LipiFlow device - what the????

[Rellis]

Thanks for this tip--I'll try it. Also would like to hear from anyone else who has had this problem with Lipiflow or another treatment.

[Hokucat]

Hi Rellis. The skin around the eyes is very thin and sensitive, especially after all the heat, massage, and manipulation with the cup and tape. I did not have the problem you describe when I had Lipiflow, but I also had something like that on the outside skin of my lower right lid for two weeks, when my optometrist gave me a MiboFlow trial last month. What helps it heal is applying Refresh P.M. Lubricant Eye Ointment to the skin. I've had some red and dry irritated skin around my eyes in the past, and one of my eye doctors recommended this. She said its like applying Aquaphor or Vaseline, but safer to put around the eye in case some of it gets into the eye, since it's preservative-free and meant for eyes in the first place.

https://www.amazon.com/gp/aw/d/B01K8...uQL&ref=plSrch

[Rellis]

I had Lipiflow 2.5 weeks ago. On the outer lower lid of my right eye, I have redness and some slight swelling that is just not going away. The skin there feels different--very dry. It doesn't hurt, but it does feel slightly irritated. I have thought that it would go away with time, but it has not. During the my treatment, the technician kept adjusting the cup and the tape on this eye, and the cup fell out in the last half of the treatment. She had to stop the procedure, re-position the cup, and re-tape it to my eye. I'm wondering if this had anything to do with the issues I'm having now. It almost looks like that area of my eye is sunburned. Has anyone else had any reaction such as this? Or does anyone have any thoughts about what this might be? I'm calling my doctor tomorrow, but would appreciate input from other patients.

[deep_dry_eye]

Thank you for your very in depth post. It seems that you have found the hot compresses to produce the most dramatic improvements when supplemented by the various other treatments. I've found in the course of my treatment the most dramatic improvement I experienced has been from bering stricter in applying the hot compresses. My improvement, after two days now, has been dramatic. I've been able to discontinue all lubricant eye drops and gels. I am encouraged and see from your post that I can be more aggressive in applying the hot compresses than my present two times a day, morning and evening.

may I ask how frequent / and how hot are you applying them?
the thing to be vary of is dmg to cornea, I've asked many ODs, most of them say the risks are low -- but the risk is still there. It's like, would you rather sacrifice your cornea or MGs?

[rbrown3rd]

Thank you for your very in depth post. It seems that you have found the hot compresses to produce the most dramatic improvements when supplemented by the various other treatments. I've found in the course of my treatment the most dramatic improvement I experienced has been from bering stricter in applying the hot compresses. My improvement, after two days now, has been dramatic. I've been able to discontinue all lubricant eye drops and gels. I am encouraged and see from your post that I can be more aggressive in applying the hot compresses than my present two times a day, morning and evening.

[deep_dry_eye]

Here's another research article that suggests IPL to work:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422561/

However, I only trust the site 1 results, site 2 has something funky going on -- even the authors had to separate them out which is abnormal for a joint site study.

[deep_dry_eye]

DDE, you could try. Drinking green tea for a month o two probably won’t hurt you. Also, Hokucat’s fifth probing was probably more effective than the previous ones. To be honest, I don’t really know what a probing is, though I can imagine.

Are you using Restasis? I tried it last year and it did nothing positive. Only it burned my eyes tremendously for 30 minutes after each application, and it dried my eyes more at night. Allergan itself says it is not very effective, only in 1 of 6 patients who have an inflammatory process (and nobody knows when there is REALLY inflammation). And even in that situation it is not clear if it is the cyclosporine or just the vehicle (the rest of the components, or part of them). But doctors are great overprescribers of Restasis, they keep the business rolling, and they don’t report when it is not effective.

There is a lubricant of Allergan, Endura UD, which has almost the same components than Restasis, without the cyclosporine. But I don’t use it because it is also strong for me. And if I apply it some minutes before going to sleep, I could wake up with a killing, desperate irritation (the same happened with Restasis).

I am on Restasis for about a month now. Thankfully I don't experience any of the side effects upon application, however I don't seem to be improving much on it? At least I don't notice any major difference thus far.

I've found none of the artificial tears to really work well for me -- all of them really last just 10-15mins or so before I feel gritty again.

You really really need to get a meibography, which country/state/city are you? Try and find a place that has LipiFlow and usually they'll also have LipiView. You need a good diagnostic first before you can proceed with treatment. A meibography is a critical part of getting good diagnostics.

I've been told TBUT has very high variance on dry eye patients.

Have you tried autologous serum, I've been told the serum drops can help reduce inflammation which is helpful in all cases of dry eyes caused by inflammation (i.e., most MGD and aqueous). I'm about to try that next along w/ IPL.

[Adrian]

I wonder if you had your hormones checked out? Testosterone, Bioavailable T, and DHT can be affected by green tea -- I may never get an answer, but I'm trying to understand how and why the green tea helps you (but not others).

https://www.costco.com/Kirkland-Sign...100220250.html

This is the green tea you use right? I'm going to give it a try as well.

DDE, you could try. Drinking green tea for a month o two probably won’t hurt you. Also, Hokucat’s fifth probing was probably more effective than the previous ones. To be honest, I don’t really know what a probing is, though I can imagine.

Are you using Restasis? I tried it last year and it did nothing positive. Only it burned my eyes tremendously for 30 minutes after each application, and it dried my eyes more at night. Allergan itself says it is not very effective, only in 1 of 6 patients who have an inflammatory process (and nobody knows when there is REALLY inflammation). And even in that situation it is not clear if it is the cyclosporine or just the vehicle (the rest of the components, or part of them). But doctors are great overprescribers of Restasis, they keep the business rolling, and they don’t report when it is not effective.

There is a lubricant of Allergan, Endura UD, which has almost the same components than Restasis, without the cyclosporine. But I don’t use it because it is also strong for me. And if I apply it some minutes before going to sleep, I could wake up with a killing, desperate irritation (the same happened with Restasis).

[Adrian]

Hokucat, thank you for the response and for sharing your story.

I don’t know if I have MGD or aqueous tear deficiency. I suppose I have a mild deficiency of the three layers, but I am just guessing.

The details would deserve a separate thread, but I take this opportunity to write them down, to practice my English and in case someone has something to suggest.

The last BUTs they made were between 10 and 15 seg. But this depends on the doctor. One day a doctor measured 14, and the other day another one measured 5. But the last one uses a strong, hot light to see, so I guess it is the intensity of light that breaks the tear more quickly (which is what in fact happen in real life activities). Also, I noticed that doctors tend to accommodate the times to give the impression that the treatments they prescribe are working. I reached the conclusion that BUTs are useless for me, they don’t offer any interesting information.

I have never been offered to do a meibography, I guess the doctors and clinics I consulted don’t offer this test. I don’t know how my MG are working.

Schirmer's Test with or without anesthetics are normal. I don’t remember the results, but something like 15 and 20, without anesthetics. And I have reflex tears. I think most of the test without anesthetic is about reflex tears. And when I did it with anesthetic I still felt something, so I don’t know if this test has some utility and how to TRULY measure basal tears.

Laboratory tests indicate “dry eye”. In March 2016, some weeks after I began feeling dryness and photophobia, Osmolarity was 321 mOsms/L, Lactoferrin was 1,0 mg/ml, Lysozyme 1000 ug/ml, and I had diminished goblet cells. But in November 2016, the same test “improved”, even if I didn’t notice any difference: Osmolarity was 301 mOsms/L, Lactoferrin was 1,3 mg/ml, Lysozyme 1500 ug/ml, but goblet cells were still diminished.

Apart from tests, doctors usually tell me I have dry eye, just by seeing them through the magnifier.

I have the impression that the diminishment of goblet cells could be the cause of my photophobia. But the fact is that in this two years I haven’t notice any improvement, I have just adapted my life to this limitation and my mind to the everyday discomfort.

What I never did is to try a radical “rest”, trying not to push my sight for several weeks, to see if there is a cumulative improvement, in case it is a matter of chronic fatigue or something.

The fact is that four years ago I took a “drug” (poison) called Accutane, and it seems that it initiated a dry eye process. This is not uncommon, in fact, this poison usually have permanent side effects, and my ophthalmologist told me the cause of my dry eye is Accutane (supposedly it affects meibomian glands, but it could affect any gland or part of the body). Probably computer use with a CRT monitor worsened the situation. So I don’t know if I can do something about it. Maybe I will try plugs.

[Hokucat]

Hi DDE. I had my hormone levels checked several years ago, when doctors were running all the other tests to try to figure out what was wrong. Testosterone was on the lower normal side. I tried testosterone cream on the eyelids, which did not do anything for me, but that was prior to getting probing, so my glands were likely blocked back then where nothing would work.

However, as part of my regular diet, I now include foods that promote testosterone....and my eyes do seem to feel even better, especially when I include protein like some beef, salmon, eggs and beans.

My theory why the lemon/tea works for me is related to the likelihood I have an autoimmune disease, Sjogren's Syndrome). I feel somehow the antibiotic, anti-inflammatory, and anti-bacterial properties are helping eliminate bad bacteria from my gut (where most autoimmune diseases start) and elsewhere, and strengthening my immune system. It makes me think even more so when recently my friend who has rheumatoid arthritis, another autoimmune disease, had dry eyes and she started doing the lemon/tea, and her eyes feel much better too now. I may never know for sure why it helped me, but my doctors think my theory is plausible. Someone in this forum posted it also helped him a great deal, but I don't think he had an autoimmune disease, or at least he did not say he did:

http://www.dryeyezone.com/talk/forum...acle-solutions

Yes, that Costco Kirkland green tea is the one I use.

[deep_dry_eye]

FYI to Canadians. Dr Albert Ng has IPL; he claims to be trained by Toyos. uptowneye.ca also has IPL but I believe their setup is different than Toyos. They seem to use the same setup as standard skin IPL.

[deep_dry_eye]

Hi Adrian. Yes, the lemon/tea is what worked for me, but not necessarily for everyone else, as we can all have different root causes and our bodies are all unique. If you are looking for natural treatment, perhaps given you have low testosterone, you can try weight lifting and making changes to your diet to foods that can help your body produce more testosterone, I posted a link earlier in this thread. Do you have MGD and/or aqueous tear deficiency?

To answer your questions:

I have very little, if any, photophobia anymore. It did subside as my eyes became less dry, however my retina problem can also cause photophobia. So I do think my light sensitivity was a consequence of the dryness. And it is not certain what caused the dryness, but likely it was due to autoimmune disease (although all autoimmune tests have been negative), complicated by reduced or partial blinking due to excessive computer use and three hour daily work commute, and possibly due to long term contact lens wear.

Actually there are several people with dry eyes I've come across who have photophobia. I'm not a doctor, but it seems many of them had at least MGD like me, but am not certain. Perhaps the photophobia has something to do with the stability of the tear film, which can be affected by meibum quality or lack of meibum.

Sclerals did not help my photophobia with fluorescent lighting and sunlight at all, but when I first got them I was able to use the computer a little more so I guess it helped in that way, now that I think back. But I have heard others who say it has helped their photophobia. The only way for you to tell if it can help yours is to go for a scleral consult. As part of the consult, at least for the Boston PROSE sclerals which I have, they have you try on a sample pair for a hour or so. During that time you can try going outside, looking at your phone, etc. to see if it helps or not, and whether you can even tolerate sclerals, as not everyone can.

Hope this helps, and that you find a solution to your dry eye and photophobia soon.

I wonder if you had your hormones checked out? Testosterone, Bioavailable T, and DHT can be affected by green tea -- I may never get an answer, but I'm trying to understand how and why the green tea helps you (but not others).

https://www.costco.com/Kirkland-Sign...100220250.html

This is the green tea you use right? I'm going to give it a try as well.

[Hokucat]

Hi Adrian. Yes, the lemon/tea is what worked for me, but not necessarily for everyone else, as we can all have different root causes and our bodies are all unique. If you are looking for natural treatment, perhaps given you have low testosterone, you can try weight lifting and making changes to your diet to foods that can help your body produce more testosterone, I posted a link earlier in this thread. Do you have MGD and/or aqueous tear deficiency?

To answer your questions:

I have very little, if any, photophobia anymore. It did subside as my eyes became less dry, however my retina problem can also cause photophobia. So I do think my light sensitivity was a consequence of the dryness. And it is not certain what caused the dryness, but likely it was due to autoimmune disease (although all autoimmune tests have been negative), complicated by reduced or partial blinking due to excessive computer use and three hour daily work commute, and possibly due to long term contact lens wear.

Actually there are several people with dry eyes I've come across who have photophobia. I'm not a doctor, but it seems many of them had at least MGD like me, but am not certain. Perhaps the photophobia has something to do with the stability of the tear film, which can be affected by meibum quality or lack of meibum.

Sclerals did not help my photophobia with fluorescent lighting and sunlight at all, but when I first got them I was able to use the computer a little more so I guess it helped in that way, now that I think back. But I have heard others who say it has helped their photophobia. The only way for you to tell if it can help yours is to go for a scleral consult. As part of the consult, at least for the Boston PROSE sclerals which I have, they have you try on a sample pair for a hour or so. During that time you can try going outside, looking at your phone, etc. to see if it helps or not, and whether you can even tolerate sclerals, as not everyone can.

Hope this helps, and that you find a solution to your dry eye and photophobia soon.

[Adrian]

So somehow the lemon/tea was what my system needed for my meibomian and lacrimal glands to function better.
...
Also, I wear sclerals 12+ hours a day to help with some dryness I still have from lost/atrophied glands.

Hi Hokucat. This green tea and lemon juice treatment is surreal. I am glad it worked for you.

I think I read that green tea was not good for some glands and for some precursors of testosterone of which I have a low level. But I read a lot of things that are not true and I have a box of organic green tea so I may try.

A question: when your tears increased, was your photophobia reduced proportionally? In this case, do you think your light sensibility was a consequence of eye dryness, or both are a consequence of another thing, still unnamed by doctors? Well, the first question is easy, but you are to obliged to answer the second one.

I think only a few people with dry eyes have photophobia, do you have a theory about what is different in this people? And lastly, do you think scleral lenses alone could reduce dry eye-photophobia? My dryness is relatively mild, but my light sensitivity is strong enough to keep me away from screens and sunlight (without dark glasses).

[hosanna13]

Deep_dry_eye, I am also Asian and unfortunately, MGD/dry eyes is more prevalent among us (I read a stat where 80% of Asians have MGD). Of course, not all are symptomatic. It's crazy that your TBUT is 10 and you are suffering so much. Mine is consistently 0. I too hope to get lipiflow at least every 3 months and use azasite for maintenance of glands. My optho told me probing is too traumatic. It is quite easy to express your own glands daily using the paddle tool at home and a magnifying mirror.