LipiFlow device - what the????

[Dryeyekami]

So.... I self expressed my glands using a q tip and gentle pressure. Clear oil came out from a number of lower glands. Small pools. I'm now very confused! The pain I feel seems to be in my lower eyelids!

[pythonidler]

Hi pythonidler
Lucky you to have found a real expert. I have visited 8 doctors.

Indeed I am lucky. I can PM you his name if you're curious...

1) Detecting scarring over the meibomian glands - how to check this scars, by meibopraphy, confocal microscopy or other tools?
I suspect I have scar tissue issue too as often I have small yellow stys/pimples around lid margin - they normally disappear in 3-4 days and do NOT get bigger.

I don't remember the machine that was used to check for scarring. It may have been the confocal microscope again, but I'm not sure.

2) Probing
I thought probing is making holes in glands while lid marig debridement
(by gulf cub spud is to remove material enabling secretions from glands to spread across the ocular surface, for a smooth surface to distribute lipid/blinking) according to Dr Korb.
I have consulted my dr who said BlephEx can solve this issue if dr performs correctly.

Considering the meibomian glands themselves are very small, I think it would be almost impossible to fit a single probe in one gland. I think what happens is the scar tissue covers multiple glands, and that you open up multiple glands with a single punch. But don't quote me on that.

3) Did you check your tear quality Osmolarity test by TearLab. I heard this is also important.

I think I had this done at some point (not by my current doctor). I don't remember what the results were.

After LipiFlow I did warm compress/Blephasteam/42.5C for 10 min. as instructed by 2 doctors, one said 3-4 times/week, another said 2 times/day.
I seldom felt oil secretion, if yes, only 2 min. - I did tell dr about it - but no solutions were given - I believe now my glands are clogged again.
Later, I found out I actually need 'constant' heat of 43-44C for 10 min. or about 42C for 15 min. - thick oil!!

I bought my first heat mask almost a year after my first dry eye symptoms - on my own research, I might add. My first few doctors (optometrists and one ophthalmologist who knew little) probably didn't know about MGD. Despite the fact that I had symptoms for almost a year, it still gave me great benefit. I didn't do it regularly, however, and a few months later it didn't work as well for me - probably because scarring had begun to develop. For the last couple years, though, I've used it once a day. I would recommend that anyone who has MGD - regardless of how much it improves their condition or not - do this on a regular basis.

I am going to do BlephEx, probing or expression soon so I can work again!

Good luck, and let me know if you want me to give you the name of my doctor.

[nori2015]

Further to previous posting; I got this message from Centre for Sight today. I requested any updates on Lipiflow's success

"The Lipiflow trial is being undertaken with tear science. Once treatment has been provided, paitents complete a monthly survey for the following three months. Therefore at this time, we do not have any paitents that have fully completed the survey. the survey is also number driven and confidential therefore we can provide comments after this period but without any named individual related to the statement......"

Did you ever go for it?

[nori2015]

Any updates on this?

[Dryeyekami]

It's so bizarre. I rarely feel the need for artificial drops and when I do they don't really have any effect ....

[Dryeyekami]

Seems a vicious circle. Potentially allergy causes mgd which causes inflammation and so on. We all get told we have mgd but rarely does anyone look into the root cause of the mgd. Deal with the symptoms as opposed to the problem so to speak.

[MGD1701]

Hi, Dryeyekami,

meibography/images - are a must to know your gland status. How many are still functional?
Also need to know your oil quality/quantity, oil is thick, clear or toothpaste like?
Some doctors will first recommend compress, massage etc at home for 3-4 months, if still no improvement, then probing, LipiFlow etc.

allergy - better do NOT put eye cream near eyes.

[Dryeyekami]

Hi. I've not had the images as yet. That's what I'm hoping for at the lipiflow evaluation....And I shall be asking all about what you've mentioned above! If there's scarring there's no point right. If my glands are clogged up then yes it's a possibility.

I've only seen the two docs thus far...Both gave the glands on my lower left lid ( by far the worst) a very quick squeeze and then stating yup you've mgd... Absolutely no interest in my questions around allergies and so on. I changed face wash about three months ago and dry eye symptoms began a week or so later... But the docs just weren't interested!

[MGD1701]

Hi pythonidler

Lucky you to have found a real expert. I have visited 8 doctors.

1) Detecting scarring over the meibomian glands - how to check this scars, by meibopraphy, confocal microscopy or other tools?
I suspect I have scar tissue issue too as often I have small yellow stys/pimples around lid margin - they normally disappear in 3-4 days and do NOT get bigger.

2) Probing
I thought probing is making holes in glands while lid marig debridement
(by gulf cub spud is to remove material enabling secretions from glands to spread across the ocular surface, for a smooth surface to distribute lipid/blinking) according to Dr Korb.
I have consulted my dr who said BlephEx can solve this issue if dr performs correctly.

3) Did you check your tear quality Osmolarity test by TearLab. I heard this is also important.

After LipiFlow I did warm compress/Blephasteam/42.5C for 10 min. as instructed by 2 doctors, one said 3-4 times/week, another said 2 times/day.
I seldom felt oil secretion, if yes, only 2 min. - I did tell dr about it - but no solutions were given - I believe now my glands are clogged again.
Later, I found out I actually need 'constant' heat of 43-44C for 10 min. or about 42C for 15 min. - thick oil!!

I am going to do BlephEx, probing or expression soon so I can work again!

Thanks and happy Easter!

[pythonidler]

In addition to the allergy drops, you might want to invest in a heat mask such as this one, if you haven't already. Use it at least once at day for about 10 minutes to see if it improves your MGD at least temporarily.

If it doesn't, you need to figure out why. There's two main possibilities:
1. The oils in your glands are thick, and are not getting heated well enough to flow. Lipiflow are IPL would be useful here.
2. You have scarring over your glands, and no amount of Lipiflow or IPL will help. Probing will help clear the scar tissue so that you can then do Lipiflow or IPL treatments.

Regarding your doctor, I agree with MGD1701's sentiment that it is tough to find a good dry eye doctor; personally, I saw three ophthalmologists, between 6 months and a year each, before I settled on my current doctor. But if you spend time with a doctor who cannot help you, you're only making your condition worse - not to mention spending lots of wasted time and money.

My current doctor took lots of different images of my eye on my first visit. They included meibography (images of the meibomian glands), confocal microscopy (images of my corneal nerves), and additional images of my lid margins to look for scarring over the meibomian glands. I felt more comfortable in his diagnosis because of all the images that were taken. Do you remember if you doctor took any images of your eye on your first visit?

[Dryeyekami]

Hi both and thank you so much for your responses! I've been diagnosed with mgd. Tbut of 5. Never been tested for allergies. To my mind my mgd is caused by allergy but not sure to what. I've just started a course of prednisolone drops to see whether this helps with the allergy.

[pythonidler]

Hi Kami,

Welcome to the forum.

I'd like to know more about the doctor(s) you've seen thus far. What kind of tests did they do? What did they diagnose you with? What other treatment options have they given you besides Lipiflow (e.g., Restasis, fish oils, heat masks)?

As for my personal experience with Lipiflow, I first had it done about a year and a half after my first dry eye symptoms. At the time, my right eye was worse than my left eye, so I only had it done on my right eye. I didn't really notice any improvement after that first treatment. I tried Lipiflow again on both eyes about six months after that, and still didn't notice any improvement.

I think the reason Lipiflow didn't work for me was because I was getting scar tissue (called keratinization) over my meibomian glands. About four months ago, I had meibomian gland probing performed to clear the scar tissue. Since then, I've had IPL (Intense Pulsed Light) done once a month for three months thus far, and I can say that it started improving my symptoms after the second treatment. I just have one more treatment to go, and then I can space them out more.

From my own experience and speaking with my doctor, IPL is probably better than Lipiflow, as it is most definitely cheaper and is just as - if not more - effective. My IPL sessions are $175 with insurance ($35 once my deductible is satisfied). Lipiflow would be about $1,500 per session with no insurance.

[MGD1701]

Hi Kami, I did lipiFlow but no much relief.

My lessons:
1) find a real expert who is keen to help and is solution-driven.
- not easy - most people need to visit more than 5 doctors.
A doctor in USA claimed his/her LipiFlow successful rate was very high as he/she took the time to explain/educate patients - I believe it is possible I just did not have such luck!

2) Do the right order - often first BlephEx, probing etc before LipiFlow should gain better results.

First identfy causes (could be several, from imcomplete blinking to medication, allergy and many others) and ask for other alternatives (like BlephEx, probing, expression, IPL...) otherwise LipiFlow is still not a solution.
Good luck!

[Dryeyekami]

Good afternoon all. I'm a newbie here....Dry eye symptoms started a few months ago and have gotten worse. I'm unable to work at the moment due to the constant pain. Apparently I have mgd but didn't think the pain could be so intense! So...Long story short, I've booked in for a lipiflow assessment next week in Manchester. Not sure what to expect or what other people's experiences have been. I'd really appreciate any feedback!

Kami

[radnad]

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.