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

Hi guys, Has anyone trying Meibomian gland probing?

I've attached just stopped my serum tears. I didn't find it too helpful and my glands have improved so much that I can go by the day without feeling super miserable. Don't take it the wrong way, I'm definitely not cured, still have constant foreign body sensation, tiredness, and occasional burning.

We have pretty much the same symptoms...seems like anybody with even mild MGD or ADDE thatvhas trauma to the eye, ends up with these ocular surface sensations. My eyes are dry, don't get me wrong, but they're probably less dry than before the accident. The accident changed my , cornea, my lids, the nerves, etc.

[deep_dry_eye]

I was reading through this thread and saw you post about serum. Serum at 4x a day did a little bit for me, not much, but still worth it. Once I went to 8-12 times a day, serum helped A LOT. Serum is very much dose dependent. Just throwing it out there because if you can afford it, and don't care, I'd use serum all day long. I believe you will notice a significant benefit at that dose.

I've attached just stopped my serum tears. I didn't find it too helpful and my glands have improved so much that I can go by the day without feeling super miserable. Don't take it the wrong way, I'm definitely not cured, still have constant foreign body sensation, tiredness, and occasional burning.

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.

I was reading through this thread and saw you post about serum. Serum at 4x a day did a little bit for me, not much, but still worth it. Once I went to 8-12 times a day, serum helped A LOT. Serum is very much dose dependent. Just throwing it out there because if you can afford it, and don't care, I'd use serum all day long. I believe you will notice a significant benefit at that dose.

[MGD1701]

Hi diydry

Doxy
I actually only took it for 4 weeks as it upset stomach - dont like medication, especially antibiotic. What actually help me thin the oil are: Omega 3 + GLA.
First omega 3, 1-2 month later, combined with GLA.

Good luck with the Bundle Method.

[farmgirl]

Diydryeye ...serum tears should help a lot with the cornea damage Done by the Lasik procedure. Your eyes feel so much worse because the nerves that instruct the eye to produce lubrication have been cut. It takes some time for them to repair if they ever do

[deep_dry_eye]

Thank you, MGD1701, deep dry eye, and others for these great ideas! I’m glad your oils are flowing much better now. I’m going to experiment and see if something works, starting with the bundle method. It looks so hard to perfect but if it works, it’s worth it. I also ordered a laser thermometer to check the temperature precisely. Hopefully something works. I met my doctor today and he thinks my blepharitis/MGD is what’s holding me back most and causing me my symptoms, not nerve damage per se. He says I might want to consider lipilflow plus manual expression twice a year (had 1st one in February) since I felt improvement after. Still looking for an IPL provider as well. Not sure doxy is doing much, stopping for now and may resume in 2-3 months per doctor’s advice.

I did x4 LipiFlow, while I do think it helped a bit (and I do recommend it at least once), I dont think it was the most important thing.

In order of importance under my own personal experience, topical azithromycin (Azyter or AzaSite) > Xiidra > IPL >= LipiFlow > oral doxy > Restasis > Autologous Serum / Prokera

[diydry]

BTW my doctor’s office offers amniotic fluid drops (I think that’s the name), but not prokera. Also said Xiidra has been shown to improve blepharitis compared to Restasis. Curious how prokera helps you. Good luck!

[diydry]

Thank you, MGD1701, deep dry eye, and others for these great ideas! I’m glad your oils are flowing much better now. I’m going to experiment and see if something works, starting with the bundle method. It looks so hard to perfect but if it works, it’s worth it. I also ordered a laser thermometer to check the temperature precisely. Hopefully something works. I met my doctor today and he thinks my blepharitis/MGD is what’s holding me back most and causing me my symptoms, not nerve damage per se. He says I might want to consider lipilflow plus manual expression twice a year (had 1st one in February) since I felt improvement after. Still looking for an IPL provider as well. Not sure doxy is doing much, stopping for now and may resume in 2-3 months per doctor’s advice.

[MGD1701]

Hi diydry

Gland Secretion
Perhaps ask dr to show you how your oil looks like. Many doctors' slit lamp equipped with camera.

One doctor told me that my oil was ok and no need to do compress. A few weeks later, another Uni. dr. said I should continue & prescribed me doxy (to thin the oil) - for the 1st time I got doxy - only took 4 weeks as it upset stomach. What actually helped me on this are: Omega 3 + GLA.

[deep_dry_eye]

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.

I am on both restasis and xiidra at the same time, the drugs have different mechanism of actions, so its worth it to do both.

IPL is very exciting atm, you can google it around, there's a lot of recent exciting scientific literature on the effectiveness on IPL lately.

Prokera is theorized that it can help heal nerve damage as well. I have minimal staining and I just tried prokera, I am post-op ~2 wks, I'll let me know how it goes.

[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.

[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.

[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]

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.