My Story / Questions about Meibomian Gland Probing

[Guest]

I went to my appointment in Houston with Dr Yee on 12/28. Received MUCH more extensive testing and information than any of my prior dr's appointments in Dallas. Schirmers test was 13 and 17 which I was happy about, but he said people my age can be in the 20's. No blepharitis. He confirmed I'm a stage 3-4 with gland loss per my scans (4 is the worst). He pressed on my glands and basically nothing came out. He films this and puts on a huge TV screen so you can see the results. He gave me the ****** article on probing and gland regrowth (that I had already read). He also did a VERY extensive examination and staining to look for damage. He said I have zero damage but have a conjunctivochalasis. He said its likely my eyes don't FEEL dry but are very red is because I have no damage but he did notice I was very red at my appointment and I told him this is how I look 95% of the day and the redness is my #1 complaint. He also said the chalasis could be a cause of the redness.

Dr. Yee believes that gland regrowth is possible. I asked if he had seen it himself, and he replied that he has not taken measurements the way ****** did but he has seen improvements firsthand in his patients. I believe he has been probing for a year or so. He estimates 10-60% of people improve with probing (seemed like a strange range to me..) and 50-60% improve with the meds he prescribes.

Dr. Yee prescribed a drug called Daspone 4X day for 30 days for inflammation, and Spironoloctone 4X day to improve the gland oil. I had to get these at a compounding pharmacy and scripts were $100 total. Daspone is drug previously used to treat Leprosy? Honestly I'm a bit nervous about putting these drugs in my body but like most of you on this forum, will try just about anything. These are FDA approved drugs but not for eye use? Dr. Yee said he was taking them to the FDA for approval. You can't use these bottles longer than 30 days due to no preservatives. He also prescribed a blinking exercise and saline rinses after and Flaxseed 3X day which I had already been taking.

I'm on day 5 of the new meds, plus taking my regular Restasis 2X day - no improvement to date but Dr. Yee said it could take a couple weeks to notice a difference. He recommended probing if the medications don't work and possible surgery to remove the chalasis. I have another appt scheduled late January.

Overall it was a good experience and I highly recommend Dr. Yee if you can make a trip to Houston. He spent about an hour with me and you can almost see his brain trying to figure out what your issue is when he is examining you. After I left the appointment when I was checking out he comes out of his office again to ask if my eyes were itchy. I thought it showed he was really thinking about my redness complaint and if allergies could be the cause. I felt he truly was concerned about what would help me! The only slight negative about Dr. Yee is he come across is a bit "authoritative" with his staff but certainly still worth checking out if you are in TX.

You have a good doctor, that is very clear. The compounded drugs, specific to your disease, are the best way to treat dry eye. I’m on heparin 100iu/ml 3x a day, methylprednisolone 1% 1x a day 50% serum tears and doxy 100mg a day. I have floppy eyelid syndrome. The heparin us a very powerful anti inflammatory drug with almost no side effects. I was not apprehensive at all about these drugs. Quite the opposite, I was excited to have access to these drugs. You should be happy you have these drugs and found a good dr. All that said, see how the treatment works, if you’re not happy with this, I akways suggest seeing another top dr for a second opinion. Dr Tseng out of Miami is amazing also, if you’re down south, he would be somewhat close. Just throwing it out there in case you want another opinion before the probing/surgery.

as for the probing, I don’t believe growth is possible in most cases. But I’m not a doctor, I’m making a decision based on very little anecdotal information. However, it’s worth a shot if you’re 85% atrophied. I do agree with above posters, you would have the best bet with the prp as well as probing.

The cch needs to be fixed, so I think that surgery is necessary. Will he allow you to do the cch surgery first to see where you stand psinwise before you guys probe? I think that’s how I would want to do it.

I think youre on the right path, good luck and please keep us all posted here. It’s always good to see members get great care and heal. Helps us all!

[farmgirl]

To me, in Dr Cremers pictures the glands look WAY better and healthier after treatment but in ******s pictures the treatment 'square' is higher on the post treatment pictures which gives the illusion of the glands being longer. If I am not mistaken though Dr Cremers did PRP injections and Dr ****** just probing

[Alix]

I went to my appointment in Houston with Dr Yee on 12/28. Received MUCH more extensive testing and information than any of my prior dr's appointments in Dallas. Schirmers test was 13 and 17 which I was happy about, but he said people my age can be in the 20's. No blepharitis. He confirmed I'm a stage 3-4 with gland loss per my scans (4 is the worst). He pressed on my glands and basically nothing came out. He films this and puts on a huge TV screen so you can see the results. He gave me the ****** article on probing and gland regrowth (that I had already read). He also did a VERY extensive examination and staining to look for damage. He said I have zero damage but have a conjunctivochalasis. He said its likely my eyes don't FEEL dry but are very red is because I have no damage but he did notice I was very red at my appointment and I told him this is how I look 95% of the day and the redness is my #1 complaint. He also said the chalasis could be a cause of the redness.

Dr. Yee believes that gland regrowth is possible. I asked if he had seen it himself, and he replied that he has not taken measurements the way ****** did but he has seen improvements firsthand in his patients. I believe he has been probing for a year or so. He estimates 10-60% of people improve with probing (seemed like a strange range to me..) and 50-60% improve with the meds he prescribes.

Dr. Yee prescribed a drug called Daspone 4X day for 30 days for inflammation, and Spironoloctone 4X day to improve the gland oil. I had to get these at a compounding pharmacy and scripts were $100 total. Daspone is drug previously used to treat Leprosy? Honestly I'm a bit nervous about putting these drugs in my body but like most of you on this forum, will try just about anything. These are FDA approved drugs but not for eye use? Dr. Yee said he was taking them to the FDA for approval. You can't use these bottles longer than 30 days due to no preservatives. He also prescribed a blinking exercise and saline rinses after and Flaxseed 3X day which I had already been taking.

I'm on day 5 of the new meds, plus taking my regular Restasis 2X day - no improvement to date but Dr. Yee said it could take a couple weeks to notice a difference. He recommended probing if the medications don't work and possible surgery to remove the chalasis. I have another appt scheduled late January.

Overall it was a good experience and I highly recommend Dr. Yee if you can make a trip to Houston. He spent about an hour with me and you can almost see his brain trying to figure out what your issue is when he is examining you. After I left the appointment when I was checking out he comes out of his office again to ask if my eyes were itchy. I thought it showed he was really thinking about my redness complaint and if allergies could be the cause. I felt he truly was concerned about what would help me! The only slight negative about Dr. Yee is he come across is a bit "authoritative" with his staff but certainly still worth checking out if you are in TX.

This sounds promising. Did the doctor tell you how bad the chalasis is and did he recommend surgical correction?

[Guest]

Thanks for sharing. Glad you have finally found a doctor who is ''capable to make an accurate diagnose'' on the 1st visit.
Curious to know the followings, if you dont mind.

Conjunctivochalasis & symptoms
you wrote: ''He said its likely my eyes don't FEEL dry but are very red is because I have no damage ...
He also said the chalasis could be a cause of the redness.''
Curious if your eyes dont feel dry? What are your key symptoms? Are your lid margins also red?

Inflammation
How doctor detected this, with MMP-9? Since no blepharitis nor (cells) damage were found.
To treat this is important as not all inflammation has visible signs.

Probing
Did doctor explain WHY probing would work? Maybe still have acini?
Because Dr Korb mentioned that if one has no acini, LipiFlow works 0%.

Testings
what testings doctor did, apart from dyes, schirmer? Perhaps osmolarity, MMP-9?

saline rinses
When to apply this (after compress?) and its purpose? You dont need artifical tears?

Causes
Did doctor identify causes (rather than CCH and partial blinking?) of your MGD?

Hope you will find relief soon. Would be great if you could share with us more late January - so we can learn too. Thanks.

No- My eyes don't typically feel dry and my lid margins are not red- it's almost entirely the excess red veins that bothers me. I use OTC tears because the Dr.s (including Dr. Yee) told me to keep using them even though I don't feel like I need them. I have read articles that some people get so accustomed to the dryness they stop feeling it, and I have also read that the more drops you put in your eye, the dryer they feel because it makes your eyes stop producing their natural tears (I definitely have experienced this). I have also heard that LASIK damages your nerve endings, which is why some can't feel the dryness. I know I'm lucky not to FEEL the same symptoms as others, but the psychological impact of chronic red eye can be very difficult to deal with also. Sometimes I wonder if dryness is really the cause of my eye redness.... but I have tried allergy drops also and they didn't help.

Inflammation - I equate inflammation to my eyes being so red and the veins being so prominent. Not sure how he detected this otherwise. If he did a MMP-9? he didn't tell me

Probing - He said it would work to open up my glands and possibly help them be restored. When he pressed on my glands nothing came out.

Testings - If he did osmolarity or MMP-9- he didnt tell me - so not sure about that

Saline rinses - He didn't say anything about me continuing with compresses, but didn't say not to either.. The saline rinse is supposed to be done after the blinking exercise to wash out any bad oil. I still haven't tried this yet. He told me to continue using artificial tears even though I don't feel dry.

Causes - No, he didn't identify a cause, he said the 2 rounds of accutane I took could have been a cause and also asked me to be tested for autoimmune diseases because at my age such severe gland loss doesn't make sense

I'll be sure to keep everyone updated!

[Guest]

This sounds promising. Did the doctor tell you how bad the chalasis is and did he recommend surgical correction?

No, he didn't say how bad the chalasis was... but he did say it could improve with the medication he prescribed. He said if it didn't improve we could do a surgical correction - but he wants to see if meds improve it first.

[Hokucat]

It’s likely too early to prove probing or probing with PRP injections causes gland regrowth, but probing was a key first step in helping my MGD because I had many glands with scar tissue. I had five probe procedures over two and a half years. After each procedure, my eyes felt a little more moist for ~a week, but would always revert back to the same extreme dryness. After each procedure, I would try different diet changes, but my glands would get blocked up again...until the last procedure over three years ago after I added fresh lemon juice to my green tea, which somehow was something that my body needed. Since then I have not needed another probe and my eyes are no longer in debilitating pain.

So I think probing can definitely unblock the glands, but something from the inside to get the meibum flowing can also be key in the long run, whether that be diet, doxy, supplements, etc. or some combination. I think it’s also pretty important for the doctor doing the probing to have a lot of experience and have the right equipment (my doctor uses an operating room-grade magnifier to make the tiny meibomian glands look huge vs. a slit lamp or magnifying glasses), because it is quite invasive and potentially damaging if not done correctly. Even my probe doctor who is very skilled at it prefers probing as a last resort, because she said the long term effects are not known.

I agree with Lena you might want to also consider sclerals. I lost several glands in the 8+ year process trying to find resolution to my severe dry eyes, so sclerals help with the remaining dryness I will always have, but it’s manageable and I know my limits.

Dr. Yee does sound like a thorough doctor, so sounds like you are in good hands. Let us know how you progress.

[Guest]

One more thing you might want to try...I have been told by my dry eye doc (Dr. Arthur Epstein) that fish omegas are found to be more effective than flaxseed so I wanted to recommend this to you in your eye journey. I have also read some research articles that corroborate this. I highly recommend PRN (Physician Recommended Nutriceuticals) Dry Eye Omega. Its really high quality stuff and frequently is tested for mercury levels. A bit pricey, but worth it, I think!