LipiFlow device - what the????

[Tankie]

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

[Tankie]

Oops posted in wrong forum. See the patients only forum.

[Minni]

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.

[LaDiva]

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]

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.

[littlemermaid]

Good point on whether/how much to poke about after hot compress. With chalazia, there is build up and infection and we've had to treat that, sometimes leaving what looks like a trashed empty gland. Purely to gross people out, without a firm but gentle two-finger pinch and upward push/squeeze under the lower eyelid margin, we've had gunk bursting through the eyelid wall and that is definitely a trashed gland. Looks like it heals eventually.

[Max52]

It is very confusing. I think the philosophy of less is best is best. I also don't understand how people on this forum go into details on self expression. They describe what kind of flow and consistency they get from their glands. And yet the doctor who wrote the article to which you refer says it's impossible to see what comes out unless viewed under a slit lamp or great magnification. So come on all you self expressors...me thinks you are doing your selves more harm than good.

[JJdryeye]

For those who haven't seen this, there is an excellent article on this site by a doctor Sandra Brown explaining expression of the meibomian glands:

http://dryeyezone.com/encyclopedia/mgcare.html

This paragraph in particular caught my attention:

Remember that the gland is a potential space containing a small volume of oil. If you express all the oil out of the gland, you have probably expressed several days' worth of "production". You have depleted your supply. When the gland is empty, it collapses in on itself and the cells lining the potential space come into contact with each other without an intervening "oil slick". This allows the cells to adhere to each other. As the gland refills with oil the potential space expands and the cells separate. Repeated expression can lead to the cells permanently adhering, causing obstructions deeper in the gland. This process will be hastened by the microtrauma induced through the mechanical pressure, especially if applied vigorously and often.

When I have tried the Q-tip method on my own, I've always felt worse the next day. I wonder if, as she described above, I depleted my supply for a couple of days. This conflicting information, with some doctors telling people to do home expression, and others warning against it, just further confuses me.

[JJdryeye]

Thank you all for the responses. MGD30 that's interesting about the temps needed to melt the hardened oil. I'm really tempted to give Lipiflow a try, especially since I'm more in the moderate range. I'd like to think manual expression would be a cheaper alternative if done properly by a trained professional, but like everything else, it's a shot in the dark, and I hate throwing cash at this problem like it's monopoly money. I'd gladly pay a pretty penny to rid myself of this nightmare if I knew there was a good chance something would stop it. With all of these treatments (expression, probling, lipiflow, IPL), I don't understand what is to keep the problem from coming back even if it does help.

[Minni]

Due to reddened/sensitive lids & eyes, I suspect that I have both MGD, as well as suspect that my severe photosensitivity is due to damage to stem cells from prolonged exposure to outgassing epoxies from a Samsung LCD monitor years ago (which lacked the capability to dim it via an external dimming button). At the time, I was unaware that dimming is achievable via Windows, because it was so hidden inside the convoluted Win-98 mess.

My local optho thinks it may be Bleph, but I'm not so sure that MGD & stem-cell damage isn't the case even more.

[Spoon]

Hi JJ

Gee, that is a lot of money for manual expression, for something which takes me 10min on a Sunday night. Perhaps a doctor or tech would be more effective, I can't say as I've never tried. I find the pain response a big advantage as it helps me guide the amount of pressure to use. I don't like to go beyond a certain level because then I'd be worse off for a couple of days - even if I'd get a good week afterwards. Regarding the sterility thing, no that's just common sense due to the way I express the glands - with a stainless steel surface against the inner eyelid (using an instrument I made which is similar to the mastrota paddle). Like MGD30 I also use a high magnification mirror to see the stuff come out. Good point MGD30 made on the 'bad oil', if you've had your meibomian glands completely blocked for a long time its more likely that some of the blockages just won't come out without heat no matter how much pressure is applied. Showering or a warm compress before might help somewhat but be quick in between since the lids return to normal temperature rapidly due to the degree of blood vessels in them.

[MGD30]

From what I've read on here it sounds like some doctors offer it more as a treatment, rather than a test. And judging by the cost of the procedure at some doctors, they are offering it more as a treatment. How was your expression done? With a q-tip? With a mastrota paddle? I'm just wondering how effective it would be, compared to probing/lipiflow, at unclogging glands that are blocked with hardened oil. Or, is it merely expressing glands in which the oils have semi-hardened. I'm guessing there must be some patients out there who find expression beneficial by itself or these doctors wouldn't be offering this as a service. If you are reading this and have some knowledge of this, please weigh in.

I've also read a few posts on here that suggest gland expression, of any kind, home or professional, is a risky procedure because the gland walls are so delicate. Wow, how confusing.

Mine was done with a regular metal tool one of the times and the second with a heated metal tool. I do it myself at home about once a week with a Q-tip with mineral oil on it and only on the bottom lid; but I dont do it nearly as hard as my doctor did. Im a bit worried about doing damage to my glands. I would not pay a doctor to do it especially if you say its that expensive. The expressions really only remove the oil from the end of your glands, unlike the lipiflow that attempts to remove all of it.

One thing to remember is that the worse your quality of oil gets, and the older it gets, the higher the temperature is needed to melt the oil. I dont have the research paper in front of me, but if I remember correctly, it may take up to 46 degrees C to melt "bad oil". The lipiflow machine temperature does 40 C, which I assume is for safety reasons. If you read these forums you will see a lot of people say that Lipiflow wont help if you have sever MGD. I belive this is the reasons why. This is why I did an expression myself right before and right after my lipiflow procedure. The machine was not able to remove all of the oil for these reasons but I think it did remove a lot of it. By monitoring my glands (I bought a mirror with the largest magnification I could find) I can see that the my oil secretions arent nearly as thick as they used to be, although they are far from healthy looking. For this reason, and through my doctors recommendation, I will be doing a second treatment. Had I not been closely monitoring my glands I might have thought that I am being ripped off (2 expensive treatments within 3-4 months) because my pain levels have remained the same; but I can clearly see a difference.

[JJdryeye]

Hi JJ

I've found manual lid expression to be helpful. I do it myself. It's easy to do on the bottom lids but a little trickier on the top lids. You do need to be careful about sterility. Hand sanitizer + hot rinse it what I use. As for damaging the glands I worry a bit about this so I am cautious about the amount of pressure I apply. I've heard the guru on this stuff Dr Korb say that you won't damage the glands when the pressure is below the maximum pain threshold for most people. My view, given the structure of the glands, is that it forceful expression might be a little damaging but it's better than leaving blocked up glands to slowly deform and atrophy.

Manual lid expression and Lipiflow have exactly the same goal of removing stagnant material (altered meibum/dead cells/bacteria/keratin) from the Meibomian Glands. Lipiflow has the big advantage over manual expression by simultaneously heating the thickened material so that less pressure is needed to remove it - think of the material like coconut oil or butter, a small rise above normal lid temperature can make a big difference in its viscosity/thickness. If your meibum is only mildly thickened the heat might not be necessary and manual expression would do as good a job, it is hard to say. How much are these docs charging for manual expression?

Probing won't remove stagnant material in itself but is done based on the proposition that there are structural blockages in the gland that need to be pierced with the probe before the material can be expressed. If you get probing done I think it really needs to be followed with warm compresses or manual expression for most cases.

Hope this helps

Thanks for the reply Spoon. I always assumed that manual expression performed by a doctor, would probably be more thorough and effective than the home version many of us are doing, but it's good to hear you are getting some benefit doing it yourself. Without naming names, I will say that some of the manual expression prices I've seen are about 60% of a Lipiflow treatment. Do the math and you'll see that's still a huge chunk of money. Which is the main reason I started this thread in hopes of gauging the effectiveness of a professional expression treatment compared to the other advanced treatments.

Did Dr. Korp give you the information about sterility? I was thinking of buying some sterile q-tips as suggested by Dr. Latkany in his book. The home version of manual expression hasn't yielded any improvements for me, but perhaps I just haven't been consistent enough with it. How do you personally perform your expression?

[Spoon]

Hi JJ

I've found manual lid expression to be helpful. I do it myself. It's easy to do on the bottom lids but a little trickier on the top lids. You do need to be careful about sterility. Hand sanitizer + hot rinse it what I use. As for damaging the glands I worry a bit about this so I am cautious about the amount of pressure I apply. I've heard the guru on this stuff Dr Korb say that you won't damage the glands when the pressure is below the maximum pain threshold for most people. My view, given the structure of the glands, is that it forceful expression might be a little damaging but it's better than leaving blocked up glands to slowly deform and atrophy.

Manual lid expression and Lipiflow have exactly the same goal of removing stagnant material (altered meibum/dead cells/bacteria/keratin) from the Meibomian Glands. Lipiflow has the big advantage over manual expression by simultaneously heating the thickened material so that less pressure is needed to remove it - think of the material like coconut oil or butter, a small rise above normal lid temperature can make a big difference in its viscosity/thickness. If your meibum is only mildly thickened the heat might not be necessary and manual expression would do as good a job, it is hard to say. How much are these docs charging for manual expression?

Probing won't remove stagnant material in itself but is done based on the proposition that there are structural blockages in the gland that need to be pierced with the probe before the material can be expressed. If you get probing done I think it really needs to be followed with warm compresses or manual expression for most cases.

Hope this helps

[JJdryeye]

From what I've read on here it sounds like some doctors offer it more as a treatment, rather than a test. And judging by the cost of the procedure at some doctors, they are offering it more as a treatment. How was your expression done? With a q-tip? With a mastrota paddle? I'm just wondering how effective it would be, compared to probing/lipiflow, at unclogging glands that are blocked with hardened oil. Or, is it merely expressing glands in which the oils have semi-hardened. I'm guessing there must be some patients out there who find expression beneficial by itself or these doctors wouldn't be offering this as a service. If you are reading this and have some knowledge of this, please weigh in.

I've also read a few posts on here that suggest gland expression, of any kind, home or professional, is a risky procedure because the gland walls are so delicate. Wow, how confusing.