LipiFlow device - what the????

[Nightbird]

Good Afternoon all,

I recognize many of the screen names in this post, but for those who are not aware, I recently posted two extremely long posts in the MD Advanced Treatment section on the main page of this forum. Hopefully that can answer a few questions.

Thanks for sharing your experiences

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.

[browneyesblu]

Thanks for the info ET

I've been asking on another professional forum about azithromycin use, and some have noted some benefit in their patients, others not as much. I'm going to try it myself and see how it goes.

Once again, thanks for sharing!

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.

[bunnyrabbit123]

Bunnyrabbit123

I use the FML drop, one drop in both eyes, about every other day. I try not to do it every day. Again, it is one of the weaker steroids. Has your doctor tried you with Alrex or FML? These two drops are very weak, and some patients who are "steroid responders", to drops like Pred Forte and Dexamethasone do well with these weaker drops. Alrex has been used a lot in the past for allergy inflammation, but works decently well for dry eye also.

DWDE

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.

[DocwithDryEye]

I do sleep on my side , problem is I sleep on both sides and my back. I do know if I could sleep with my eyes wide open, I would be fine with no eye discomfort. Which tells me the lipids in the limited functioning glands would not get a chance to get thick as I would be blinking normally and expressing my glands. Now I know what my solution is. Can someone tell me how it is people (my glands were one time normal too) without dry eye can close their eyes for hours without blinking and pop open their eyes like mid day without any symptoms. I know the eye muscle keeps moving when sleeping but when there is no blinking, how does the tear film and its army of MB glands produce adequate lipids?

Following some of the above posts, I do often bring up sleeping position to patients. Sleeping on the back is best, as it was mentioned that sleeping on your side or your stomach can cause you to press your face into the pillow in a way that may cause the eyelid to be pushed up. That can sometimes account for why one eye is more irritated then the other, if you always sleep with the same side of your face on the pillow while on your side or stomach.

I think "normal people" who dont have dry eye do not have any kind of nocturnal lagophthalmos, or no eyelid opening of any kind at night, and then they are NOT partial blinkers as they go about there day. Regular blinking throughout the day does not promote thick pasty secretions of the glands. It is chronic partial blinks that causes this, or underlaying inflammation from things like rosacea.

Just my thoughts

DWDE

[DocwithDryEye]

Thirstyeyes- thanks for the info- I agree it is confusing. I can't say what the dr. I'm going to see does about expressing glands after procedure but I guess I'll find out. I've got to do something! I'm a little disturbed to know that docwithdryeye is using fml drops every day as that certainly helps control inflammation in the glands and on the eye surface. This is not an option for me- steroid responder Aggh!! Just when you think you have a good idea of how something should be done, it gets all murky again.

Bunnyrabbit123

I use the FML drop, one drop in both eyes, about every other day. I try not to do it every day. Again, it is one of the weaker steroids. Has your doctor tried you with Alrex or FML? These two drops are very weak, and some patients who are "steroid responders", to drops like Pred Forte and Dexamethasone do well with these weaker drops. Alrex has been used a lot in the past for allergy inflammation, but works decently well for dry eye also.

DWDE