Advice On Treating Meibomian Gland Dysfunction (Lipiflow/Q Tips/other ideas??)

[Kabuto]

Hi everyone,

So about two years ago, I got a Meibomian Gland Dysfunction diagnosis. My doctor then had recommended the Bruder eye mask, lid massages afterwards, & Omega 3 supplements. After a while of doing all this, I also added Refresh Plus eye drops to the regimen.

Now, I had another Dry Eye exam yesterday. According to their results of this latest exam, my condition hasn't really improved all that much.

The doctor recommended I continue with Bruder/massage/Omega 3 - but recommended I change my eyedrop to either Refresh Optive Mega3 OR Retaine Eye Drops. Thus, I will change my drops and continue my regimen- but am I convinced this alone will make a big difference?

I have some other options. My doctor said I could be a good candidate for Lipiflow- as even though the glands are blocked, they are not inherently damaged, and can be restored. This does cost about $690, as this isn't a procedure insurance covers at the moment. At this point, I'd splurge anyway, given that I really want to treat this. However, I've heard mixed feelings on Lipiflow.

Famous NY dry eye doctor, Dr. Latkany, for example, tends to avoid Lipiflow and use Q Tip treatments. However, Dr. Latkany doesn't accept my insurance either, and I don't know the first thing about the Q Tip method...

So as a result, I'm quite lost as to how to proceed. I'm not sure what action to take- but I do know that I really really want to treat this Dry Eye. Any suggestions on how to take action with this?

[MGD1701]

Hi Kabuto

Thanks for sharing.

Dr. Latkany
It is very interesting to know he '' tends to avoid Lipiflow and use Q Tip treatments.'' Any idea why? How does he treat MGD then? So curious!
LipiFlow is FDA approved and I have tried it and it helped me about 65% - unblocked glands.

Monitor treatment plan
How did your dr evaluate his treatments?
Did you take LipiView, compared Lipi layer thickness, inflammation test MMP-9, osmolarity etc?

Thanks!

[Kabuto]

Hi Kabuto

Thanks for sharing.

Dr. Latkany
It is very interesting to know he '' tends to avoid Lipiflow and use Q Tip treatments.'' Any idea why? How does he treat MGD then? So curious!
LipiFlow is FDA approved and I have tried it and it helped me about 65% - unblocked glands.

Monitor treatment plan
How did your dr evaluate his treatments?
Did you take LipiView, compared Lipi layer thickness, inflammation test MMP-9, osmolarity etc?

Thanks!

I don't know much more about Dr Latkany's methods than you do to be honest- as mentioned, he doesn't accept my insurance, so I haven't really had the chance to talk to him about it.... But from what I understand, he tends to use Q Tip scrubs. The receptionist over the phone of his office says he doesn't use Lipiflow..

As far as the evaluation, I'm not sure. It's a pretty comprehensive Dry Eye exam though, so I'd imagine they tested most of this stuff.

[Hokucat]

Hi Kabuto. Do you know the quality of the oil from your glands (normal, frothy, thick like Crisco Oil), and if there are some glands producing little or no oil? Your eye doctor should be able to see this by pressing firmly on several of your glands.

If there is still some oil, gland expression, LipiFlow, or IPL by themselves or in combination has helped some in this forum. From what I’ve read, seems less people have been helped by LipiFlow than IPL, but LipiFlow is more widely available...both can require several treatments before seeing improvement. Gland expression is often performed just prior to IPL and probing procedures. If none of these three work, you may have scar tissue, which in that case only probing can unblock the glands. Both expression and probing are very uncomfortable procedures. Probing is also very invasive, but for my situation having many glands with scar tissue, it was necessary.

pythonidler did a write-up that includes in-depth explanations of Treatments for MGD (plus much, much more). Would definitely recommend you read this section, as it explains expression, LipiFlow, IPL, probing, at-home treatments, etc. very well. It’’s also a great resource to help those starting their dry eye journey get up to speed, and I’’ve even learned a lot from it as a dry eye veteran.

http://forum.dryeyezone.com/forum/dr...nduced-dry-eye

[deep_dry_eye]

Are you on Restasis + Xiidra? Those drugs can help reduce inflammation and help MGD.

$690 for two eyes is quite cheap from LipiFlow prices I've seen. You should also consider IPL, as IPL can also help reduce inflammation in your glands.

[MGD1701]

Well, some doctors who do not have IPL nor LipiFlow, treat dry eye with great success. For example, Prof. Dara Chan (from Canada). She says most of her patients can not afford these expensive treatments so she offers expression. I have high respect for her great passion to help. So lucky to habe such doctor.

Warm Compress
She recommends 20 times a day, each time 5 min. and it is effective.

---------------------------------------------
IPL, according to opinion leader, Professor Preeya Gupta (from USA)

most successful for patients with
*advanced MGD, (mild to serve) evaporative DED
*+/- Rosacea or Seborrheic Dermatitis
*Telangectasia lid margins

. a non-laser light source
.suitable for almost any patient
(Dr Toyos, 1st dr who applied IPL to treat dry eye, mentioned in one of his videos that there is NEW model which suits for (almost) all skin types, I recalled)

[deep_dry_eye]

MGD1701, are you from Canada? I would love to compare notes w/ you if you are from Canada.

Yes, these treatments are expensive for a variety a reasons (ranging from profit machines for drs; but also these machines are also expensive). Regardless of price, it should be an option for those who can afford them. Personally, I find these options while expensive, worth it, because the alternative is permanent damage to my eyes which would obviously impact my career and future earnings.

[MGD1701]

Hi deep_dry_eye

Great you tackle your problems actively - very wise.

You mentioned in another post that you did LipiFlow 4 times and do IPL monthly.
I assume you then dont need to do warm compress at all at home?
I wonder if dr recommends you omega 3 supplements and lid hygiene?? These are equally important/effectively..

I did LipiFlow too in order to save glands - right decision - helped about 65%.
Luckily, recently I have finally found a dr who expresses my glands.
I will do it on a regular basis - this is all I need.
I am so happy - it is so so hard to find! No idea why, as it is so easy - just with q-tip, takes about 30 sec. for 1 eye.

[deep_dry_eye]

MGD1701,

I did LipiFlow 4x in the past, not doing any more LipiFlow atm, but doing IPL monthly now.

I still do warm compress daily, approx x4 each 5 mins. I feel oil expressed after each warm compress around 80% of the time. On bad days, I don't feel any oil.

I do omega 3, PRN or Nordic Naturals , however I don't find that it helps.

I also do Xiidra and Restasis both BID, I find both drugs to be critical in reducing inflammation. I highly urge you to consider both BID and ask your dr about it.

I also do autologous QID, however I don't find autologous to help.

[MGD1701]

Hi deep_dry_eye

Restasis
You are lucky to get it. No doctors prescribed me which was a big mistake.
Prof./Dr Sheri Rowen says she prescribes it right in the beginning to control inflammation and I think she is very right. None of 10 doctors said I had inflammation but the Lid spray with HOCL works - which explains I did have but maybe too low so doctors failed to detect it???? That is why I said Prof. Rowen is very right.

[deep_dry_eye]

Hi deep_dry_eye

Warm compress
I do about 13 min, 43-45C and feel oil flowing & feel great afterwards. Not sure if 5 min is enough???
Recent study by Dr C Blackie (partner of Dr Korb) shows 45C and reheat can achhieve the best results.

many or most opinion leaders in USA recommend HydroEye (omega 3 + GLA etc).

What have helped me: omega 3 + GLA + pure HOCL spray, like Avenova.

Restasis
You are lucky to get it. No doctors prescribed me which was a big mistake.
Prof./Dr Sheri Rowen says she prescribes it right in the beginning to control inflammation and I think she is very right. None of 10 doctors said I had inflammation but the Lid spray with HOCL works - which explains I did have but maybe too low so doctors failed to detect it???? That is why I said Prof. Rowen is very right.

I visited 10+ drs, most of them did not prescribe it to me till I hit the 11th. You need to ask for it. Most drs are not well informed on how to treat dry eye.

Get yourself on Restasis and Xiidra.

Warm compress, its different per patient, and yes I read 15 mins 45C is better.

[diydry]

I'm still working on my warm compress game. I've tried Occusci/Bruder mask 5 minutes 2x a day for months now, now I'm trying 10 minutes 2x a day. I microwave for 10 seconds one side, then 11-12 seconds on the other side. Repeat at 5 minutes.

Honestly, I never feel oil come out, and my eyes feel no different afterwards. It's crazy. I don't really get why. When I had Lipiflow done earlier this year, the optometrist said I definitely had oils come out after the procedure, although the consistency is really bad. She looked closely at it. I wonder if I need to do a gland self-expression to force the oils out.

I tried using finger massage after compress and even purchased UK product eye peace for several weeks but again, I notice absolutely zero difference. Thinking about buying one of those medical expression tools you can purchase online, but I don't want to damage the glands (the meibography shows that the glands are still largely intact but a little abnormal in shape). Other ideas?

FYI, before LASIK, I would do a 5 minute 1x day warm hand towel compress to manage my blepharitis, and it worked like a charm. Virtually asymptomatic if I did 1x per day minimum. After LASIK, it inexplicably get a lot worse. Such a mystery. Thanks for your tips.

[deep_dry_eye]

I'm still working on my warm compress game. I've tried Occusci/Bruder mask 5 minutes 2x a day for months now, now I'm trying 10 minutes 2x a day. I microwave for 10 seconds one side, then 11-12 seconds on the other side. Repeat at 5 minutes.

Honestly, I never feel oil come out, and my eyes feel no different afterwards. It's crazy. I don't really get why. When I had Lipiflow done earlier this year, the optometrist said I definitely had oils come out after the procedure, although the consistency is really bad. She looked closely at it. I wonder if I need to do a gland self-expression to force the oils out.

I tried using finger massage after compress and even purchased UK product eye peace for several weeks but again, I notice absolutely zero difference. Thinking about buying one of those medical expression tools you can purchase online, but I don't want to damage the glands (the meibography shows that the glands are still largely intact but a little abnormal in shape). Other ideas?

FYI, before LASIK, I would do a 5 minute 1x day warm hand towel compress to manage my blepharitis, and it worked like a charm. Virtually asymptomatic if I did 1x per day minimum. After LASIK, it inexplicably get a lot worse. Such a mystery. Thanks for your tips.

Did you try IPL, Xiidra and Restasis as well?

Autologous might help your symptoms, and you might want to try Prokera to heal the nerves after LASIK.

[diydry]

Thanks. I have not tried IPL yet, I'm interested in trying it, but it's currently not offered at any of the doctors I've been to. No one has mentioned Prokera to me. I thought amniotic membrane was meant to restore corneal erosions and epithelial damage, but maybe I should ask my doctors if it can help with corneal nerve damage.

I've been on Restasis 2x a day for 7+ months. I'm not sure it's helped, either with my MGD or tear production. I'm planning to stop it after my last box is up to see if there is any discernible difference. Xiidra I have not tried in earnest, I tried it for maybe a few weeks before a specialist told me to switch to Restasis.

Curious if any others can relate to my warm compress regime above and have suggestions.

[MGD1701]

Hi diydry

Warm Compress
Likely your problems: insufficient temperature and time.

Based on my experience & intensive research
-constant heat & enough time. Recent study from Dr C Blackie (MGD expert) team shows 45C & reheat achieve the best results, such as Bundle Method.
-Best indication: feel oil flowing (like when I received LipiFlow treatment) and feel great afterwards -- these are my own finding.

Now my oil is ok, I do 42.5-45C,13-15 min, (plan to cut to 10) twice day. Note: too long (& over massage) could make eyes dryer. In the beginning I did 10 min as all doctors recommended - just wasted time as no oil flowing feeling.

Bephastem is effective/safe for its constant heat 42.5C & moist. Professor Clara Chan from Canada, recommends 5 min, 20 times/day while Dr Sandra Cremers suggests 15 min, day x2.

Manual Expression by dr
Better find a dr to express glands on a regular basis as we are not skillful (+ some doctors actually do not recommend massage at home - but they do not provide solutions unfortunately.) If your oil is not so thick, it is piece of cake for them, may just take 1 min with q-tip.