Who is a good candidate for lipiflow?

[Milo007]

Hello everyone,
I am new to this forum and it's been great to have interacted with so many unfortunate people like me suffering from a life disrupting condition of dry eyes.In just about a few weeks I have learnt a lot and have gathered some inspiration from people who had success in battling out their conditions. It is so essential to have people around who are on the same boat to ease out the anxiety and self-dejection I have been carrying for quite sometime.

Anyways, coming to the point I had my first meibography done a few months back and the results indicate that I have a 24% gland loss on each of my lower lids and a 23% and 44% gland loss on my upper lids.These percentages are AI calculated after processing the images of the meibography. I have always felt that my right eye is way more troublesome even though the percentages indicate otherwise. I had first signs and symptoms of dry eye 3 years back and it's manageable with eye drops. I had intermittent episodes of dry eyes back then. It's only the last winter I had been experiencing severe symptoms of the condition. I went to several ophthalmologists only to be prescribed eye drops that didn't provide relief. Finally I went to a speciality eye hospital where they did the meibography.

The ophthalmologist there said that my gland loss wasn't that severe but my TBUT was 3s for both eyes. She said my tear film was definitely unstable but she didn't tell me the reason.My schirmer's 2 minutes and 5 minutes test results were 12 mm and 25 mm of tear production on the litmus paper. She put me on oral doxycycline for a month and Azithromycin eye ointment for a month along with chloroquine phosphate eye drops (for its anti inflammatory effect like restasis) and occasional use of systane ultra. After the end of the antibiotic administration period I felt better. I could manage without artificial tear drops for the first time in several months. But recently I am having problems while reading and my eyes start to feel dry when my blink rate goes down for some time.

I am yet to visit there for the second time for a review in December (1946 kilometers away). To be honest I am not sure why they didn't suggest me lipiflow in the first visit. I am also confused with the fact that despite I don't have extreme gland loss I am still having symptoms of advanced dry eyes. When I wipe my lower eyelids with a q-tip and press the lids to see if lipids are coming out I can see oils flowing out more in quantity in the left eye lower eyelid and lesser in quantity in the right eye lower eyelid. Upon a blink my vision gets blurry after such manual expression again more on my left eye and less on my right eye.
I fear that my glands have partial blockages with fibrotic tissue or they are partially clogged. I am also in a dilemma whether to approach them directly for the lipiflow to save my glands as much as possible at this stage but they haven't spoke of it yet.I don't think they perform a Meibomian gland probing in case I have scar tissue blockages.

I am really confused whether to I am suitable candidate for a lipiflow procedure. Since it's costly I can't take a wild shot at it to be on the safe side. I would like to have opinions of people on how they have benefitted from lipiflow. Also I don't seem to understand why hot compresses followed by lid massage won't be as effective as lipiflow both being essentially the same thing as warming the glands and expelling out the blockages by applying pressure. I use a warm compress at 45-50 °C for 12-15 minutes with a quick change of washcloth every 30s to a minute.

[Milo007]

I am attaching the images of my meibography in case it's beneficial.

[ebi1368]

I have done lipiflow and I saw some improvement. Maybe not sure. My docotor said Lipiflow is equivalent to 3-6 month of warm compress. I would say it is beneficial but it is not going to do magic. If the cost is really is issue, you can approach it when you exhaust all other options.

Hope you get better soon

[Milo007]

I have done lipiflow and I saw some improvement. Maybe not sure. My docotor said Lipiflow is equivalent to 3-6 month of warm compress. I would say it is beneficial but it is not going to do magic. If the cost is really is issue, you can approach it when you exhaust all other options.

Hope you get better soon

Did you feel any relief from doing warm compress for a few months?

[ebi1368]

I am post Lasik and I have Rosacea as well. Not a good recepie.

I have not seen improvement with warm compress but it might be due to to the fact that I have rosacea. What is your diagnosis?

[Milo007]

I am post Lasik and I have Rosacea as well. Not a good recepie.

I have not seen improvement with warm compress but it might be due to to the fact that I have rosacea. What is your diagnosis?

I have been diagnosed with MGD and moderate gland loss. Warm compresses have had mixed responses for me. It's been tolerable when my eyes are relatively less "worked" and with occasional use of loteprednol (once or twice in 10 days). At other times even if I seem to have slight irritation warm compresses have actually aggravated my condition with more inflammation and irritation. So,in a nutshell warm compresses are not a regular thing for me.

[ebi1368]

Do you know what is the root cause of your dry eye?

[Milo007]

Do you know what is the root cause of your dry eye?

There is no root cause of dry eyes in particular. Dry eyes are either a result of meibomian gland dysfunction or lacrimal gland dysfunction or both. By meibomian gland dysfunction I mean decreased quality and quantity of lipids with or without significant gland atrophy and drop out.Meibomimggland dysfunction could also be due to autBy lacrimal gland dysfunction I mean decreased quality and quantity of tears possibly due to glandular inflammation or autoimmune diseases destroying the glandular cells.

The root causes of meibomian gland atrophy or drop out are :

1. Excessive near work that requires constant focus which results in decreased blink rates like reading for long hours daily for years, using a computer or any digital screen for hours daily for years (this is the culprit in 80% cases), doing stitching work for years and so on.

2. Direct effects of radiation in cancer therapy or accidental radiation exposure that instantly kills the cells of the gland tissues.

3. Altered consistency of the lipids due to systemic changes (maybe hormonal) that solifies within the gland ducts and creates a mechanical blockage. The glands gradually down regulate and stop oil production with chronic blockage.

4. Glandular inflammation due to such blockages or autoimmune destruction of cells.

5. Wearing contact lenses that results in gland loss the cause being not properly explained.

The root causes of lacrimal gland dysfunction are :

1. LASIK surgery that cuts through the corneal nerves that results in disruption of the corneal nerve-lacrimal gland feedback loop system. Ultimately destruction of corneal nerves results in no feedback to lacrimal glands and it down regulates and atrophies. (LASIK - A classic example of reckless commercialization of flawed technology that is comparable to human experimentation without careful studies of potential side effects)

2. Inflammation either due to autoimmune diseases or other causes that destroyes glandular cells.

3. Wearing contact lenses for long hours on a daily basis. Again the corneal nerve-lacrimal gland feedback loop is compromised because the eyelids don't touch and stimulate the corneal nerves to induce lacrimal gland secretions so the gland down regulates, atrophies and dies.


Verdict : Don't go for LASIK even if you look stupid in specs. Do enough research on any medical procedure before consenting to it. Don't trust doctor's blindly even if they say it is 100% SAFE. DONOT use computers or digital screens for long hours at a stretch and if you absolutely need to blink consciously and train your eyes to blink more frequently during screen time. It takes time but it gets into a habit. Don't flaunt contact lenses just because you look smart without specs. Do your research and gather as much knowledge about your condition, think logically, assess and choose the best course of action. Be patient to experience improvements and be diligent with your efforts. Don't exaggerate anything and remember more of anything isn't essentially good.

[MGD1701]

LipiFlow vs warm compress

LipiFlow
1) constant heat can go inside the lids
2) can massage ---- both of which warm compress can NOT achieve.
(I believe Dr Korb mentioned these in all his videos)

Blephasteam has constant wet heat but the heat can not go inside the lids and massage.

[Milo007]

LipiFlow vs warm compress

LipiFlow
1) constant heat can go inside the lids
2) can massage ---- both of which warm compress can NOT achieve.
(I believe Dr Korb mentioned these in all his videos)

Blephasteam has constant wet heat but the heat can not go inside the lids and massage.

I hope lipiflow gets cheaper.