LipiFlow device - what the????

[linguininess]

Demodex

Hi PG & linguininess

Do you feel gritty and it disappear after using Cliradex wipes?
Or sometimes feel something are moving in the eyes (just a few seconds?)?
I have such feeing recently, I suspect it might be demodex

Thank you!

Yes, cliradex definitely helps with the gritty feeling. It does sting though and causes a lot of irritation. I think it may be causing more harm than good. I have stopped all lid wipes and scrubs after seeing Dr. Toyos. I'm currently on my second IPL treatment with him, and he informed me that doing lid scrubs and wipes causes more inflammation to your lid margins when you are physically scraping the margins.

Gland expression is painful, so you would know if he did it. They use a metal tool on one side, and a qtip or something like that on the other side and they squeeze. Like popping a pimple. One gland at a time. Did he do this? I had IPL 4x followed by expression. This was super helpful for me.

Have you treated the demodex with Cliradex wipes?

Been using cliradex pre-IPL but has not really helped with the redness or dryness or glands. You've had IPL x4? When did you finally start to see positive changes in your MGD? I am 6 days after my second IPL with Toyos and I feel no improvement.

[deep_dry_eye]

Thanks so much for the advice! I think I want to try both; might make sense to try plugs first. I will see what my ophthalmologist says later this month. I know my glands are blocked and nothing came out when my doctor pressed them, so I feel like Lipiflow would be good. Don't want to mess around with gland atrophy. I am already on Xiidra, Omega 3s, and using a warm compress mask.

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.

[MGD1701]

Hi
aqueous deficiency
Have you taken Sjö Diagnostic (blood) Test (Bausch + Lomb)? to detect biomarkers for Sjörgen’s syndrome/SS?
The test is a valuable diagnostic tool & the advantage is it can detect SS 4.5 years early than the traditional test.

effective Lidhygiene is important for MGD.

LipiFlow helped me opened ALL glands and 3 doctors said I did not need probing.
if your glands are blocked and nothing come out - good to find out WHY? inflammation or scar tissue (probing helps this).
If you have inflammation - very important to put it under control as it makes glands worsening.

recent study shows a combination of Omega 3 + 6/GLA are more effective. I am trying this now and seems that is the case.

Inflammation: did dr do InflammaDry test to make sure you do not have (or low) inflammation before putting plugs?
''The test has been shown to significantly and positively correlate with corneal fluorescein staining scores and abnormal superficial corneal epithelia as seen with confocal microscopy.'' ......By Mark Schaeffer, OD January 1, 2017'', for your info.

[LHeston2]

Thanks so much for the advice! I think I want to try both; might make sense to try plugs first. I will see what my ophthalmologist says later this month. I know my glands are blocked and nothing came out when my doctor pressed them, so I feel like Lipiflow would be good. Don't want to mess around with gland atrophy. I am already on Xiidra, Omega 3s, and using a warm compress mask.

[Hokucat]

I agree it's important to address the root cause, however, as Charlie says, it's important to get symptom relief in the meantime. So it may be a good idea to try the plugs now, especially since it's a relatively simple procedure to insert them. Usually they start with lower plugs first, and if that alone does not help, they may also plug your upper ducts at some point. For some members in this forum, quadra plugging made a difference.

I have only the lowers plugged, from early on. It didn't resolve my problem, but recently I noticed my right eye was feeling a little drier than normal, and then noticed the plug was missing. So it was helping some.

I had Lipiflow several years ago, but it didn't work, probably because I had severely blocked glands, several with scar tissue, which ultimately I had unblocked with probing. Besides Lipiflow and probing, there are other next level treatments to address MGD, like manual gland expression, IPL, etc.

[MGD1701]

Good you know lots of info on your situation incl. oil/glands etc. Lucky you.

In office expression: did you feel better after expression?

[deep_dry_eye]

Have you taken Sjö Diagnostic Test (Bausch + Lomb)?
Manual in-office expression: Why doctors are not willing to do it?

A lot of drs I've been to say they don't think its helpful.

Doxy: you said you dont have inflammation, why take doxy?

The doxy does seem to be helping me to thin out the oil despite no visible inflammation. I believe the inflammation could be internal and the Dr just can't see it?
I also responded positively to Azyter (topical azithromycin) -- it was the best drops I've had, even better than lotemax. I don't have access to Azyter (or Azasite) anymore in Canada -- so I figured to either try oral doxy or oral azithromycin. I'm still debating whether to switch to oral azithromycin.

Glands/oil status: how many glands are alive, are they clogged? your oil is thick or toothpaste like??

I have around 80% of both upper and lower lid glands expressible via light finger pressure AFTER warm compress according to my last visit to Dr. The quality is decent, I have an odd gland or two that is toothpaste.

However, despite the glands expressible, I'm more worried there is internal blockage and hence considering probing. However, it is hard to quantify the risks of probing -- i.e., reading some stories on this forum, there seems to ppl to have probing and not help at all, or help a bit then stop working, and worse case scenario, im worried itll damage my glands with more/new scaring internally.

I've also read that some Drs used to do probing but stopped -- why did it stop? Not effective? Doesn't work? Causes damage? Even if its not effective, it isn't usually a reason to stop doing a procedure; but rather if they stop doing a procedure completely, it makes me think it can cause harm (i.e., risks outweigh the reward).

allergy: red eyes: did you check if allergy issues??

I test negative for allergy skin test.

[deep_dry_eye]

Since my eye doctors can physically see I have some tear film now and my eyes FEEL good, they do not take my TBUT or Schirmers anymore, so I have no idea what it is now. I guess it would be interesting to know, but seems when the symptoms subside, there's no pressing reason for doctors to take those tests. But I also have an unrelated retina problem I've been spending my time on with other eye specialists, so have not been focused on getting all the latest dry eye stats, given the dryness is manageable now.

I don't know how many functioning glands I have now. And I have not had a full fledge manual expression since my last probe almost two years ago, as my eyes have continued to feel better. I do plan to go back for a follow up with my probe doctor at some point, so may ask her to give me the status of my functioning glands, at least an approximate percentage.

Please, would you report back the TBUT, Schrimers, and # of functioning glands, quality of meibum pre-post your probing procedure. You can probably get it all if you ask for a copy of your medical records and your MD/OD takes detailed notes. It's good for yourself to know, as well as good for the rest of the dry eye community if you don't mind sharing! It would be nice if you wrote up a detail post. This will help others to decide whether to go for probing a lot. The clinical signs (i.e., TBUT etc...) may not be a good indication of dry eye, but they are objective statistics to look at.

I use the Costco Kirkland Green Tea (matcha + sencha). I use a spoon to tap the tea bag against the cup in warm water ~100 times, until it's a really dark green. I think the main thing is make sure the green tea is not on the browner side, otherwise most of the nutrients were processed out. Then I squeeze in the juice of 1/6 slice of a medium/large Meyer lemon. I often add a slice of crushed ginger too. I drink it right away, so it does not lose it's potency. I do this 2x daily. Yes, I stopped drinking the lemon/tea after one month, and within a week my eyes started feeling dry again, so this was my confirmation it was indeed the lemon/tea. Plus I methodically made only one diet/supplement change at a time, so I could isolate what diet changes helped, and also what negatively impacted me (like sugars, gluten, dairy).

I will give this a try, thanks!!

[CharlieGreenEyes]

I've got so confused (especially when I panic about my eyes and the situation) that I couldn't work out what was best - and what to try first.

But I think I've finally decided that, for me (everyone will have different priorities and needs for their eyes), it would be best to get plugs asap (I was going to have them but put it off because I wanted to try to clear the inflammation first). I've decided that the end-goal is as effective as possible treatment for the disease, but I need something to ease the symptoms in the meantime - to enable me to function better in everyday life (and hopefully ease the pain and soreness).

[MGD1701]

Have you taken Sjö Diagnostic Test (Bausch + Lomb)?
a blood test that identifies biomarkers for Sjörgen’s syndrome. The test is a valuable diagnostic tool & the advantage is it can detect SS 4.5 years early than the traditional test.

Manual in-office expression: Why doctors are not willing to do it?

Doxy: you said you dont have inflammation, why take doxy?

Glands/oil status: how many glands are alive, are they clogged? your oil is thick or toothpaste like??

allergy: red eyes: did you check if allergy issues??

[Hokucat]

I didn't have any visible scar tissue either, nor were my glands inflamed. I told my dry eye specialist at the time that I was going to try probing, because my glands did not secret much oil and my TBUT time was virtually nil, so I suspected only probing could unblock my glands. Besides, it was one of the few treatments left I had not tried. I had to find my own probe doctor, as several years ago probing was uncommon, and my specialist had never heard of it, so had no one to refer me to.

Probing is a little more prevalent now, so I don't think you need to go Dr. ******, if you can find a doctor in Canada with some experience. Faith1989 is supposed to have the procedure in Canada this week. Perhaps connect with her in the next few weeks to see how it went and the name of her doctor. I did not go to ******, I was fortunate to find a couple doctors locally with some probing experience, at a much more reasonable cost, plus the majority was covered by my insurance.

Since my eye doctors can physically see I have some tear film now and my eyes FEEL good, they do not take my TBUT or Schirmers anymore, so I have no idea what it is now. I guess it would be interesting to know, but seems when the symptoms subside, there's no pressing reason for doctors to take those tests. But I also have an unrelated retina problem I've been spending my time on with other eye specialists, so have not been focused on getting all the latest dry eye stats, given the dryness is manageable now.

I don't know how many functioning glands I have now. And I have not had a full fledge manual expression since my last probe almost two years ago, as my eyes have continued to feel better. I do plan to go back for a follow up with my probe doctor at some point, so may ask her to give me the status of my functioning glands, at least an approximate percentage.

I use the Costco Kirkland Green Tea (matcha + sencha). I use a spoon to tap the tea bag against the cup in warm water ~100 times, until it's a really dark green. I think the main thing is make sure the green tea is not on the browner side, otherwise most of the nutrients were processed out. Then I squeeze in the juice of 1/6 slice of a medium/large Meyer lemon. I often add a slice of crushed ginger too. I drink it right away, so it does not lose it's potency. I do this 2x daily. Yes, I stopped drinking the lemon/tea after one month, and within a week my eyes started feeling dry again, so this was my confirmation it was indeed the lemon/tea. Plus I methodically made only one diet/supplement change at a time, so I could isolate what diet changes helped, and also what negatively impacted me (like sugars, gluten, dairy).

[deep_dry_eye]

LipiFlow MIGHT improve the disease (i.e., clear the glands of your thick oil, unclog any clogged glands). This may hopefully lead to better symptoms later.

Punctual Plugs just improve your symptoms without improving the underlying disease.

You need to treat the underlying disease (whether it may be warm compress, Omega 3, LipiFlow, oral/topical antibiotics, Restasis/Xiidra, or something else) -- else the underlying disease may go worse and your glands may die. However, be warned, Drs will push for LipiFlow since its expensive and a good profit maker for them, however that doesn't mean the treatment isn't good for you or that you can't shop around for cheaper LipiFlow pricing.

[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?

[MGD1701]

How often: depends how clogged. some needs 1-3/month. Drs are not willing to do it so he/she can earn more money from IPL, LipiFlow perhaps??
I find doctors do it are sosososo kind - this shows they really have passion to solve our problems. unfortunately, I could not find such service.

These two tests are pretty standards for many doctors now in USA. If you understand more, you will realize the big difference.

[deep_dry_eye]

Hi Deep_dry_Eye
Did you try manual expression by doctors on a regular basis (to unblock glands)? This is effective, studies show.
We are just not skillful enough to unglock them by massage.

Maybe TearLab's Osmolarity & InflammaDry tests could help you get more precise diagnosis = effective treatments.
Schirmer only tells tear production - not so useful, in my view.

What is regular expression? Once every wk? I get mine done approx once ever 6 wks. The Dr's here aren't really willing to do it, even when I ask for it explicitly they push back.

I have not had those tests done before. But I think the test results won't matter, they'll still put me on Restasis regardless? I just started on Restasis... I wish I tried it earlier, I've already suffered 1yr of dry eyes