LipiFlow device - what the????

[Waesk]

Hi Guys,

I have been lurking on this forum everyday for the past 4 months.

I have MGD and evaporative dry eye.

I have tried warm compress, Pred forte, Optimel Manuka honey and many different tears.

My condition has been getting worse over time. Eyes are burning and are bloodshot with a lot of veins.

I am scheduled in for my first lipiflow session today.

I will keep you updated on how I get on.

Cheers,

Kane

[Waesk]

Hey Hokucat,

Thank you so much for you reply. I have been drinking green tea with lemon ever since I came across your post in the triumphs section. Your story is very inspiring and gives me hope.

I think it might be from either excessive use of devices or medication that I was give when on a trip to thailand. I uses Visine alot when I was younger so it could be from this also.
I have not been tested for auto-immune diesease.
The specialist said that when they push on my lids that oil does come out but it is a little thick and of low quality. The inside of my lids and eye balls are very inflamed and has gotten worse over the last few months.

I have been looking at the lens today and think I will ask my ophthalmologist about this tomorrow.

I have also been on the GAPS diet for 2 days. It is hard but I am willing to try anything.

Thank you again for your response it is comforting to know we are not alone in this battle.

If you have any more advise for me please feel free to throw it my way

Kane

[MGD1701]

Hi Kane
I also did LipiFlow no much relief.

Vit. D and A - Good to check these out.

[Hokucat]

You're welcome, Kane. Thanks for providing further background.

You mentioned excessive use of devices might be a cause. I've read people blink 60% less when using devices. If this is you, your eyelids are not pressing together often enough to release oils in your glands, causing blockage and MGD. When you had the LipiView consult, did their tests show you were not blinking enough or had partial blinks? If so, doing hourly blinking exercises can be helpful.

If you try sclerals, it's important to see a practioner who has extensive training and experience fitting sclerals. Since there is not a PROSE clinic in Australia, there are a couple non-PROSE fitters in Australia listed in the scleral resource below, which Rebecca sent out in one of her recent KeratoScoop emails. My PROSE doctor and another doctor I heard good things about are on the list, so hopefully this is a good resource for you:

http://www.sclerallens.org/scleral-fitters

Autologous serum tears may help with the surface of your eyes. These are eye drops made from your blood serum, which have properties very similar to tears. This would need to be prescribed by the ophthalmologist.

I'm glad reading my original post gave you hope you can get through this. This forum is certainly a wealth of information and support. You will find the thing or combination of things that will help you, it just may take some time.

[regularjoe]

I am new to the forum, and trying to wrap my head around the all of this stuff, specifically with regard to Meibomian Gland Dysfunction (MGD) which I suffer from.

From my readings here and elsewhere, it seems there are 3 Heavy Hitter procedures you can have done for MGD:

1. Lipiflow
2. IPL
3. Probing

Am I missing a big procedure, or is that the Big 3? And, though I am sure it is a can of worms even asking, what is considered to be the most effective option of the 3? The least expensive? The least dangerous? The best bang for the buck?

My cursory reading gives me the impression Probing offers the best results, but is the most expensive and dangerous; requires the most surgical skill. IPL is the least invasive, and least expensive, and I haven't read any injuries from it, and I feel like it is considered more effective than Lipiflow. Lipiflow seems like it is the most common treatement, best marketed, middle-of-the-road in expense, but usually only mildly effective?

May be I have this all wrong? Maybe I am missing an effective surgical intervention? Please let me know! I am new, but have done a ton of reading here.. I may be confused.

FWIW, I live in Toronto, and only Lipiflow is offered here. There are some doctors offering IPL in my province, but (surprisingly) they are a few hours away. No one offers Probing, but if this was the Holy Grail I would do what I needed to, travel-wise, and expense-wise. But so far I am not sold on it.

Thanks so much! *smiley icon*

Regular Joe

[pythonidler]

Hi Joe,

Lipiflow, IPL, and probing are probably the most talked about procedures on this forum. I'm aware of a couple other options as well:

• MiBo Thermoflo, by MiBo Medical Group - a heated massage of the outside of the eyelids. My intuition tells me this procedure is not likely to more effective than a heat mask you can put into the microwave, since it heats the glands from the outside.
• Heated manual expression - like probing, but using heated probes instead of cold ones. As far as I'm aware, only Dr. Korb out of Boston has offered this procedure. But since Dr. Korb is affiliated with TearScience, the maker of Lipiflow, I'm not sure he offers heated manual expression anymore.

My doctor did probing on me, and told me it is meant to be a one-time procedure to clear out scar tissue. All the other procedures (Lipiflow, IPL, etc) are maintenance treatments to be done every few months, to keep the oils flowing. When asked him to rank the effectiveness of these maintenance treatments he said it was, in order from most effective to least effective:

1. Heated manual expression
2. IPL
3. Lipiflow

Personally, I've had both IPL and Lipiflow done. Neither worked for me before I had probing done, probably because the scar tissue was blocking my glands. After I had my probing a few months ago, I had three more IPL treatments and am due for my 4th next week. I noticed an improvement after my second IPL. I'm lucky in that I've found a doctor who can do this procedure for a relatively cheap price. Additionally, my insurance has accepted my claims on IPL, and once I meet my deductible (which I probably already have), they will only cost me $35 per session.

In conclusion, for me IPL is probably the best "bang for the buck." Lipiflow may be less effective, and is an order of magnitude more expensive than IPL.

[MGD1701]

Hi Joe,

Here is an interesting/useful case report (Jan. 2017), comparision of: LipiFlow, Blephasteam, Bruder mask, MiBoFlo
title: ''The Limitation of Applying Heat to the External Lid Surface: A Case of Recalcitrant MDG''
I have been curious about this topic. I have tried three of above except MiBoFlo.
full text https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301113/

If you have stye often, you might have scar tissues then BlephEx/probing should help.

IPL seems very effective for people with both Rosacea & MGD, I have read.

[linguininess]

Well, looks like I'm just checking off yet another item on a list of very expensive treatments.

I have papillary conjunctivitis (though the insides of my eyelids don't look THAT extreme when you google the images of this condition) and MGD. I think the reason behind my red, inflammed eye lids is due to allergies. I only think this because I get extreme relief when using Pataday, unfortunately the preservatives in pataday cause my eye to go back to being irritated and red after only a few hours. I also think this because I did't get any positive results from MG probing + steroids.

So about lipiflow: I knew subconsciously that this treatment wouldn't work for me. Luckily, I do have money to spare so I said why not. Turns out, the lipiflow treatment made my eye lids worse afterwards. My lids now feel stiff, dry, burning/stinging..basically they feel like I'm at a beach and the sand and salt water are irritating my lids.

I'm not sure what else to try. I am on allergy shots, though I won't be seeing results until a year from now. I'd love to try pataday again but the preservatives end up doing more harm than good. I recieved PF ketotifen, but I get no relief from that (I guess only pataday helps me with my allergies). No relief from: autologous serum, lid scrubs, supplements, doxy, night goggles, PF re-wetting drops, probing, prokera, and now lipiflow.

I'm trying to stay positive, but it seems like allergies+lipiflow, allergies+probing, or allergies+anything just aren't good combos. Lipiflow introduces heat, which "activates" my allergies. I feel relief from irritation with cold washes and compresses, but they end up feeling dry a few moments later.

I'm not sure what else to try. I'm trying my best to stay positive. My next step is to tackle my chalasis. I saw ****** a few months ago who diagnosed me with chalasis. I assumed that he literally tells every patient they have chalasis, but I've seen many world-top doctors here in Beverly Hills who also say I have chalasis. I'm just worried because even if I do go for the AMT procedure, it will treat my chalasis but will obviously not help my MGD or allergies. Even so, I'm still willing to do this procedure if it means improving my symptoms.

I'd like to hear what other people are doing for their eyes and lids when they have extreme allergies like me.

[Hokucat]

Yes, there are some drops the compounding pharmacies are not able to make because a company has the patent on the active ingredient, or I guess even a patent using the active ingredient in a certain application or something. I've come across that before on a different eye drop.

Perhaps try looking for a different ingredient allergy drop that is preservative-free. In the U.K., Catacrom is often mentioned for allergies and it's PF. Perhaps that active ingredient is available in the U.S.

http://www.moorfieldspharmaceuticals...tacrom_PIL.pdf

[PhoenixEyes]

Another preservative free allergy option is Hylo Dual (available in Europe via Scope and Ursapharm, Canada via Candorvision). I think it was also known as Hycosan Dual in another dispenser. Also called Hylo Protect, CONISAN N, Collypan, Ectohyal, Eye-t in certain countries (based on the Ectoin site).

It's also meant to help spread lipids / oils more evenly across the eye which might help with evaporative dry eye due to MGD.

0.05% Sodium Hyaluronate and 2% Ectoin

http://www.ectoin.net/EN/home/

http://candorvision.com/hylodual/

http://www.scopeophthalmics.com/hylo/hylodual

http://www.butterflies-eyecare.co.uk/hylo-dual.html

Study regarding effect on lipid layer / meibomian oils:

http://www.sciencedirect.com/science...05273614001837

[linguininess]

Yes, there are some drops the compounding pharmacies are not able to make because a company has the patent on the active ingredient, or I guess even a patent using the active ingredient in a certain application or something. I've come across that before on a different eye drop.

Perhaps try looking for a different ingredient allergy drop that is preservative-free. In the U.K., Catacrom is often mentioned for allergies and it's PF. Perhaps that active ingredient is available in the U.S.

http://www.moorfieldspharmaceuticals...tacrom_PIL.pdf

Thanks Hokucat I tried finding this in the US, but to no avail, I was not able to find it after calling many compounding pharmacies in the US.

Another preservative free allergy option is Hylo Dual (available in Europe via Scope and Ursapharm, Canada via Candorvision). I think it was also known as Hycosan Dual in another dispenser.

It's also meant to help spread lipids / oils more evenly across the eye which might help with evaporative dry eye due to MGD.

0.05% Sodium Hyaluronate and 2% Ectoin

http://www.ectoin.net/EN/home/

http://candorvision.com/hylodual/

http://www.scopeophthalmics.com/hylo/hylodual

http://www.butterflies-eyecare.co.uk/hylo-dual.html

I love Candor Vision products. I have every single one of their products. I used to live in Quebec (which is where they're based), so their products were easily available in pharmacies. Unfortunately, the allergy drop from Candor vision isn't as effective for me specifically.

[linguininess]

So I've always had ocular allergies since as long as I could remember, but my eyes always felt 100% okay. They were a little red when I wore contacts as far as I can remember since I was in middle school, but they definitely looked way worse than they felt. As of 6 months ago, I started experiencing dry eye pain and discomfort from what I guess was years of wearing contact lens that I was allergic to. Now, my lid margins feel burn-y and dry and stiff... I tried probing by ****** 4 months ago : no relief at all and I think it somehow caused more irritation. I tried lipiflow 1.5 months ago : no relief at all and caused my lid margins to burn even more so.

I've been seeing an ENT, rheum, endo, derm doctors. All have performed their respective lab tests, blood tests, ultrasound, CT scans and etc, however everything came back normal. So frustrating! The only thing that was abnormal were my Vitamin D levels, but that was on the border of normal and low. I am continuing doing allergy injection shots, but I am only on week #9 so it's too early to tell if it is effective. I find 0 relief from warm compresses, and only temporary relief from cold compresses. I find mild relief from blephedex and avenova, it helps but it definitely is not a cure.

The only thing I can think of is that my redness and irritation is mostly caused by allergies. I had a dramatic reaction to dust mites that my allergist was shocked. I do what I can with dust: pillow and mattress covers, proper air filtration, AC vent filtration, etc.

My glands were grade 3 according to another doctor at Ocala Eye. Grade 3 being toothpaste-like quality and grade 1 is like olive oil. Even after lipiflow and probing, my oil seems to still be grade 3. I literally have no idea what to try next other than wait for my allergy shots to have some effect which could take up to a year unless I do cluster or rush shots. Olopatadine is effective but the preservatives seem to negate its effectiveness. This doctor also suggested I try a gluten-free, sugar-free, dairy-free diet and to up my omega3 intake. I've done all that but there's been so significant progress.

Anyone have any idea on what to do?

[PhoenixEyes]

Are you already wearing moisture chamber glasses to reduce exposure to irritants? Ziena, 7Eye, WileyX etc.

Looking at this page on dust mite allergy I wonder if using humidifers for your dry eye actually increases the dust mite population, "dust mites hate dry and cold air, so try to air the house and don't use an air humidifier". This page also mentions some types of eye drops "sodium cromoglicate, nedocromil, or antihistamines (eg azelastine)".

http://www.netdoctor.co.uk/condition...-mite-allergy/

Have you already tried preservative free antihistamine ketotifen Zaditen / Zaditor?

https://www.ncbi.nlm.nih.gov/pubmed/24388379

There's also preservative free Hylo Dual for allergies with Ectoin in it.

http://www.ectoin.net/EN/home/

[MGD1701]

.................

[MGD1701]

Hi
Do you guys also feel oil secretion when perform Blephasteam or other sorts?
My dr finds it hard to believe which is to my suprise.

After using the facial steamer/44C, I always feel oil flowing in about 3 min.
today I tried Bruder - no oil feeling & actually did not feel so great as with Blephasteam
- maybe becasue of dry heat??

Massage:
Many doctors do not recommend massage (to avoid damage cornea) but
my doctors consider massage is better. I therefore come up with an idea:
forcefully blinking for about 3 min. when do Blephastem= LipiFlow? (kind of), I think.

Blephastem is great to monitor oil status.

[MGD1701]

Yes, if not, my eyes are unhappy.
Such moist heat is the best to remove debris, especially in the morning, my experience tells me.

[fernellen]

I am faithfully using bruder mask (moist heat) eyes feel nice after — kind of damp, but they look no different than before I used mask. Why? Also, I only masssge under eye brow. My corneas are too delicate; prone to eruptions

[mbperso]

From my experience :

Blephasteam:
+ constant heat, moist heat
- not enough warm, more expensive

Bruder:
+ moist heat, easy to use and quickly
- heat not constant, moist heat not long enough, lasts only 5mn, needs microwave twice

Meibopatch with wet cotton rounds : (My favorite solution)
+ pretty constant heat, lasts for 10mn
- Needs to wet the cotton rounds and put the mask in a freezing bag

[DKott27]

I have MGD, dry eyes, blocked glands, etc. I've had this for a long time. Good days, bad days. But this last week it's been unbearable to the point where I want to die. It is so bad I can't take it anymore. I feel like I'm going to rip my eyelid off my eye at any moment, Luckily it is only one eye so I only need to do the one. How much does it cost?

[DKott27]

Would Medicaid cover it? So my diet is very good. But maybe what I eat isn't sitting right? I eat the same thing everyday. Always eat chicken for dinner. Protein shakes in the morning. Veggies, brown rice, pasta....I do not eat unhealthy. I'm just trying to do something right now, I can't handle this anymore.

[Hokucat]

Once you find a doctor who does probing (or other procedures), you can usually ask them to check with insurance whether it's covered and how much you would have to pay. Some doctors do not take any insurance at all.

During my worse years, Genteal Severe Eye Gel helped give me a little relief when nothing else did. It stays on the eye longer than drops, and I found it soothing:

https://www.amazon.com/GenTeal-Sever.../dp/B0000534X3

Here's a post where I outlined what helped me get better and continue to be able to manage my symptoms, including food, in case there's something here you want to try:

http://www.dryeyezone.com/talk/forum...ccumulate-info

I hope you get some relief soon.

[MGD1701]

Hi Dkott,
I did LipiFlow which helped greatly, mainly opened glands. I did not do probing prior or after given the fact that I do not scar tissue issues, I was told.
It is wise to know your causes, problems so you can solve them more effectively/economically.
Some people did LipiFlow, probing, IPL still not much relief later did Mibo x4 times then helped.
Some peple just need BlephEx. How about inflammation, Omeg 3, warm compress, lid scrubs/lid cleanser which also play important roles.
Good luck!

[linguininess]

I've done what I could with my blocked glands. My glands at the moment are still there, they are just blocked with toothpaste oil. I've tried tons of treatments:

- lipilow
- ****** probing
- 6 months of fish/flax oil
- 2 months of doxy
- cold and/or hot compresses
- lid wipes/cliradex
- moisture chamber glasses
- gels and ointments = absolutely hell for me
- given up gluten and sugar for 2 months

At this point, I'm literally just checking off boxes for every other over-priced treatment there is for MGD. I have only tried 1 treatment of IPL, but I am wondering if I should try the entire 3-6 treatment course of IPL. I am a bit skeptical since my skin is olive skin (I'm latino/asian, which is why I discontinued after only 1 treatment), but if you compare my skin's darkness color, it's pretty much the same as caucasian.

I have an appointment with Toyos this weekend and would like to hear anyone's opinion on whether or not the cost is worth it.

[MGD1701]

Hi PG
Thanks for sharing and congratulations.

Indeed, it is hard to beleive (all articles I have read said the oppositive) so could you be kind to clarify:
Do you mean lid hygiene and massage, or just lid hyiene cause inflammation? WHY??

What kind of infammation you refer to, bacteria or demodex??

Thanks a lot! I am sososo curious!

[Bodziu]

Hi,
I had 3rd IPL treatment last weekend. It did help from the first one, 2nd,3rd I feel did nothing good or better but was able to give up all my eye drops. Maybe I did not need them at all? It is a bit strange because I feel the pain of dry eyes, all the symptoms but yet it is kind a better. So maybe the placebo effect ? Never the less, I'm better but kind feeling getting a bit worse now. I don't know. So will it help you or not leave it to professional consultation I guess as everybody is different and my particular case won't much even 10% of yours. If they recommend it, hey go, if you can afford it, go. But there are side effect. Had to cold sores, gum infection and lately cold, weird as I consider my imm.sys.strong and never get all at once. And another thing, got a floater, big like a flying fly before my eyes. Not sure too many coincidences. I hope the treatment lasts for a while or is it like a boutox. So conclusion is, not sure still have morning eyes pain, what do ppl do for it, tried ointments, my eyelids get swollen, can't use it.
On the bright side there is one thing which works and maybe will for others too, cheap. hydrochloric acid face mask, 10-20 doll. for a pack, put on a face every second day for 30 min, relief comes the next day, wears off on third day. O BTW, I had so much treatment without any results I can say you ppl are not alone, in general nothing works as problem is multiple-fold, the final result is dry eye syndrome. Any body using Xidra? How's that new development working, I hope better than restasis as everybody's dream is to find the magic bullet.
And another finding, be careful what you put on your face, soup, cream etc, all goes to your eyes you wanted or not. Good for skin may not particular mean good for you eyes.
regards
B

[Bodziu]

Hi,
had 4 IPL's already, well kind a better but some days are bad (what's new) and some days not too bad. So not sure if that 600$ was worth it I suppose yes as I'm better I think but don't expect miracle here.
B

[deep_dry_eye]

I probably developed MGD via poor blinking (i.e., partial blinks, excessive computer usage) over a long period of time (years). I also may have a deficiency in aqueous and mucin. Due to poor optometrists and opthamologists, I was misdiagnosed without proper course of treatment for several months (and possible years). It is very important to find a good dry eye specialist who will work with you to get a good diagnostic. My insurance company spend thousands on Harvard education opthamologists that never diagnosed me and just told me to use artificial tears while my MGs got worse. Also be warned, the practice that offers LipiFlow will sell you the LipiFlow treatment, the practice that offers IPL will sell you the IPL treatment etc… It is important to educate yourself and don’t just rely on your OD/MD.


Symptoms/Background

• Male, mid 20s, ethnic Chinese, skinny (minimal muscle mass)

• Inflammation (red eyes).
• Tired, foreign body sensation, light sensitivity.
• TBUT <5secs (high variability).
  • Note sometimes I have 10secs TBUT but still feel miserable.
• Schirmer's Strip Test <5mm (high variability).
• Meibography (LipiView) shows some gland disconnect, kinks, dropout and atrophy.
  • LLT ranges from 30nm to 50nm (high variability).
• MGs are expressible after some pressure with the Mastrota paddle. The oil is generally thick but no discoloration. The # of expressible MGs range from 15 to 25 (high variability) per eye. I have an odd gland or two that are thick thick white toothpaste.
  • According to one Dr, I have 21 MGs expressible per eye w/ some paddle pressure (1 wk after latest LipiFlow treatment; 1wk into doxy).
  • According to another Dr, I have 50% of my upper MGs and 80% of my lower MGs expressible with just light finger pressure (2 wks after latest LipiFlow; 2wk into doxy).
• Sticky and loud blinks. I can literally feel the stickiness of the oil and hear myself blink very loudly from the thick oils.
• No signs of demodex.
• No signs of blepharitis.
• No signs of rosacea.
• Symptomatically, I feel the best in the mornings and late nights. It’s the afternoons and early evening when I feel the worst.
• Bloodwork for autoimmune is negative, however testosterone is on the lower end (10 nmol/L).

Treatment

• Warm Compress
  • I use 4-8 times per day with 10 to 15mins each time at approx 45C. I am quite aggressive with this, and I do attribute a lot of my MGD progress to warm compress. My glands were filled with thick oil that were not coming out via regular blinking, so we need to heat it up and liquefy the thick secretions and make it easier to get the bad oils out of the glands before production of the new oils kick in. There are plenty of research papers out there suggesting warm compress to be effective in many patients.

• Lid Massage
  • After warm compress (or sometimes by itself), I do a gentle lid massage. I massage the upper lids downwards fashion, and the lower lids upwards fashion. The idea is to express the oil and keep the glands open.

• Blephasteam
  • Don’t waste your money on this product, microwave warm compress is way better.

• Blinking Exercises
  • When your eyes blink (with contact, i.e., not a partial blink) they squeeze the MGs to express oil. If you don’t blink properly, your MGs don’t express oils and eventually they get clogged and die. I literally spend all day thinking about blinking properly. Go watch a Netflix movie and train yourself to consciously blink (fully) the entire movie.

• Omega 3
  • I take around 3000-4000mgs of DHA+EPA in triglyceride form per day. Note the triglyceride form is supposedly much better than the ethyl ester form. I can’t find any quality research papers to statistically suggest Omega 3s to help MGD, but it doesn’t seem to hurt. I use Nordic Naturals Ultimate Omega 3.

• LipiFlow
  • I’ve performed it 3 times approx 3 months apart each time. Cost is 1.5k CAD per treatment. I am still not quite sure how effective this treatment is, but I don’t think it hurts and the physics/logic of the procedure seems sound. I am actually considering LipiFlow every month to ensure my glands are unblocked. I feel repeated frequent LipiFlow should be complemented with warm compress. However, there are research papers out there that suggest LipiFlow is no more effective than warm compress.

• Mibo Thermoflo
  • Don’t waste your money on this treatment, microwave warm compress is way better.

• Cliradex/Ocusoft Lid Scrub
  • I was doing Ocusoft lid scrubs daily and now switched to Cliradex morning and nights.
  • According to Drs, my lid margins are relatively clean and these don’t seem to help.

• Physical Activity
  • I’ve found moderate cardio to help me. I run ~5 times per week at 30mins 6mph, I find a high correlation that my eye inflammation to be down after running and when I was on the Azyter my eyes will be filled with oil after running.

• Punctal plugs
  • Tried the temporary (collagen) ones, didn’t work for me.

• Artificial Lubricants
  • I’ve tried Hylo (including the Dual and Gel versions), Retaine MGD, Refresh Advance Optive, Bausch and Lomb Soothe all without much symptomatic relief.
  • Bausch and Lomb Soothe XP works somewhat but contains preservatives and cannot be used long term.
  • The delivery vehicle of Xiidra and Azyter gives the most immediate symptomatic relief.
  • I find on a short term basis (i.e., less than 30 mins), the artificial tears give some relief, but after that I feel like the tears wash away my good natural tears and make my symptoms even worse.

• Prescription Topical Eye Drops
  • Xiidra (Lifitegrast). I tried it ~2months but did not help me. The ophthalmologists that prescribed it to me did not even check my MG glands! It was a classic, let me charge you $$$ and take some medication and now go away and use more artificial tears.
  • Lotemax. Gives immediate symptomatic relief, however steroids can not be used long term due to IOP, glaucoma, cataracts and other risks.
  • Azyter (topical Azithromycin). It seems to help by being an anti-inflammatory. I was on it for 2x2wk trials. It seems effective after 3 days, and during the trials the glands seem to be open, MGs express easily with minimal finger pressure and lots of oils in the afternoons as well. Note Azyter is preservative free available in EU, while AzaSite contains preservatives and available in the USA. Neither are available in Canada.

• Prescription Oral
  • Doxycycline (Apprilon 40mg/day; 30mg + 10mg slow release). It seems to be help by being an anti-inflammatory. After around 2wks, the glands are open and the MGs express easily with minimal finger pressure. From personal observation and symptomatic relief, it doesn’t seem to be as good as the Azyter (at least at the 2wk mark). Cost is around $100 / month at Costco Canada.

Current Treatment

• I just started Cyclosporine (Restasis). I suspect a lot of my dry eyes (both MGD, aqueous and mucin deficiency) may be attracted to some inflammation problem. Despite Xiidra not working for me (after 2 month trial), I’m now trying Restasis. It’s been more than a year since my dry eyes started and I am quite miserable, and not too hopeful since the research literature suggests only around 15% of the population respond to it. Fortunately, I experience none of the side effects of restasis. Cost is aroudn $200 / month at Costco Canada.
• Doxy. I’m still continuing the doxy at 40mg per day.
• Warm compress. This is probably very important.
• I am debating oral Azithromycin (since I can't get topical Azithromycin drops in Canada; especially since the Azyter gave me the best relief thus far of all my treatments) -- I can get a perscription from my MD, but I am not sure what dosage to go on -- I was thinking 500mg loading dose followed by 250mg every 2 days.
• I am debating IPL.
• I am debating probing.

Any comments/suggestions are welcome!! I am a fellow sufferer and it has greatly impacted my career (can't work).

[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?

[Adrian]

Hi DDE. Thank you for the information.

I saw the Tear Science site and the tests (LipiView, LipiScan, Korb MGE). I don’t know if I can find this machine in my city. I live in Buenos Aires, Argentina, which is a big city, but it seems to be quite precarious in terms of dry eye tests and treatments (well, it is quite precarious about a lot of things). An ophthalmologist offered me collagen plugs, but he only has the smaller size, which I don’t know if this is common with other doctors from other cities. And it is difficult to find a dry eye “specialist” or something similar.

I understand there are other methods to do a meibography. Can a doctor see what is seen in a meibography with a slit lamp and a proper light? I mean, probably it is not necessary to take a photograph. So I don’t know if my ophthalmologist saw my MGs properly. Besides, if Accutane is the culprit, maybe there is nothing wrong with the glands, visually, only that they produce less oil, their activity is “inhibited”, in the same way that it inhibited the sebum glands of my face. I am just guessing. Probably there is no inflammation in the MGs. But it would be very interesting to see how thin is the lipid layer in my eyes, and there is a Tear Science test for this. In fact, it would be interesting to see a graphic representation of the tree layers, is there a test for this? (I think I saw once a test made in France, on the Internet of course, but I don’t remember the name)

I haven’t tried autologous serum. It is costly, and I was willing to try plugs first, that is what my doctor told me. If you try it, let me know how it works.

If Allergan itself says Restasis is not effective, and that it doesn’t know how it works and if it is really the cyclosporine or the castor oil or whatever, I imagine it is less effective than that. But that doesn’t mean it couldn’t work for you. A box of Restasis should last three months, applied two times per day. You will see at the end of that period if you notice a difference. Also, if it works as lubricant, you could try Endura UD, or even castor oil alone, if that is safe. I think your case is different from mine.

[Adrian]

DDE, so your first symptom is grittiness? And burning? Mine is burning, and if I don’t push my sight, it is my "only" symptom, apart from photophobia which is at the origin, and certain discomfort or tension, sometimes. Light dries my eyes and then appear the other symptoms (pin-like pain, headaches in the region around the eyes, blepharospasm, and other awful sensations). But I learnt how to avoid these other symptoms, and this implies having some limitations, or doing things differently.

[LHeston2]

Hi,
I have recently been diagnosed with MGD and aqueous deficiency. My eye doctor recommended lipiflow, but I already have an appointment to get punctual plugs first. Anyone have success with either?

[LHeston2]

You might want to also try Restasis as well. I have MGD and Xiidra didn't help me (but I was only on 2 month trial). You can go on both Restasis and Xiidra, esp if your insurance covers it. Restasis (while only works on some 15% of the population) has slightly more literature behind improving MGD if there is an inflammatory cause. You might also want to go on doxy to thin out the oil as well, even if there is no visible inflammation.

Thanks, I am considering Restasis, but I worry about how long it might take to start working. I did not think of doxy, so I could try that.

[MGD1701]

Hi LHeston

InfammaDry Test:
Woo, seems the test is great. Do you think it is more accurate than the examindation by slit lamp?
Did your dr dectect sources of infammation?

[LHeston2]

I wanted to update that I did get the lower plugs. They seem to be helping a bit, although I am doing a lot of other things that could be contributing to my improvement (Xiidra, Omega 3 oil, Retaine MGD drops, Bruder mask every night, cleaning lids). I did find out that I tested positive in the Early Detection Sjo test for one of the autoantibodies...my rheumatologist thinks I am on the path to having Sjogren's.

[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.

[hosanna13]

Hi Rellis, I also had Lipiflow a few weeks ago, but I did not have this kind of problem. How do you feel about the procedure? I think my meibomian glands are secreting more oil now. Did the tech put in lidocaine drops prior to putting in the cups? Some others told me no drops were put in, and I would have preferred that as well because lidocaine itself is irritating.

[Rellis]

Yes, I did get some sort of numbing drop before putting in the cups, but I'm not sure if it was lidocaine. Unfortunately, I can't tell any difference in before and after the procedure. If anything, my right eye (the one that's irritated) seems worse. I'm going in to see my doctor today.

[linguininess]

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.

I had this exact sensation. After lipiflow, my upper lids felt stiff and burny... it didn't hurt, it just felt like lipiflow really annoyed and irritated my eye lids. I am 5 months post-lipiflow and I have no positive results.

[sophie0416]

Well guys I’m literally crying in my doctors office cause they just checked my glands and did the Meibography.

I have a bunch of dead and atrophied glands.

Remeber once I asked about dark spots between my glands? That’s right your guessed, dead glands.


I am absolutely devastated.

The doctor is one of the best ones in Virginia and I am glad I drove 2 hours to meet him. I don’t feel like driving back home though. I really want to stay in bed and cry.

My glands are super atrophied and a few left. He’s offering lipiflow to save the few I have left . Is it worth it? I’ve been reading a lot and sometimes people say they get more irritation and no help. He’s telling me this is my only chance to save the glands I have left.

Is it true? What do I do?

[wakeupscreaming]

Hi Sophie,

This is my own personal opinion:
My doctor recommended LipiFlow as well. Through the LipiView test, the assistant distinctly showed me that my eyes were secreting oil from the Meibomian glands -- they showed the colorful oil coming out -- even though several of mine were worn out. So the assistant clearly showed me I had oil coming out -- i saw it on the LipiView screen.
But when the ophthalmologist came in to the room, he was trying to convince me I need the LipiFlow treatment, at a cost of $1000 Cdn.
I chose NOT to get it.
I wasn't convinced it was because of any Meibomian gland clogs -- even the assistant showed that it wasn't. If there was clogging, the oil wouldn't have been coming out as easy.

I don't have the web link, but I came across a study on hot compresses doing the exact same thing that LipiFlow does -- heats the meibomian glands and melts and liquifies the fats so they aren't clogged anymore (that's even IF they are clogged to begin with).
If you read up about LipiFlow, that's all it's doing. It's not doing anything more magical. It's just got fancy clips that go right on your eyelids.
Basically you can melt fats that are possibly clogging your MBs with a hot compress on your eyelids at a steady 40 degree celsius (104 degree Fahrenheit, but don't quote me on that, I'm not American) for 6 minutes. Even hot baths and putting a hot wash cloth on your eyes would help.


I'm getting frustrated with my dry eye, MG issues as well.
My own opinion, is that it is bacteria that colonizes our bodies, and it just happens to screw up all the balances in our eyes, and causes all these problems, like Meibomian Gland Dysfunction, Redness, tearing, Dry Eye, Blepharitis, etc.
So all of these treatments that Ophthalmologists are pushing really aren't curing our problem, it's just treating the symptoms.

[sophie0416]

Hi! I haven't been here in a while.

Since I mentioned on one of my posts during the holidays my family came to visit me, so I just was too busy and forgot to take my vitamins.. OH BOY, this past few days my eyes are like DESSERT dry, dear God I'm doing like suuper super bad : (

Thank you everyone for their response regarding their lipiflow experience..that someone mentioned it.. they did that test to check how much oil I was producing and he said some of the glands were producing a little bit and the majority of them was fine.. as you can see on the picture of my glands, I have

"a lot of good ones"

I missed my appt to do it, it was about 2 weeks ago, but I've been so busy and he's so far away that my boyfriend needs to drive me there.. to be honest I haven't had the time, and the more I read about it the more I'm convinced not to do it... It's not just about the money, but I do warm compresses everyday and this past few days that I've been bad, it doesn't really help, I feel like I dont know, like my glands are already producing whatever they can, you know?

I stopped making appt with more doctors, I don't even want to think about this anymore it's so time consuming, I'm even having problems at my job because of this, I'm always late because of so many appts...

I hope I don't offend anyone by saying this, but now, I'm just doing whatever it's in my hands, I'll use my warm compress, my vitamins, my eyedrops, and then I pray. If someone can help me get through this, it's God. I'm tired.

[nathalia.g]

Hi Sophie, I'm reading forums on dry eyes and it is disheartening to read that you have lost hope in doctors and dry eye treatments and still having issues with your dry eyes.

I am 1.5 years post lasik and started to have dry eyes after the surgery. I have never been able to attain the 20/20 vision on my own - initially I was able to see crystal clear when placing tear drops in but I feel as though that doesn't happen anymore. I recently went to the optometrist and was told that my eyesight has regressed. Every time I have had a follow up at the doctors office that did my lasik, I am always told it is just the dryness causing the blurry vision but my vision is 20/20. Recently I noticed that I was able to see a sharp image when looking through a wine glass (curved glass) and I thought, will glasses help me see? I got trial contact lenses from the optometrist I saw and I was able to see crystal clear. So now I am in doubt that it is"just the dryness" causing my poor vision - I fear that my vision has indeed regressed.

I recently did some reading up and found out about lipoflow. However I wanted to know how it worked for others who have tried it. I am considering going for a consult to assess my meibomian glands as I produce a lot of tears but no oils for them to stick.

[Jeffery0808]

Sorry my English is not fluent, so have some mistakes.

I did PRK last year and had lived well till December last year.

From end of 2017, I felt that my eyes are burning and itching. So I went to my doctor and he said that I had MGD.

He prescribed Restasis(?) and Diqua(?) for 3months, but it didn't help me at all. Also I did warm compress with cleaning lid margin and didn't feel any outcome.

So I got 1st IPL at and of Jan, and it helped me quite a little bit, but still felt uncomfortable. After 3 weeks, I got 2nd IPL and went to Taiwan for trip. and at there my eye condition got severly worse

(guess caz of motorcycles everywhere and smokes). So when I come back home, I have been taking tetracycline.

Before I got IPL, I can't use notebook even an hour a day, but I can use computer now. But still uncomfortable while taking class, or just hanging outside.

I took mibography and 90% of my meibomian cells are good. Doctor said that it's a destructive MGD and have to do 4 or 3 sessions of IPL.

Next monday, I'm going to have 3rd ipl + lipiflow together. I will keep writing how my eyes go on.

Thank you

[Jeffery0808]

It helped when I first got it but after about a month went back to normal. I’m going to do it again next week. Found a new doctor that charges half. I’m planning on doing it once every 6 months. I I don’t understand why it’s not covered by insurance yet.

After a month? well.. if it lasts 6months i think it can be reasonable. Did you got IPL too?

[shakenbake]

Haven’t done IPL yet. I may have been focusing on my tear production instead of my oil glands because a previous doctor said they were fine. Dr. Cremers tried to express them and they were not fine by any means. Only had 3 oil producing glands in my lower left lid. So I think I’ll concentrate on mgd for the next couple months.

[Jeffery0808]

Miserable... LLT went down even i had finished 3rd ipl and lipiflow.

[bobXfr]

Conclusions Drawn from Nonclinical & Clinical Evaluation The results of the evaluation demonstrate that the iLux System is substantially equivalent to the LipiFlow Thermal System as it pertains to the indications for use and device performance.

The iLux arm of the study met the criteria for non-inferiority relative to the LipiFlow arm for the coprimary effectiveness endpoints – Meibomian Gland Score (MGS) and Tear Break-Up Time (TBUT) and the secondary effectiveness endpoint – Ocular Surface Disease Index (OSDI).
• MGS improved significantly from baseline in both treatment groups at both week 2 and week 4. MGS improvements did not differ significantly between the two treatment groups at either follow-up visit.
TBUT improved significantly from baseline in both treatment groups at both week 2 and week 4. TBUT improvements did not differ significantly between the two treatment groups at either follow-up visit.
• OSDI improved significantly from baseline in both treatment groups at both week 2 and week 4. OSDI improvements did not differ significantly between the two treatment groups.

There was a total of four device/procedure-related adverse events (AEs) of any type. All AEs were observed in the iLux arm and consisted of: burning sensation without skin findings (n=2), petechial hemorrhage in lower lids (n=1), and transient decrease in BSCVA with findings of superficial punctate keratitis (n=1). All were self-limited, transient, and resolved without sequelae.

The secondary safety endpoints were: 1) discomfort and pain, and 2) changes from baseline for ocular surface staining, Intraocular pressure (IOP), and BSCVA (Best Spectacle Corrected Visual Acuity). • Pain scores were significantly lower from the baseline for both treatment groups, immediately post-treatment, and at day 1, week 2 and week 4. Immediately posttreatment, the mean pain score was significantly lower for the LipiFlow arm than for the iLux. Pain scores did not differ significantly between the two treatment groups at day 1, week 2, or week 4. • Discomfort scores were significantly lower from the baseline for both treatment groups, immediately post-treatment, and at day 1, week 2 and week 4. Immediately posttreatment, the mean discomfort score was significantly lower for the LipiFlow arm than for the iLux. Improvements in discomfort scores did not differ significantly between the two treatment groups at day 1 or week 2. At week 4, however, the discomfort score was significantly lower for the iLux group. • Ocular surface staining was significantly increased immediately following treatment in both treatment groups. At day 1, week 2, and week 4, the ocular surface staining significantly reduced relative to baseline in both treatment groups however did not differ significantly between the two treatment groups. • No clinically significant changes in IOP were observed immediately post-treatment or throughout follow-up in either treatment group. • BSCVA was significantly reduced relative to baseline immediately post-treatment in both treatment groups but not to a clinically meaningful level. At week 2 and week 4, BSCVA was significantly improved relative to baseline in both treatment groups, but the change was not different between treatment groups.

see:
https://www.accessdata.fda.gov/cdrh_...17/K172645.pdf
and
https://www.youtube.com/watch?v=8qjd...ature=youtu.be

[phenix01]

After one year of suffering from dry eyes and visiting numerous doctors that told me my eyes were fine, I learned about Lipiflow.
I went to the clinic and score 46 and 51, with all my glands blocked and 15% atrophy.
1 week after lipiflow I already see improvement but hoping it keeps on going.

The one thing I am puzzled about however are my ghosting/starbursts symptoms. Although all my glands were clogged, I never really had red eyes, but did feelthe burning sensation.
Today, my eyes feel healthy, but I have no improvement in my ghosting/starbursts symptoms which I believe started 1 year ago with dry eye.

Currently battling inflammation (doc put me on cortisone and xiidra), although I am not sure there is inflammation (eye is not red!).

Can inflammation cause ghosting/starbursts? Any opinion?

[mbperso]

mbperso unfortunately, before that test I was already doing a lot to reduce inflammation - including taking Lotemax daily, taking 3000 mg of omega-3 daily, and going on a gluten-free diet. Those PRP injections really jacked up the inflammation in my eyes.

Hi python,
Sorry,I'm not sure to understand: you did PRP injections into the meibomian glands ? did it help ?

[pythonidler]

Hi python,
Sorry,I'm not sure to understand: you did PRP injections into the meibomian glands ? did it help ?

I had injections into the lacrimal glands. Probably 1-2 minutes after the injections my eyes started to feel gritty for the first time in over 2 years. The grittiness was from nerve deterioration caused by the rapid increase in inflammation. I've had intermittent grittiness ever since then. That's why I warned people about this - so that they don't increase the inflammation in their eye.

[farmgirl]

Has that resolved somewhat pythonidler or is it still the same as when it first started.\?

[fernellen]

Am scheduled for lipiflow; still doing research

[fernellen]

Thanks. I have a five week appt with optometrist. started lid scrubs and warm compresses when everything went south. If improvement stays at this, I will be satisfied. I don’t expect miracles. Disease is at stage 2 1/2. I am hoping the lipiflow and post care will slow negative progress

[fernellen]

Went to gym (lost strength and endurance, working on getting it back despite sticky feeling and some discomfort) appetite coming back; continuing regimen; not ready for travel yet. This was a big set back.

[fernellen]

Not a good day; tearing and burning; eye drops helping a bit; have to go to work at 3:00; will start hot and cold compresses in an hour.