/20, yet I could not see any oil.

      He also prescribed Tobradex (after I complained of soreness & crusting in the punctal area), but I'm scared to use it, as it has both steroids and benzalkonium chloride. I did try it today, and didn't feel as if it was doing me any good. Rather a cold burning feeling in the eye.

      Frankly, the guy didn't look like he had my best interests in mind.

      He was merely doling out a prescription, playing along with my description of soreness/crusting. If I'd told him only that my dry eyes cause me severe headaches (which is also the case) he wouldn't even have prescribed the Tobradex.

  • Oops posted in wrong forum. See the patients only forum.
    Last edited by Tankie; 13-Feb-2015, 19:15.

    Comment


    • Hi everyone,

      I haven't been around in a long time since I am no longer struggling with my dry eyes. I do still have the problem, but it is very manageable, I don't take any drops ever, and I've been working successfully as a teacher for over 2 years. I am now 28 years old. I started with my dry eyes when I was 20, and I didn't overcome them until I was 26. So how did it do it?

      1. Hot compresses never worked for me. The towel would get too hot, too cold, I'd burn myself, or I'd get the temperature just right but only for a few seconds and then it would cool off. Standing under the hot shower spray with my eyes closed never seem to get the job done either. However, what did work was buying a space heater that sprays out hot air on my face. Here is the one that I bought: http://www.canadiantire.ca/en/pdp/li...l#.VN6SQ_nF_II. For what it's worth, this will only heat a very small room, but that's not what you are buying it for. For me, I would lie down in front of it with my eyes closed for 10 minutes every morning when I would wake up. While doing so, I would also do blinking exercises and sometimes use my fingers to help excrete the oil out of my glands. This is the only treatment I do for my eyes to this day. I also use my car radiator for this, where I will turn the heat up to the max, aim the vents at my face, and melt the oil while driving. I know that might sound a little scary, but I don't take my focus off the road for even a second and it works really well. However, for the driving version of this, I do it with my eyes open. I also do the blinking exercises and sometimes use my fingers to excrete the oil out of the glands. Feel free to do this for over 10 minutes if you feel that 10 minutes isn't long enough and it is helping. By the way, this is what I meant by "free lipiflow" because all lipiflow is is a device that melts the oil for 12 minutes non stop, and then they will charge you $750 per eye. The option I present here does the same thing, it's free, and you can do it to your heart's content.

      2. Punctal plugs: to this day I still have my lower punctal plugs in. Before I discovered what I just mentioned with the space heater and melting the oil, I tried plugging all 4 ducts, but all that lead to was tear overflow and getting a rash around my eyes due to wiping away the tears all day long. It cured the problem since there were so many tears in my eyes, but the rash was very painful itself and I had to do something about it. I then tried leaving my lower plugs in, but putting flow controller plugs (punctal plugs with holes in the middle) in my upper ducts to control the amount of tears that could drain away while keeping some of them in the eye, but I still had the overflow problem with this and so I had them removed. After this, I discovered the space heater method, and since I still had my lower plugs in and they weren't bothering me, I've decided to keep them to this day.

      3. I realize that this is not a religious forum, so I'll keep this comment brief but I am a Christian and I believe that drawing near to God played a large part in me getting over the dry eyes. I'll just leave it at that, and I hope this comment doesn't offend anyone.

      All in all, I recommend anyone with dry eyes to try my space heater method and getting all 4 punctal plugs put in, and then if you have the overflow problem, get the top ones removed. One major word of caution is that I've had punctal plugs put in by 4 doctors in my time, and 2 out of the 4 doctors did a terrible job of inserting them and they fell out by the time I got home. The way to check if the plugs are actually still inserted, is to look at the inside of your eye and search for a black dot. If you see the black dot, it means there is no plug there since that's the normal drainage duct. If you see a little white plastic plug there, that is good since it means the plug is in. You can observe the black dot (or white plug) in both your lower and upper punctum if you pull your eyelid back.

      Good luck everyone, I hope this helps you all and that this will be the thing that turns your life around!

      Tankie

      Comment


      • Dog2012
        Dog2012 commented
        Editing a comment
        Hi Tankie,

        It is nice to hear about you again...:} . The link you supplied doesn't work. Also did you try Blephasteam ?

      • Tankie
        Tankie commented
        Editing a comment
        Sorry, here is the link again: http://www.canadiantire.ca/en/pdp/li...l#.VN_Zb_nF_II

        I did not try blephasteam actually.

        Tankie

      • Dog2012
        Dog2012 commented
        Editing a comment
        Thanks. I will try that one.

    • Hi,

      Which places offer IPL and Lipiflow treatments in Europe? Preferably in Central Europe or Scandinavia.

      Comment


      • Toril
        Toril commented
        Editing a comment
        Hi there!

        Tørreøyneklinikken in Oslo offers Lipiflow. Check out therir webpage on www.torreoyneklinikken.no

        Regards,

        Toril

      • PiotrSWE
        PiotrSWE commented
        Editing a comment
        I heard from a very unlikely source today that a dry eye clinic has been opened in Stockholm: An employee of Bausch & Lomb, manufacturer of dry eye drops, told me this.

        I checked their website, and they do not seem to have any advanced treatment options like IPL or Lipiflow, but even an eye doctor who knows about dry eyes is a huge leap forward in Sweden. When I have said before that I have dry eyes, eye doctors look confused and look at me as if I am crazy. Soon, they remember e that some company sent them some sample for something called "dry eyes" and they give me a bottle and send me away.

        For anyone in Stockholm, here is the link: www.kallmarkskliniken.se/

    • I'm a 50 year old women with dry, red eyes. My eye lids and the whites of my eyes are red. My eyes are much worse at night.

      I've been to 3 doctors in the past 3 years and have been diagnosed with MGD disease. I've had a variety of treatments including restasis, hot compresses, punctual plugs, lid scrubs, lid foams, steroids, doxycycline, retaine MGD drops, prescription eye drops for allergies, and every other type of preservative free eye drop and gel on the market. I currently use Sustain Ultra as it is less irritating. I don't sleep with a ceiling fan and I drink lots of water. I also take a high quality omega 3 supplement, specifically designed for eye health. Plus, I take a multivitamin and mineral supplement for people 50+.

      I got the punctual plugs one year ago and started the warm compresses (along with a variety of preservative free drops) and my eyes kept getting worse and bloodshot, especially in the morning. I eventually stopped the warm compresses. The plugs are still in.

      My face has visible broken capillaries and after reading posts on this website I decided to visit Dr. Toyos. He said that I have ocular rosacea. I have fair skin, so he is optimistic that IPL treatment will improve my dry, red eyes. I have had IPL treatment on my cheeks and nose to get of the red veins for cosmetic reasons about 5 years ago. Of course, the dermatologist avoided getting anywhere near the eyes.

      I've recently read several articles that a paleo diet helps with dry eyes. Has anyone had any success with this?

      I've also read that "bullet proof coffee" helps with dry eyes, any success stories?

      I'm scheduled to go for my first IPL treatment the first week in June. It costs $395. I will most likely need a series of 3-4 treatments then maintenance of one treatment per year.

      Dr. Toyos gave me a video to watch that was very interesting. One interesting thing is that he said for patients with MGD, punctual plugs could make the problem worse as plugs allow the tears with bacteria stay on the eye instead of draining.

      I will let everyone know how the IPL treatments go. The treatments will be 4-6 weeks apart and I don't want to rush to a conclusion too quickly. I will give you the long-term effectiveness. I pray that IPL is my fix. I'm sick and tired of looking sick and tired with these red eyes!

      Comment


      • savino
        savino commented
        Editing a comment
        Originally posted by redeyesat50 View Post
        I'd get the lipiflow every 3 months if I could. It really created a lot of oil in my eyes and no nighttime dryness. But it is TOO expensive to do it every 3 months. If it was about $100 US perhaps it would be worth it. They need to create an at-home device that was no too expensive. That would be nice.

        I want a permanent solution, but I don't see that happening.
        ...........
        Last edited by savino; 02-Sep-2016, 06:17.

      • SharonS
        SharonS commented
        Editing a comment
        Originally posted by waterbee View Post
        Hi, yes it's so complex a condition every thing effects everyone differently. My eye issues originally started as I had open glands but no oil coming out as there simply wasn't anything there (this accursed the knock on effect of tear deficiency too) since starting fish oil I finally have oil (just found out last week at my 4 month follow up) so I think the fish oil has started the process of improvement, yet my tbut is still the same and in that time I have developed bleph from mild to moderate which is actually stopping the oil I now have, doing its job! It's so much about detective work and trying new things to try and manage this condition. Omega eye is quite pricy to take if your not sure of its benefits, but I have been told by one ophthalmologist that in can be 9-12 months for some times the benefits to shine through of any type of fish oil so I would keep at it, even if you change to a cheaper brand. Xx
        Yeah I have heard that too - I will definitely keep taking them as I imagine they won't be doing any harm either way, and I am too scared to stop. I wish I had been offered medication back then rather than just omega 3, I was in so much pain (still am) and was being told omega 3's will cure me! ahhhhhhhh to go back in time...I have had Lipiflow done as well but it didn't help me at all, not sure why, think I just have chronic inflammation that isn't being controlled xx

      • redeyesat50
        redeyesat50 commented
        Editing a comment
        Originally posted by savino View Post
        What is the root cause of your dry eye? Is your oil solidified?
        Yes, my oil gets solidified. The IPL treatments have helped tremendously. But, I still have dry eyes in the middle of the night.

    • Hi all,

      So glad that I found this forum.

      Back in June, I began having problems wearing my contacts -I'm in my 40's and have worn contacts since I was 14 - and my lids looked a little swollen. The doctor said "dry eyes!" and I began a short course of steroids along with Restasis. Things seemed to settle down in July and I was able to wear my contacts for short periods of time. In August, I began having severe headaches and ocular migraine symptoms. My formerly normal ocular pressure began to swing up and down. In September, the dryness hit me really hard. I could barely see to drive and working on the computer was virtually impossible. I started looking around for a specialist and found an ophthalmologist who offers Lipiflow. I had that procedure on October 16.

      The doctor said I would feel a bit worse for two weeks, then would start improving. She said improvement typically plateaus at 3 months, then you have 18-24 months before the procedure is needed again. At the moment, 1.5 weeks in, I feel some better, but I think that's also due to a decrease in whatever environmental allergy I was reacting to in Aug-Sept. The blinking exercises have also helped as well. I try to do them 5-6 times an hour - makes wearing mascara impossible, but worth it.

      I'll keep those interested posted on my Lipiflow progress.

      Comment


      • Bibliogirl
        Bibliogirl commented
        Editing a comment
        Mooner, so sorry for the delayed response. I often browse the posts without logging in, so did not see your post right away.

        Well, as my luck would have it, not long after my post (about a month actually) my eye woes really flared up again. Fall seems to be problematic for me.

        Long story short, I tried IPL sessions - not much help-- then had Lipiflow again in November. Once again, I could feel a really dramatic difference. The persistent blepharitis I was dealing with in my left eye cleared up, I have less burning etc.

        I've stopped the spironolactone drops for now. I really took a shotgun approach to treatment and was trying so many things that I wasn't sure what was helping.

        At this point, I know the following have definitely helped (in no particular order):

        1) Lipiflow
        2) Daily heat masks and massage
        3)Daily blinking exercises
        4) Quadra plugs (recently lost an upper plug and could tell a big difference)

        I just got a prescription for Xiidra and will try it after the holidays. I'm also looking into Regenereyes.

        Overall, I'm definitely better than I was when this began in June 2015, but still searching for greater relief.


      • Hokucat
        Hokucat commented
        Editing a comment
        HI. Have you ever looked into PROSE scleral lenses? It's a nickel size dome-shaped contact that keep a layer of saline over your eye. These are being used more and more for dry eye sufferers with great success. I wear mines 12 hours a day, they work well for me.

        Like you, I also had issues with the oil from my meibomian glands...it was confirmed mines was very thick. Its much better now because for whatever reason, adding fresh squeezed lemon to my daily green tea significantly reduced my dry eyes by making my oil less viscous - I posted a few days ago under Dry Eye Triumphs forum. If there is very little oil coming out of your glands because it is thick and clogging up your glands (versus your glands not generating much oil), perhaps this will work for you too. If you have a doctor express and/or probe your meibomian glands, he/she should be able to tell you the consistency and clear out any blockage there is, so that any subsequent diet changes or treatment related to your glands have the best chance to work.

      • Hokucat
        Hokucat commented
        Editing a comment
        BTW, Lipiflow did not work for me at all, likely because my meibomian glands had gotten so blocked and caked over time with thick meibum/oil. However, the expressing and probing procedures were able to remove some of the blockage temporarily. Maybe Lipiflow will work even better for you if you express and/or probe first.

    • After receiving the email that said Tear Science was going to reduce its pricing on Lipiflow by 50%, I called my closest provider which was UCLA. They said the current price of $750 per eye was going down to $600. Not exactly 50%. Has anyone found similar pricing?

      Comment


      • Just wondering, my first try with lipiflow showed no significant results to help my MGD. Has anyone done lipiflow more than once? What should my next option be? I am already on restasis, using a humidifier and taking fish oil supplements.

        Comment


        • waterbee
          waterbee commented
          Editing a comment
          No IPL yet, the journey to london (6 times and back) is making me delay it and I suppose I quite like having it there in the background as some thing new to try when I'm having a "ugh what's next?!" Crisis moment. 😨😨😨😃

        • Betsy
          Betsy commented
          Editing a comment
          Hi waterbee, I understand. Funny I didn't get notification of your response. You mentioned doing lipiflow in one eye due to costs reasons. I feel like if doctors were confident it worked in enough people, they would be willing to charge 20% for the first eye and when you figure out if it worked weeks or months later, 80% for the 2nd eye. No one will go around with one working eye if they had relief, they'd want, no, they'd NEED it in both. Everybody wins, they get compensated what they originally set as their profit, and patients don't feel jipped so much money for that 12 minutes if it failed them. Technically, if it works so well and their skilled at determining who it might work best for, doctors shouldn't have issue with my pricing structure, right?
          Last edited by Betsy; 06-Feb-2016, 23:10.

        • Daniel2
          Daniel2 commented
          Editing a comment
          I tried Lipiflow twice. Absolutely no effects so far. I heard some people say that it helped them so I guess it depends in each person.

      • So a year ago when I wasn't doing nearly as badly as I am now, an opthamologist wrote that I have 6 working glands in the right and 7 working in the left. This as never communicated to me, I just happened to find out that's the notes he wrote. No info on the quality of those that are working nor if this is upper or lower glands. This was based on slit lamp exam I assume since I did not have a meibography nor lipiview.

        A year later I am doing very badly. I did the lipiview today and when she asked if one eye was worse, I said it was always the right before, but now it's definitely the left, though both are super bad. She said that I have 17 working glands on the left and 6 on the right! This was crazy because both eyes are equally bad with the left being worse sometimes. Those working do produce a thicker than ideal oil. She said my lipid is 50 in the right and 100 in the left. My tbut was 3 and 4 seconds. She felt I would only benefit from lipiview in the right eye and said the left does not have MGD. She said if we did LF in the left it may not be a noticeable difference. What confuses me is how can I not have mgd in the left if my tbut is so low? She thought it was more of an aqueous deficient eye an the right mgd. She showed me where my glands were atrophied and I naturally felt really depressed about them. But she said "it's not that super bad yet."

        So I agreed to do the right eye against all reason and logic in my head based on what all of you have said. So if it fails, I have no one to blame but myself. I don't earn much so it will be an expensive lesson that was preventable. But like many, I feel desperate. I asked her to do manual expression afterwards and she said the lipiflow already gets all the oil out. I insisted and she put very light pressure and said nothing was expressing but that she expected that post lipiflow for that eye. I wonder what she saw for the other eye that didn't undergo lipiflow. I asked if it was upper or lower glands she counted and she said lower only but that they are usually the same as the upper and so I guess she multiplied by 2? So if she saw 3 working on the right on the bottom then assumes 3 more work on the top? Is that normally how it's done?

        Part of me feels like how can I get better when mine is systemic, I am dry everywhere and lately my nose, throat, mouth have been unbearably dry and painful. Even if I ever got comfortable again, the nasty Sjogren's may keep destroying. I am negative on the tests but so are many with all the symptoms till late in the disease process. Lately the dry mouth, lips, throat, nose have been unbearable.

        Any insight appreciated very much, thank you!

        P.S. I screen printed my results and photos but I got this error when trying to post: Error while saving content: SyntaxError: JSON.parse: unexpected character at line 1 column 1 of the JSON data
        Last edited by Betsy; 25-Feb-2016, 18:30. Reason: Trying to add tags and photos but failing.

        Comment


        • Betsy
          Betsy commented
          Editing a comment
          I don;t know, a patient said that it can somehow push the clogging even farther down. Not sure how. The optometrist said that it's normal to be worse the first week or two but I don't know why ? And yes, my right eye does feel worse. I don't know if irrigation is what I need. My pain started way before I had begun the night time ointments and I hadn't had plugs for a long time at that point. I am not sure what is best to try next.

        • Daniel2
          Daniel2 commented
          Editing a comment
          Betsy I just got the Lipiflow yesterday. Exactly in my right eye too, which is the eye that I feel absolutely horrible in. I too feel worse right now. It's probably the inflamation, perhaps the glands are still a little swollen and that might affect the pathways of the glands? I don't know for sure.

          Had you tried getting moisture glasses? I think those helped me, I have the Dustbusters 2, the ones thing that work a little bit too is washing my face with cold water. I have a bottle cold water always and if the pain gets too unberable, I just put the water in my face, feels refreshing to me and helps me deal with the pain.

        • Betsy
          Betsy commented
          Editing a comment
          Thank you Daniel2. I am sorry you are feeling worse too. I was told after 2 weeks the right eye should get back to normal if not better. But so far that hasn't happened. The LF seems so not invasive and with my eyes constantly changing i don't know what's what anymore. But it's weird because my right was always the worst, then over the years both eyes became manageable, then December 10, 2015 they both got so bad, but the left was even worse. Now it's the right more so, though they fluctuate. At least i know no benefit yet to the LF, not to say it won't work for some others, just not me yet. You may get benefit, who knows? I hope you do!

          I have not tried goggles because my glasses rx is so high that i worry they will be too heavy, my current glasses are half frames and small, from the kids dept as my face is narrow. Also, I suffer from dizziness so I have a hard time getting use to new glasses. I fear paying so much, getting these heavy ones and I can't even get use to them. Ugh, messy. But also, I did this goggle test and the humid environment didn't seem to help my eyes much, nor the humidifier I have. I don't know what to make of all that.

          I splash my face with water too. It's funny (more sad really) because before I got worse overnight, I was wearing eye makeup. Now with splashing water on my face throughout the day, that is no longer an option at all.


      • Hello All

        I have had sever MGD for about over a year now and tried all the usual stuff and meds with about 7 different doctors. I had lipiflow about 6 weeks ago, for 2 weeks after it was great. Glands open producing oil. then after that it went back to normal, blocked glands and toothpaste like secretion. Then after those two weeks it got REALLY BAD, worse than before the lipiflow even. My eyes were so dry (like a hairdryer being blown in them 24/7) and no amount of drops could relieve them - even for a few seconds. I now have constant eye fatigue and foreign body sensation from the time i got up to the time i go to bed, seems like my glands have stopped producing any oil at all - when i do the microwave bag it doesnt feel oily afterwards slike it used to, it still feels dry as a bone!. I am really confused how this has happened? I thought that the lipiflow may not work - but didn't expect to be worse off after. I have an appointment to see the dr who did it in a couple of weeks (he was too booked up to get a follow up quickly).

        Has anyone else experienced anything like this before?

        Comment


        • skeeterlondon
          skeeterlondon commented
          Editing a comment
          Hi all

          Saw the doc at 2 month follow up he didn't say anything other than, it doesn't work for some and can take up to 8 months for others. It seems that it only works in mild cases and not for people whose case is already very chronic. Its also so expensive. I paid almost £2000! for nothing but at the same time could not live knowing there was something out there that could potentially help me that i had not tried.

          its now 4 months post and nothing has improved. i would say that before lipiflow i had a heavy top eyelid all the time, this disappeared after the treatment. But i also got a lot of inflammation on the lids after the treatment so perhaps that set the whole thing off again! I don't think lipiflow treats the route cause because no one knows what that is.

        • Klee
          Klee commented
          Editing a comment
          I myself still think the root caus is bacterial, have you tryed doxcyciline?

        • radnad
          radnad commented
          Editing a comment
          I nearly went for the Lipiflow as well and was about to shell out a lot of money, sorry to hear about your story. I am lucky to have cured my problem a few years without surgery.
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