Dr Korb 2016 video: recommends Blephasteam, squeeze lids etc

[gilles]

For people who found the videos of Donald Korb interesting, I invite you to watch following two videos of Dr. Art Epstein:

Art Epstein: Dry Eye: A Simple Approach to In-Depth Understanding
Arthur Epstein: Mastering Dry Eye: Step by step

Some notes I made from the content of these videos:
- Shannon Bream, who suffers from dry eye and finally got diagnosed of Recurrent Corneal Erosion. (doing some research I found examples of potential help are an operation, doxycycline and or zinc supplementation)
- Omega 3 (in tryglyceride form, but I wonder if phospholipids might not be even better)
- IPL works wonders for people with ocular rosacea
- Daily eyelid hygiene routine (with e.g. Hypochlorous Acid, HyClear)
- use of sleep mask as a way of sealing.
- For people who suffer from nocturnal lagophthalmos (and even people who suffer from abrasions on the cornea) vita-pos is recommended. As vita-pos consists of vitamin A, which might play a role in corneal ulcers. Keep in mind that there are contradictions in people saying that ointments might also block the glands; so it is recommended for night time use and proper eyelid hygiene in the morning is recommended.

[gilles]

i went out this morning and it was windy, my eyes were so sore and red.

gilles you mentioned about blinking exercises in dr korb's part 2 video around 27 mins but i cannot see this?

Here you can see him explain how to do them.

[orange86]

i went out this morning and it was windy, my eyes were so sore and red.

gilles you mentioned about blinking exercises in dr korb's part 2 video around 27 mins but i cannot see this?

[gilles]

gilles are you using Blephasteam googgles? what's your routine?

I had the chance to borrow them from a local hospital 2 years ago, but I had a feeling that did they not help that much. On the other hand, I did not really understand my problem really well and thus did not pay attention to take good care of my eyes throughout the day (much screen use, cycling, outdoor activities without MCG, etc.). I also rubbed my eyes (as in "massage"), which might have been contra-productive (oc. rosacea=red eye and nerve "damage"=grittiness).

I bought one yesterday, leading to the videos I shared in this thread, as to adapt my routine. But I am suspicious that I have to do a LipiFlow and manual expression by a doctor before my routine has any effect as my glands seem blocked; there is a red line on the bottom of my upper eyelids and the summary beneath is only a good home treatment when the glands are unblocked (keeping the situation as it is/under control).

Routine: csA drops 3 times a day.
Cold compress with TheraPearls when eyelids seem more inflamed (red).
Blephasteam in the morning and evening (no massage, just blink exercise) and clean lashline (not eyelid margin) with blephasol on cotton pad.
Wash face with ph neutral "soap" once a day (e.g. Sebamed), try to focus on cleaning the eyebrows.
Recently bought omega3 (krill oil), but this is a waste as per dr. Korb, which I did not know at the moment of buying.
Prescription glasses, as my left eye was kind of blurry (still not sure if this has anything to do with MGD), but it helps against eye strain.
Will order Ziena Kai soon but am using eyeseals at night already, as to 24/7 keep the eyes moist (and thus lowering the inflammation).
Wiley X Gravity for cycling.
Thealoz duo eyedrops when needed.
Try to limit screen usage to fixed times (mail checking etc.)
Blink exercises throughout the day

I would recommend not using a screen (e.g. computer) when using the blephasteam and some time after, as to have a regular blink in order for the meibom to secrete out of the glands. Avoid desiccating stress on the eyes (fan, draft, screen, etc.) after blephasteam - because I feel they are a bit more sensitive - and as a general rule to protect your eyes.

[orange86]

gilles are you using Blephasteam googgles? what's your routine?

[LindaDawn]

Thanks Giles. I did listen for what seemed an age!, Will try again. Apologies.

[gilles]

Hi. Just tried your link Gilles. It’s not in English!

The introduction is in Spanish, as it is a Spanish audience, but the whole conference after that is in English.

[LindaDawn]

Hi. Just tried your link Gilles. It’s not in English!

[gilles]

Even if this was posted over 2 years ago, it is still very valuable information.
I learned that wet heat is one of the most effective treatments to do as home treatment against MGD (so I will use my mask with the pearls as cold compress; to help with ocular rosacea/inflammation rather than for heat) and try the Blephasteam again, as it seems it is quite difficult to do the bundle method right (check if the temperature is not too high/low and keeping the temperature steady).
Why wét heat treatment, because water is a good conductor and thus will more efficiently conduct or transfer the heat.
The order of effectiveness for heat treatment seems to be: LipiFlow, Blephasteam, Bruder mask, MiBoFlo (Christen J. Kenrick, Sabiha S. Alloo, 2017).
Eyelid massages should never be done on the cornea (only with tools where a backplate supports the force), so no massages anymore for me (which is a good thing, as it seemed to increase my corneal inflammation) and maybe squeezing of the eyelids against eachother later on. For people who are already doing this, it is suggested to let a practioner do manual expression. This is called 'debridement-scaling' with a golf club spud¹, which dr. Korb also points out in the video which I shared below. As a home treatment, he suggests to do blink exercises; and combining them with heat treatment could have remarkable results (see here how to do them).

Repetitive Lipiflow is suggested for people who have a meibomian gland malfunction (blocked glands) and find no relieve with the home treatment. But first one needs to find out the reason of the inflammation of the glands (eyes that are not sealed well when sleeping, partial blinkers, allergies, screen use as that leads to not enough blinking (lifestyle), bad eyesights, a combination of things, etc.). I put 'not enough blinking' in bold, as this seemed to be the core or essence of the problem as per dr. Korb; seeing screen usage is everyday in our lifestyle and leads to not blinking enough.

In a more recent conference of dr. Korb I learned that Restasis/cyclosporine only helps with the aqueous part, so more water in the tear film; but other than that it does not help with the MGD part. Also the confirmation about the ineffectiveness of supplements (e.g. omega3) was pointed out.
Also, the rule of how you would dry your clothes (keep your eyes moist, out of wind; e.g. with moisture chamber glasses, avoid ventilators/fans, use humidifiers).

Furthermore and as conclusion: it is important to prevent MGD, as dr. Korb mentioned, just as you brush and or floss your teeth to prevent cavities. Meibographies could and should be a standard procedure at an eye check, seeing as our lifestyle does a lot of desiccating stress to our eyes.

For the people who are interested in the conference from 2018 (topicstarter is about 2016): part1 and part2. The introduction is in Spanish but the after that it is all plain English.

^{1 Image of golf club spud:}

[Andrey_V]

However, the very very very effective is, Bundle method (about 45C (113F)[/SIZE], video https://www.youtube.com/watch?v=fpwA76xepa4
I have read/tried a lot and find Blephasem is the best - more importantly, safer.

Blephastem
my booklet from the company indicates 42.5C.

MGD1701 , so, does it matter that BLEPHASTEAM has a temperature less that recommended 45C? And what do you personally use - BLEPHASTEAM, or "bundle method", or something else?

[MGD1701]

My doctor does not recommend 20 min. as it is too long, for info.

[MGD1701]

of course, such approach will NOT be as effective as LipiFlow
This is only for maintance at home and only helpful when the obstruction is removed by LipiFlow, IPL etc..

The idea is generated from the LipiFlow theory & famous expert in USA, professor Richard Yee, who recommends (8-9/row?) forceful blinkings after compress (but afterwards the heat disappears quick to together is more effective, in my view). Dr Korb and other doctors do not recommend massage so such approach should work more effective/safer.

You may blink a bit longer - the key is you should feel good.

[mbperso]

My new discovery
*forceful blinking for the last 1-2 min. toward the end but close eyes for the first 1-12 min.
heat + blink = Lipiflow?? not really but kind of?

Thanks for the advice , I'll try it. How did you discover that ?
Lipiflow is really different because it empties completely the glands and could unclog gland inside (not only at the edge of the lid)

[MGD1701]

My new discovery
*forceful blinking for the last 1-2 min. toward the end but close eyes for the first 1-12 min.
heat + blink = Lipiflow?? not really but kind of?

*I did confirm with my doctor who said if it is ok. But wise to consult your doctors too.
I always explore different/better approach and mostly it works.

[MGD1701]

I find close eyes are more effective
but the company booklet does not suggest so & also just recommend 10 min.