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**farmgirl** · 07-Jul-2019, 23:14

Hmmm.....Your glands look amazing compared to mine BUT your LLT is abysmal. Your schirmers is also really high, almost abnormally high which could mean that you are overtearing which is common with dry eye. This would tell me that you are not aqueous deficient so chances are your biggest problem is with your oils. Since your glands look good it seems reasonable to conclude that they could be plugged with old congealed oil. I also notice that you don't blink all that often but perhaps that is because you were not blinking normally. I did that the first time I had this test but later I had like 15 blinks per test.

Understand I am not an eye doctor or any kind of expert but from what I know, gathered from my own experience, there are probably a couple of things that might be helpful.

-One would be blinking exercises (look online), that is free.
-The second biggie would be at least 4 go-arounds of IPL followed by manual expression by Dr. (not so free). I don't know where you live or if that treatment is even available to you but my LLT, even with my marginalized glands went from something like 71 to 100+. I was halfway up into the grey area every blink after IPL. If IPL is not available in your area then you might try lipiflow but I understand it is not as successful as IPL.
-The third suggestion I have is to do compresses with expression daily at home to keep the oils moving but if they are badly clogged then that will not be really effective.
-Lastly limit your computer/electronic device time because that is killer for eyes.

**ishank_b** · 08-Jul-2019, 05:49

Thanks, finally someone replied.

My doctor does not think that I have dry eyes. He was not willing to do Lipiviw eye tests. I think he pressed and checked my glads under a slit lamp. But I insisted him to do Lipiview.

After seeing Lipiview reports, he said no dry eyes.

I pointed out dropped glands in one eye, he was not concerned. He said there is just one problematic gland (gland area, IDK) which he has marked with a pen here- http://prntscr.com/oc3vvb Overall, he was not concerned otherwise he could simply tell me to do Lipiflow.

He mentioned about low LTT but not a major deal. He said to take Flex seed and Omega capsules. When I asked him how to protected my glands he said blocking and warm compress - but again it was something he shared when I asked him. He was not concerned.

I am planning to do another test, IPL this time. Planning to go to a new doctor to reconfirm if I have dry eyes or some other issues.

ONE IMPORTANT THING, I don�t understand why I was having pain/discomfort while they were doing Lipiview tests. But my NIBUT is normal or not that bad. Do you think I had symptoms due to low LTT?

Another doctor has confirmed that I have convergence insufficiency, maybe that is causing eyestrain or asthenopia symptoms.

**ishank_b** · 08-Jul-2019, 05:53

"Since your glands look good it seems reasonable to conclude that they could be plugged with old congealed oil."

Really?

What about the gland dropout in the right eye (upper eyelid) and tortuosity in the left eye (lower eyelid)?

**Guest** · 08-Jul-2019, 14:09

You have some gland drop out. They�re not perfect but they�re pretty darn good. You have full blinks, also good. But llt is low. I believe as farmgirl does, you have poor quality oil or not enough oil getting into your eye, maybe both. If you have discomfort, you should be concerned. The fact that you had to push your doctor is a bad sign. Try looking for another doctor now if you can. Find one that believes you and wants to address your co verbs. This is my best advice. Good luck, you�re not crazy, you�ll eventually find a dr with a brain, keep looking.

**farmgirl** · 08-Jul-2019, 16:08

Originally posted by ishank_b View Post

I am planning to do another test, IPL this time. Planning to go to a new doctor to reconfirm if I have dry eyes or some other issues.

Note that IPL is not a test it is a treatment like lipiflow is a treatment.

Honestly, if you could see my glands you would be shocked. That tortuosity doesn't seem to be an issue. some of mine are twisted, truncated and just plain old missing but my Dr said that if you have 35% of glands functioning you can still be comfortable...so I wouldn't worry too much about the glands themselves they look great to me. What I would want to know is what kind of oils are they producing. Is it free flowing and liquid or is it coming out like toothpaste.

If they are free flowing and liquid then I would be looking for another cause, like do the eyes close firmly when you blink (ergo blinking exercises). The fact that he is not concerned about your LLT would tell me that you need to find a new Dr.

If IPL is available to you then I would try at least one of those treatments followed by manual expression. The manual expression afterward is really important to determine what kind of oils you are producing. If they are free flowing and easy to express then I wouldn't waste any more money on IPL. I would do IPL over lipiflow as the results seem to be much better.

I would suspect that the reason you were experiencing discomfort during the testing is because the oil layer is so thin that your TBUT is probably really low and the eyes were yelling that you needed to blink during the course of the tests.

**ishank_b** · 09-Jul-2019, 02:42

Thank you, guys.

Low Tubut but breakup time is over 10 seconds in both eyes. It means that tear films were stable for over 10 seconds in both eyes, right? If tears are stable, should not I suppose to be asymptomatic?

Maybe it was asthenopic symptoms, IDK. But I remember it was all back to normal in the next 2-3 days.

Maybe because I slept 10 hours for the next few days. And this alleviates pain/discomfort.

I noticed the things which trigger my symptoms:
- Near work (Computer, phone) for an extended period of time.
- Disturbed Sleep pattern (lack of sleep). Travel.

Wind and Temperature: generally see no issue with winds or extremely hot temperature.

Humidty- Can't comment. Sometimes I can be symtom free even at low humidity (<20%) and sometime I have symptoms even at high humidity (90%).

I am going to another doctor this week. Planning to do these tests:

Meibography: to check LTT and TUBUT this time. I took omega capsules last month.
Convergence tests- Maybe its eyestrain (asthenopia) due to poor convergence (aka convergence insufficiency). I have a receded NPC (near point of convergence)- I see two pencils if I do a pencil push up exercise.

One more thing my symptoms are no consistent, they waxed and waned. I mean there are days where I can be totally symptom-free. Is it same for you?

**Guest** · 09-Jul-2019, 16:24

Do you have mucus and itching accompanying these symptoms? Could be an eyelid disease causing the lid to scrape the cornea. Which would account for your but and discomfort. I�d have doc check lid laxity as well.

**farmgirl** · 09-Jul-2019, 22:11

I am never symptom free but for sure some days are better than others.

Have you considered taking a break from computers to see if that makes a difference. Have you ever read the post by pythonidler on computers. Here is the link:
http://forum.dryeyezone.com/forum/dr...nduced-dry-eye

I really think that you could benefit from some IPL cause it seems to me that your LLT is really poor considering your glands give the appearance of being functional and intact. If your LLT was good and your oils like liquid gold, then I would be thinking...nope must be something else causing the symptoms like you have suggested. Lets see what the next Dr has to say.

**mbperso** · 10-Jul-2019, 04:27

Your upper glands seem very good.
Your TBUT is great
For me the issue could be the lake of glands in the nasal lower glands of right eye.
Tortuosity on the left lower is not a problem if they are functional.
Partial Blinking is perfect.
I found the test you've got is great because it is full. I would have liked this compete test "dry eye work up sheet" in France. Where do you live ?

Finally your issue is low LLT. I have the same issue (LLT 47)
That means the problem is poor quality/quantity of oil.
Agree with farmgirl you should examine the gland with expression to know.
For info experts said i have good oil clear and fluid (so why a low LLT?)

What are your symptoms ?
Do you have debris on eyelids ? => Blephex is very good treatment to clean eyelids
Do you have eyelid itching ? => test for demodex (I had it)

At this stage of knowledge I would say to do : compress + lid hygiene + omega3
Lipiflow could be good to renew the old oil but not sure (no relief on me)
Interesting to keep us inform about IPL. I'm thinking about it too.

I managed to increased LLT from 47 to 74 but only on one eye, I don't know why.
Don't trust the Dr, find a new expert.

**deep_dry_eye** · 13-Jul-2019, 08:31

Your glands don't have dropout but appear dilated. In my opinion, you can still have dry eyes and the glands may be malfunctioning but haven't dropped out yet.

What is your current treatment plan. Viewing the glands alone, I would put you on Xiidra and get some IPL scheduled to reduce the inflammation of your glands. Both the Xiidra and IPL will aim to reduce inflammation and return your glands to a more healthy state.

**ishank_b** · 25-Dec-2020, 13:13

Hello Guys,

I thought to post an important update about my condition.

I'd showed my reports to a few renounced doctors. All of those said one thing- "no dry eyes". I did not believe them as I could see low LLT.

I suffered from dry eye like symptoms for almost 2 years. I am not really sure what they looked in my reports. But I can tell you that I don't have dry-eye like symptoms and I am fully cured. My problem was misalignment issue i.e. convergence insufficiency and accommodation insufficiency. It had been successfully treated with vision therapy and eye exercises.

I've no symptoms for the last 9 months; the long period of depression and agony is over.

I'm also sharing some relevant articles for other members of this forum.

https://www.reviewofoptometry.com/em..._pearl179.html
http://epubs.democratprinting.com/pu...articleBrowser
https://univmed.org/wp-content/uploa...usnunFinal.pdf
https://www.fcfamilyeyecare.com/neur...0neck%20strain.

Thanks,
Ishank

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