LipiFlow device - what the????

[DocwithDryEye]

My ophth prescribed a course of oral azithromycin - 1 gram three times a week (Mon, Wed, Fri) for 5 weeks. It did seem to clear my oil glands but didn't help with my pain. The glands then got clogged with thick oil again. He now suggests taking 1g of azithromycin 3 times a week for one week, to be repeated every 6 weeks. I'm not convinced this will help as it's not long enough to clear the glands (I've tried it), and also I'm concerned about taking this high a dose of antibiotics long term. I asked him about trying Efracea (uk name for Oracea) as an alternative that might be safer long term, and he got very angry with me and denied that such a drug existed. He also won't prescribe Azyter as he says there is no evidence it works.

Needless to say I'm not sure I want to see this doc again. (Long story, but his hostile attitude and refusal to listen to questions isn't exactly helping).

I'd appreciate your thoughts on this, DWDE.

Unicorn

Thanks for sharing your experience. I like to hear what other eye care professionals are recommending.

From what I've heard, that sounds like a HEAVY dose!! You don't have any heart conditions, do you? Arrhthymias? Just have to be careful with Azithromycin with these patients.

I've honestly not done much with Azithromycin in the past.

What you are saying makes sense though. Until you address the route cause, and have your glands expressed (regardless of which procedure you choose = LipiFlow, probing, manual expression by a doc, etc...), then I would not expect any improvement. The antibiotic helps a little, but I understand why you go right back to where you were before. You have to address the meibomian gland issue, and get that nasty old oil out of there before you experience any real lasting relief.

DWDE

[Max52]

Just venting a little. I had lipiflow about 3 weeks ago and although I've read thru this thread that it could take 3 months or longer, I thought I'd feel SOMETHING. Some kind of change, even minor, but so far nada, so doubt as to whether this will work for me is creeping in.

[cathy8889]

Hi all, this thread has been really useful so far, thank you. I didnt know there was a difference between MGD and meibomianitis.

I am really confused about my diagnosis a few weeks ago. I was told I have a 4 second tear break up time, aqueous tear deficiency and blepharitis. I dont know if I have mgd or not? Im looking at my glands in a mirror and the little stems look yellow, does this mean they are blocked? When I express my glands I cannot see anything come out. Im guessing if my tear film break up time is so short I do have some type of MGD or can a quick break up time be purely due to lack of tears?


I feel like I have been well and truly wripped off by doctor, ive wrote to him asking for clarification but 3 weeks later I still havent had a reply. I paid 160 pounds and all I gained from it was a prescription for sno tears (the cheapest eye drops listed within the NHS guidelines).

Any help would be really appreciated.

Cath x

[DocwithDryEye]

LM

I refer all the time. I would address any ophthalmic allergy, rosacea and MGD issues, and most likely refer for the hormonal testing, dermatology testing, etc. I'll often send letters to these other doctors with my findings.

[unicorn]

I've tried Azasite myself with little help. I have yet to try azithromycin orally for any period of time. I chatted with a few doctors on another forum I take part in, and I learned that some doctors are prescribing 1 g of azithromycin for one time use, and others that are prescribing a Z-pak (6 tablets that are often taken over a course of 5 days for stys or other eyelid infections), and taking one tablet every other day for 12 days. New research has been posted on this forum indicating that may help. The one thing to watch for are patients with heart issues, as the medication can cause arrhythmias.

DWDE

My ophth prescribed a course of oral azithromycin - 1 gram three times a week (Mon, Wed, Fri) for 5 weeks. It did seem to clear my oil glands but didn't help with my pain. The glands then got clogged with thick oil again. He now suggests taking 1g of azithromycin 3 times a week for one week, to be repeated every 6 weeks. I'm not convinced this will help as it's not long enough to clear the glands (I've tried it), and also I'm concerned about taking this high a dose of antibiotics long term. I asked him about trying Efracea (uk name for Oracea) as an alternative that might be safer long term, and he got very angry with me and denied that such a drug existed. He also won't prescribe Azyter as he says there is no evidence it works.

Needless to say I'm not sure I want to see this doc again. (Long story, but his hostile attitude and refusal to listen to questions isn't exactly helping).

I'd appreciate your thoughts on this, DWDE.

[bunnyrabbit123]

Bunnyrabbit,

The goal of the LipiFlow is indeed to improve the quality/quantity of oils in the tear film, creating a more stable tear film, and I believe that it can do this very well. However, there are multiple other things that need to be looked at.

1. Lid structure - some patients with MGD have healthy lid margins, while others have swollen, red, dilated, tortuous margins. There is a difference between meibomian gland disfunction and meibomianitis. MGD is the thick pasty secretions alone, while meibomianitis takes the lid margin into account (That being, is there swelling, redness, frothing, ulcerations). In this later case, often a regiment of steroids in either a gel or drop are often warrented, and I often Rx doxy with this.

2. Nocturnal Lagophthalmus - again, I deal with this myself. I personally feel the LipiFlow has helped me signficantly, but of course the procedure doesn't treat my partial blinks throughout the day, or that my eyes don't close all the way at night. This chronic open eye can cause inflammation, that the steroid drop does help.

I guess the long and short of it is that there can be multiple components associated with the dry eye issue. The LipiFlow system treats one issue, but if there are other underlaying issues, the steroid may come in handy.

Hope this helps

DWDE

It does help!! Thank you.

[Nightbird]

Thanks for posting Nightbird

I have heard the name Diquafosol on a few posts on this site, but I don't know much about it. It would be great to see if doctors and patients outside the US start to use it, and to see what they think. If the drug does indeed reverse gland atrophy, this could be something big! Let's continue to watch and see what happens. New meds/technology always comes out OUTSIDE of the US, and then it can take months to years before making its was to us.

Thanks again for sharing!

DWDE

Thanks for responding. Yes, it could be something really big! The really interesting thing is that the Japanese think it’s so safe, they don’t even require a prescription for it. And there are online pharmacies there that will ship it anywhere. I agree with your cautious approach however. One study isn’t definitive. Let’s hope there is more good news from abroad, and that it takes months instead of years.

[MGD666]

re: Bruder eye mask
Isn't the Thermalon eye mask just a rebranded version of the Bruder one? If so, I tried the Thermalon and found it to be too rigid - as in it did not conform to the contours of the eye area - the home-made "rice in stocking" is still the best in that regard. Is the Bruder perhaps softer than the Thermalon?

[browneyesblu]

I've tried Azasite myself with little help. I have yet to try azithromycin orally for any period of time. I chatted with a few doctors on another forum I take part in, and I learned that some doctors are prescribing 1 g of azithromycin for one time use, and others that are prescribing a Z-pak (6 tablets that are often taken over a course of 5 days for stys or other eyelid infections), and taking one tablet every other day for 12 days. New research has been posted on this forum indicating that may help. The one thing to watch for are patients with heart issues, as the medication can cause arrhythmias.

DWDE

Thanks DWDE, littlemermaid is right, you are so welcome here! I noted you use and like the Bruder eye mask. I'd love an alternative to damp washcloths. I've been advised to use moist heat for compresses and the reason was quite logical--water is a conductant and so transfers the heat more effectively. Does the Bruder mask deliver moist heat, as moist as a moistened wash cloth? Also you mentioned it stays warm for 2-5 minutes. How do you use it for 10 minutes? Do you reheat it or do you use more than one? If the latter, how many do you need for a 10-minute treatment? Thanks again.

[littlemermaid]

Thanks again for sharing, and keep the posts coming!

DWDE, As a professional you might be interested in patient histories. If you haven't already found the feature, click on the poster's name and select 'View Forum posts'. 'Advanced search' top right for long timers, cures and conditions.

If you have a minute, would you look at 'Niaz 47' in Kolkata, India? Maybe you can think of something we've missed. Obviously he can't access Lipiflow but you might know something else to help him.

others that are prescribing a Z-pak

The one thing to watch for

Someone here had a severe SJS reaction to a Z-pak in the ER. My d got intracranial hypertension reaction to oral Lymecycline 6wk, which she is still living with. Hope prescribing docs in US are careful to warn people about side effects and what to do.

Which pain killers do you prescribe for optic neuropathy or chronic eye pain?

[DocwithDryEye]

Dear DWDE- First, thanks for all the time you've taken to explain lipifow and what one might reasonably expect to gain-I used fml years ago,after we moved new doc absolutely refused to allow use of this on any regular basis. My current opth has me on a compounded dexamethasone from Leiters in CA. I guess I was thinking that if lipiflow improves quality/quantity of tear film one shouldn't need steroids on a regular basis- I'll ask about Alrex tomorrow when I see my doc.

Bunnyrabbit,

The goal of the LipiFlow is indeed to improve the quality/quantity of oils in the tear film, creating a more stable tear film, and I believe that it can do this very well. However, there are multiple other things that need to be looked at.

1. Lid structure - some patients with MGD have healthy lid margins, while others have swollen, red, dilated, tortuous margins. There is a difference between meibomian gland disfunction and meibomianitis. MGD is the thick pasty secretions alone, while meibomianitis takes the lid margin into account (That being, is there swelling, redness, frothing, ulcerations). In this later case, often a regiment of steroids in either a gel or drop are often warrented, and I often Rx doxy with this.

2. Nocturnal Lagophthalmus - again, I deal with this myself. I personally feel the LipiFlow has helped me signficantly, but of course the procedure doesn't treat my partial blinks throughout the day, or that my eyes don't close all the way at night. This chronic open eye can cause inflammation, that the steroid drop does help.

I guess the long and short of it is that there can be multiple components associated with the dry eye issue. The LipiFlow system treats one issue, but if there are other underlaying issues, the steroid may come in handy.

Hope this helps

DWDE

[DocwithDryEye]

Are you planning to try Azasite or oral azithromycin? If oral, at what dose, how many times a day and for how long? Thanks.

I've tried Azasite myself with little help. I have yet to try azithromycin orally for any period of time. I chatted with a few doctors on another forum I take part in, and I learned that some doctors are prescribing 1 g of azithromycin for one time use, and others that are prescribing a Z-pak (6 tablets that are often taken over a course of 5 days for stys or other eyelid infections), and taking one tablet every other day for 12 days. New research has been posted on this forum indicating that may help. The one thing to watch for are patients with heart issues, as the medication can cause arrhythmias.

DWDE

[DocwithDryEye]

Littlemermaid

Thank you so much for the kind words. It's great that forums like this exist so that those of use with dry eye can all come together and share our experiences.

Thanks for sharing your experience with FML. I try to do the same. I noted one drop in both eyes, about every other day. But if I can wake up in the morning, and my eyes don't feel do bad, then I may try to refrain from using the drop. That's great if you can get to one/10 days.

Thanks again for sharing, and keep the posts coming!

DWDE

[DocwithDryEye]

Hi DocwithDryEye,

First of all thanks for all your time and help, it's nice to have a pro on the site that is willing to answer questions. This is a off-topic, but I am wondering if you've seen this study about Diquafosol from Japan:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664386/

As far as I can tell from researching, this drug was not approved in the USA, not because of adverse affects but because the pharmaceutical company didn't achieve the results they were aiming for in clinical trials, but they were testing it's use for AD. The Japanese tested for MGD, and it's the first time I've seen anyone report that they were able to reverse gland atrophy. Just curious if you have any comment, or know of any renewed interest in this drug in the US. Thanks.

Thanks for posting Nightbird

I have heard the name Diquafosol on a few posts on this site, but I don't know much about it. It would be great to see if doctors and patients outside the US start to use it, and to see what they think. If the drug does indeed reverse gland atrophy, this could be something big! Let's continue to watch and see what happens. New meds/technology always comes out OUTSIDE of the US, and then it can take months to years before making its was to us.

Thanks again for sharing!

DWDE

[littlemermaid]

DWDE, I'll say it again, you are so welcome here with us. Docs are finding their way forward with sharing safely on social media and I think you are handling it just right. Very brave and pioneering and plenty professional kudos to you.

I use the FML drop, one drop in both eyes, about every other day.

Paediatric, we have managed to taper FML in long-term use to one/week, even one/10 days. Then off as the eyes settled. We started tapering regimes with eg 3/day for 2wk or even 3 or 4wk to control serious inflammation. Why this works, we can only imagine.