I need a description of in-office MG expression.

[Ariel]

I'd like to hear from any one who's had his glands expressed by a doctor. I'd like to know what this procedure involves, how much time it takes, and what the doctor actually does so that I know what to expect.

All the information I have is based on what I read here:

http://www.guldenophthalmics.com/ima...Expressor3.pdf

[Rebecca Petris]

In my personal experience it's really no big deal and does not take a long time: somebody just pressing on the gland orifices at the edges of your eyelids. Some doctors use an implement, most just their fingertips. - For someone who has really hard caps in the glands it is more painful as they may have to apply some pressure.

[Ariel]

GOOD AND BAD "HEALTHY LOOKING" OIL ---How can we tell them apart?

Rebecca--- If I understand correctly, in most cases of DES caused by Bleph, the oil that comes out during expression may be thickened "bad oil" that should be wiped out and I'm afraid that even when the oil is clear and it looks good it may be contaminated with harmful bacteria which will make it necessary for it to be removed from the lid margin.

It looks like if the oil we force out is no good all we accomplish with MG expression is unclogging the orifices, thus reducing the accumulation of bacteria but the "good quality oil" we so desperately need continues to be oil we're not getting.

Does the oil quality improve over time so that at some point it becomes "good enough" for us not to need to remove it?. If so how do we know when the clear oil that used to have bacteria has stopped having it?

[Rebecca Petris]

I dunno. Couldn't tell one bacterium from another if put to the test.

Expression has 2 uses in my book:

1) Just to figure out what's going on. That's the kind of expression I get when I go in. What are my MGs looking like. Bad oil? Good oil? ANY oil?

2) Expression on a regular basis to keep the glands clear. That's for people whose glands get so badly clogged that they can't clear them with heat and normal manual expression in a form safe for patients to do to themselves. I'm not one of them so can't describe in detail.

What part of the US are you coming to... have you already got a doc lined up or do you need a recommendation.

[Ariel]

Rebecca--- I'm not coming to the US. It just isn't possible for me at this time ---long, long story. I may be going to the UK and later in September I'm going for sure to Japan. I'd really appreciate it if you could recommend doctors for me to see anywhere outside the US.

[manitobaskyline]

Ariel,
My doctor uses her finger nails and pushes in at the lid margin and pushes oil out. It takes minutes.

I'm not sure you need to worry so much about the composition of the oil. The goal is to loosen up that oil and get it flowing. The other important thing is to keep your eyelashes and lid margin immaculately clean. I do that with baby shampoo lid scrubs.

In the beginning, my doctor used to express my glands and marvel at the "mushroom shaped oil" that came out. Not good. Once we determined that my glands were in bad shape, she put me on doxy and I began lid scrubs 4 times a day. That took care of the bleph and allowed my mushroom shaped oil to turn into thin flowing oil.

That is the goal. When you blink you eyes, that is when this thin oil is spread over your eye surface. It's purpose is to keep the tears you make from not evaporating. It was amazing how the process of getting my glands working better helped my pain. I also don't make enough tears. But with the glands working right and punctum plugs, it compensates for the reduced amount of tears keeping me generally very comfortable.

Keep working on your glands and change doctors if the one you have is not taking the time with you. Dry eyes is a tedious time consuming process for a physician with a lot of trial and error they must be willing to work with you through. Many doctors have no interest in this (not a money maker) Other more caring doctors are concerned about helping you attain comfort and will work with you until you find relief.

[odydnas]

In my experience, there are two types of expressions:

1. To check how well the glands are functioning. To do this, the doc simply pushes along the lid with his/her finger to see how much oil is coming out. THis is generally not uncomfortable.

2. To force the oil out in an attempt to clear the glands and make me feel better. I've only had two doctors do this, and it is a generally uncomfortable to painful experience. One doc even asked me I needed a break since most patients do need one halfway through. First, they put in numbing drops. Then, they put a q-tip inside the lower lid and use a 2nd qtip outside the lid, and then push the q-tips against each other as hard as possible.

[Ariel]

Thank you everybody.

Odynas--- Your description gives me a better idea of what to expect depending on the kind of doctor I get. The second type of expression you described appears the one shown on the link I posted at the beginning. Instead of Q-tips, the doctor on the photo is equipped with magnifying glasses, a mastrota paddle, and a MG expressor but he seems to be doing the same thing you mentioned.

In Spain eye doctors say that MGE is "something they did in the old days" I couldn't believe hearing it but now that my girlfriend is asking doctors in Japan she tells me that some of them are saying to her the same thing. So what's wrong with these people?

I would think when meibum is not flowing out of a patient's MGs any good eye doctor would focus on getting it out, both expressing the glands in his office and showing the patient how to do it at home as part of his every day routine.

Does the doctor remove the oil that comes out or does he leave it on the eyelid?

[Rebecca Petris]

Rebecca--- I'm not coming to the US.

Sorry - I misread a different post of yours.