LipiFlow device - what the????

[MGD1701]

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.

[deep_dry_eye]

Probing was beneficial for me because almost all my glands were blocked, many with scar tissue, only a few expressed anything when pressed and only then very thick Crisco-like oil. So IPL likely would not have worked for me. But since you have several expressible glands, probing might not be necessary, perhaps just IPL. Did your meibography show you had any scar tissue? A few people in this forum found doing probing first, and then maintaining with IPL helpful because they may have had scar tissue to be cleared first.

Thanks for your reply. I've been told I have no vissible scar tissue on top of the glands, but I don't know inside the glands. I believe my DRs are not qualified to make that judgement. Should I visit Dr Mask for a consult?

I'm just afraid he will sell me probing regardless of whether I do need it or don't need it.
How many glands do you have now? What is your TBUT and Schirmers? How much has the probing improved your expressions?

After unblocking your glands, to prevent the cycle from repeating, it would be helpful to change the quality of your meibum from the inside out. Looks like you started doing that trying doxycycline and Omega-3s. You may also want to methodically try changes to your diet. I actually had five probe procedures over two and a half years, and after the first four, despite making continual adjustments to my diet, my glands quickly got blocked up again. After my fifth/last procedure, I adding fresh squeezed lemon juice to my strong green tea 2x daily, and within a week my eyes were more moist. I have continued to drink this and have not had a debilitating dry eye day since, almost two years ago. So somehow the lemon/tea was what my system needed for my meibomian and lacrimal glands to function better. Here's a post where I listed factors that helped me improve, including diet changes, in case there's something there that might help you:

I saw your other posts -- I will give the lemon juice + strong green tea a try. Do you have a specific green tea you drink? I want to keep it exactly the same as you since you have some results.

Have you tried stopping the lemon juice + green tea to confirm its actually helping, and then restarting it?

You might also consider a temporary low dose testosterone treatment just to see if that is the root cause. Weight lifting is also known to increase testosterone.

Also, I wear sclerals 12+ hours a day to help with some dryness I still have from lost/atrophied glands.

I'm not sure how to read my testosterone, according to the lab report, its within the labs "reference range" -- but when I google the number, it's definitely on the low side.
I am considering those as well -- my prescription is too high for goggles : (

Thanks for the reply again!

[Hokucat]

Hi there. The fact that you still have several expressible glands, and that your TBUT can be as high as 10 seconds at times are good things. This is coming from someone who had almost completely blocked glands, 0-1 TBUT and zero Schirmers.

Hopefully Restasis will help with your tear production, it can take several months before you see any results.

As far as your meibum, I think you are on the right track considering IPL and probing to help unclog your glands. As part of both those procedures, many doctors also manually express the glands to get out all the old, thick oil build-up, which is also helpful to make way for new oils.

Probing was beneficial for me because almost all my glands were blocked, many with scar tissue, only a few expressed anything when pressed and only then very thick Crisco-like oil. So IPL likely would not have worked for me. But since you have several expressible glands, probing might not be necessary, perhaps just IPL. Did your meibography show you had any scar tissue? A few people in this forum found doing probing first, and then maintaining with IPL helpful because they may have had scar tissue to be cleared first.

After unblocking your glands, to prevent the cycle from repeating, it would be helpful to change the quality of your meibum from the inside out. Looks like you started doing that trying doxycycline and Omega-3s. You may also want to methodically try changes to your diet. I actually had five probe procedures over two and a half years, and after the first four, despite making continual adjustments to my diet, my glands quickly got blocked up again. After my fifth/last procedure, I adding fresh squeezed lemon juice to my strong green tea 2x daily, and within a week my eyes were more moist. I have continued to drink this and have not had a debilitating dry eye day since, almost two years ago. So somehow the lemon/tea was what my system needed for my meibomian and lacrimal glands to function better. Here's a post where I listed factors that helped me improve, including diet changes, in case there's something there that might help you:

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

For you, it may be some other diet changes, especially given your testosterone is on the lower side. There are foods and supplements that help boost testosterone.

http://www.healthline.com/health/low...food#overview1

You might also consider a temporary low dose testosterone treatment just to see if that is the root cause. Weight lifting is also known to increase testosterone.

Also, I wear sclerals 12+ hours a day to help with some dryness I still have from lost/atrophied glands.

Am glad you are asking questions in this forum. There's lots of people who are or have been in the same boat as you, and want to help. Hope you find some relief soon.

[MGD1701]

GLA: there is one doctor mentioned GLA in this forum (some years ago) - please search it or google ''GLA'' to find out what kind of food, not many, about 5 types. More info could be found from this professional magazine http://www.optometricmanagement.com/...17/august-2017

Cliradex is with tea tree oil for demodex while HOCI/Avenova is for bacteria - they are different.

[deep_dry_eye]

What helped me and you did not mention:
lid cleanser with pure HOCI, like Avenova but I can not get it - which I have found by myself.
None of my doctors know about HOCI. Several doctors said I did not have inflammation but it helps me.

Omega 6/GLA: new study shows a combination of omega 3 & 6 is more effective, what I have read.

Thanks! I am doing scrubs (Cliradex/Ocusoft Lid Scrub) right now -- but I dont think they help me. I was told my lid margins are relatively clean.

Can you give me a source on Omega 6? I was under the impression Omega 3 is anti-inflammatory and good, while Omega 6 is an inflammatory.

[MGD1701]

Thanks for sharing. Well, I can not agree with you more that we can NOT count on doctors.
I visited more than a dozon, only one was honest to tell me, ''sorry, I can not help you.'' - last year.

After exploring these and that, I solved most of my problems and my eyes are now manageable!
It is really NOT fair that WE have to pay such big prices
(incl. expensive treatments etc)
If doctors are not capable/knowledgeable, WHY not tell us the TRUTH??
Maybe they would, if they also need to pay the prices??

What helped me and you did not mention:
lid cleanser with pure HOCI, like Avenova - which I have found by myself.
Omega 6/GLA: new study shows a combination of omega 3 & 6 is more effective, what I have read.

[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).

[PG]

I just read about probing, and it includes expression but it is not done in the same manner as I described for IPL -
"MGP inserts sterile stainless steel wire probes through the natural gland orifice to physically and directly unblock the orifice and ductal obstruction from thickened meibum and other non-fibrotic sources of obstruction. "

I would not do IPL without expression ...

[MGD1701]

Thanks. Do you find IPL without expression would still helpful?
No doctors here express glands after IPL (nor with probing).
We dont even have in-office expression here. Thanks!

[PG]

IPL helped to unclog glands. I have not done LipiFlow or probing.

[MGD1701]

Hi PG
Glad to know IPL helped you - for clogging glands?
Did you do LipiFlow, in-office expression, probing too? IF so, the order? Thanks

Thanks!

[MGD1701]

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!

[PG]

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?

[MGD1701]

Inflammation:
I think demodex could also trigger inflammation.
1% Ivermectin Ointment, studies show it is effective/safe to treat demodex.
Ocusoft now has a ready kit to treat demodex performed by doctor.

allergy component: how to test it and for what items? I only did a test by dematologist on pollen.

Probing: Do you feel better after probing? I have read that probing could also cause some level of damages, then it makes the blocking glands more worse? Do you agree such statement?

[linguininess]

Just curious, did Dr ******
1) express your glands (after/before) probing?

2) tell you WHAT cause your blocked glands?
I do know allergies could cause blocked glands.

3) recommend you take/increase Omega 3, do LipiFlow again?

before: no
after: I asked about that. they said he DID express my glands, but i only remember them probing + injecting steroids into each gland. If they did do expression, it didn't last long. I pretty much almost left immediately after the probing finished.

He said I tested positive for demodex and that I have an allergy component. I have been taking olopatadine for years now, but my lids are still inflammed from allergies. Steroids were also no help in reducing the inflammation

He didn't recommend to take or increase omega3 nor lipiflow. Literally just said to do probing and AMT surgery