Let's have a Lesson on MGD & Dry Eyes

[Alli]

help finding doc

Hi Jade,
I see that you are also from Buffalo and have gone through much the same experiences I have. I am looking for a new eye doctor - have gone to a recommended corneal specialist with little result. He only takes a few minutes with me and wants to see me once a year ! If there's any way you could let me know who you are seeing that you are happy with, I would be eternally grateful. Thanks and Happy New Year !
Alli

[HOSADOS]

Rory I feel your pain!!! I would like 2 share with u ALL a story...LOL :-)

mmm... I would like to share with you all a very inspiring story I once heard, and from that day I kept it in the temple of my heart. This story serve as a strong reminder for one of most important lessons I have ever learned in my life !

An old brahman (priest) was very angry that this fellow Buddha is teaching something that is totally against our religion. My own family members, my son, my daughter in-law, they all stop this right, this ritual, and ceremonies, and they sit in a corner do this respiration, respiration, sensations, what they are doing ?! He would spoil all our religion. I must go and open his skull, that is the only way to stop his teaching. And he goes there, very angry, come nearer abusing, abusing. Buddha said, “old mand, you seem to be very agitated, come sit let us discuss your problem.” The old man made a decision, I won’t start discussing with him, because he is a very clever person, the moment I will start discussing with him, my anger will go away, and if my anger gos away, I can’t open his skull. I must carry on with my anger. And he keep coming nearer and nearer abusing, abusing.
Buddha said: “Just answer one question. Don’t you get some visitors at your house ?
“yes, yes, so many visitors come to my house, what does it get (got) to do ?! “,the old man replied.
Tell me, some visitors might be bringing some presents to you ?” Buddha continued.
“yes, yes, some visitors do bring presents, what does it has to do ?!” said the old man.
“A visitor bring a present to you, and say you don’t accept this present, what happen ? what happen ?!” asked Buddha.
“The present remains with whom, who brought the present” replied the old man.
Buddha continued: “The same thing I want to tell you, old man you came like a visitor to my place, you brought all those presents of abuses, I have not accepted them, they are with you, your property ! not my property.

The old man, was a very intelligent person. Only a small veil, curtain of ignorance which didn’t allow him to understand the truth. This Curtain got broken, and he started understanding. How is it, the whole life people bring presents to us, a present of one abuse, in return we give ten presents. We give ten presents, in return we receive hundred presents. This exchange of presents, you be unhappy, I will be unhappy. Gottatama Buddha, how do you learn this technique where you don’t accept any presents ?!!! the old man asked. Buddha replied: “sit old man, sit. Close your eyes, and observe respiration, observe respiration, observe sensations, observe sensations. You must observe yourself- unless you observe yourself, you can’t come out of this problem. This is a big problem for everybody. The old man, Bharatta, practicing, practicing became an Arahunt, fully enlighten person. His whole life, serving people, kept on serving people.



I would like tell Rory- I could see your point, and I could feel your pain, as I have DES/Blepharitis all my life and currently not working and not going out of the house because of this, not seeing people, etc... so I think I have a bit of a sense of what you're going through. Dealing with it all my life since the day I remember myself (it literally ruined my entire life -notice I use past tent), having it misdiagnosed, devalued, degraded, by physicians and people around me, eventually I realized that the only thing I could do is accept this peacefully and maintain the balance of my mind. This alone, improved my quality of my life significantly, including the disease, and although it's much better than what it used to be I'm still in great misery not able to function ! Easy to say then done- but I found an amazing technique that helped with that (accept the reality, develop the mastery of the mind and equanimity) but this is for a different thread and post.

Having said all that, I like to remind myself to former from times to times, and to try and live my life accordingly. And believe me when I say, that at least for me, I found that trying to live according to it is a much more harder work, than from dealing with Blepharitis and DES. Though, it's all connected and related.

So in the context of this website and forums, I do my best to find solutions to this disease, and on the same time to develop equamimity- the balance of the mind, and the mastery of the mind. G-D know that this is a must for people in our condition, and for any suffering people, as well as any people on this earth.

So do my best to observe my pain objectively, and not generate negativity since my experience had taught me that this only multiply my misery, and no good come from it....So today, I have learned to relate to my disease and suffering from a different angel, and some times in moments of grace, I feel myself lucky and fortunate that I have came in contact with this disease, since it had me changing my life (eventually), viewing it from a much more healthy (it's funny how mentioning healthy and DES/Blepharitis, in the same sentence-DES jokes, lok ) perspective. Don't get me wrong, I'm not blessing my disease, but the fact is remain that I have this disease and it won't go, so what do I with it ? I take advantage of it and make as a tool, to improve and grow. Easy to say then done, but this all we have left to do, to improve our situation and reduce our misery.

I won't get into details since my personal story isn't that interesting....

So now the questions remain, how do you learn this technique where you don’t accept any presents, and how can we all improve our situation by better dealing with this disease, in all its aspect. For me, I decided, to dedicate the following months to fight with this disease, learning everything I can about it and figure out a way to improve my life and hopefully, is successful helping others. I would like to take this opportunity, to express my gratitude and deep appreciation to Rebbeca, whom in my mind made a great job and I feel humbled and blessed that I came in contact with this wonderful community and website. This is one of the answers I found for the second question I presented above.

I wish all of us health and happiness and I suspect that many of the people in this community, if not all of them, became better people due to this "experience", the roller coaster called DES/Blepharitis, and eventually when you feel better, you would be able to appreciate the strength and lessons you all learned during this hard times...

Rory, I learned that if I want to survive this "hell", lol, I must change my lifestyle and adjust it to my condition. My lesson is adjustment. For me this meant giving up of a lucrative investment banking job and other wonderful opportunities. For me adjustment, mean be open to relocate a more comfortable climate. For me adjustment, mean giving up part of the social life. But more importantly, for me adjustment mean, changing and working on myself -my traits, developing those traits that would be helpful and supportive in the war against Blepharitis/DES, and detach myself from some of the "dreams", "aspirations", I had before, which I realized can't co exist with my condition (i.e when I was younger, I was very frustrated because when I went out I always had pain and headaches due to my DES, and many times I used to go out because all my friend were partying, but I never was able to enjoy myself...so I've learn to accept this and stay at home and do other things instead, and go out only when weather is appropriate). But I have a great faith that, my life would turn even better than what I had planned in the past. Since this is where all the angers and frustration are coming from, on top of the constant pain of course, lol

Wow ! if you read to this point with your DES, or without it , lol , I must congratulate you...lol

p.s
I always keep in mind, that there are people some where who are suffering more than I do. Every disease is a suffer, no disease is fun, but....

[NYer]

Hi Rory, My impression is that it wouldn't work as well with a finger as with a q-tip. The Q-tip seems to press in a more focused way on specific spots and you can give it more direct pressure, whereas the fingertip would be a softer touch and you can't quite press in as directly with your finger (especially if you have fingernails). The idea was to really use the tip of the q-tip in sort of a perpendicular direction to the lid...not the side of the q-tip or anything like that. So that tells me that having the smaller, firmer focused object poking into the lid is important.
Also, your fingers would have to be really really clean before doing that. You probably have a better chance of having a very clean q-tip.

[Rory]

I saw Dr. Latkany today and he watched how I was doing the meibomian gland expression procedure and showed me what I was doing wrong. I think I might be able to clear up some of the questions in this thread.

First of all, press harder than you're probably doing it - and with the tip of a Q-Tip. I was not pressing hard enough. When he did it, it was more uncomfortable than when I did it. I was afraid to put that much pressure on it but it should actually move your eyeball a bit. And you're NOT pressing up or down, as mentioned earlier in this thread - you're pressing in toward the eyeball. And finally, you're pressing just below (really JUST below..like a hair below) the lower eyelashes and JUST a hair above the upper eyelashes. If you're lower than that on the lowers or higher than that on the uppers, you're not doing it right.
Start from the nose side, work toward the ear side. Then swipe the Q-Tip along the upper and lower margins to clean them off. Then rinse your eyes. And you can rinse your eyes with plain water.

AND...he said that you DON'T have to use the hot compress first (heads-up fellow rosacea sufferers who are concerned about heat). He said you can just do it right after you take a shower.

I hope this helps. I'm glad I went to him.

Thanks Nyer,

I will give that a go!

I wonder can a finger be used just as effectively? I never really get the same control with a cotton bud.

[NYer]

Updated instructions on expressing meibomian glands

I saw Dr. Latkany today and he watched how I was doing the meibomian gland expression procedure and showed me what I was doing wrong. I think I might be able to clear up some of the questions in this thread.

First of all, press harder than you're probably doing it - and with the tip of a Q-Tip. I was not pressing hard enough. When he did it, it was more uncomfortable than when I did it. I was afraid to put that much pressure on it but it should actually move your eyeball a bit. And you're NOT pressing up or down, as mentioned earlier in this thread - you're pressing in toward the eyeball. And finally, you're pressing just below (really JUST below..like a hair below) the lower eyelashes and JUST a hair above the upper eyelashes. If you're lower than that on the lowers or higher than that on the uppers, you're not doing it right.
Start from the nose side, work toward the ear side. Then swipe the Q-Tip along the upper and lower margins to clean them off. Then rinse your eyes. And you can rinse your eyes with plain water.

AND...he said that you DON'T have to use the hot compress first (heads-up fellow rosacea sufferers who are concerned about heat). He said you can just do it right after you take a shower.

I hope this helps. I'm glad I went to him.

[calli66]

Rory, it's hard to communicate the details of this process in words, isn't it?

For example, when you ask whether I'm "putting pressure under the lids," well, yes I am, but I think of it as "along the lid"--directly under (talking of lowers) the lashes. So I'm not directing the pressure on the openings of the glands, but rather at the base of the gland. Hopefully, this stimulates circulation and movement of oils to the surface.

I don't "address each gland"--to me that sounds like something one would do to the gland opening. So I don't need a magnifying glass.

A Q-tip works for me because I can press with the tiny tip at various points under the lashes (like 10-12 points along the lid). I tried the side of my finger, a "rolling upward" motion (I read this method somewhere), but I didn't get the hang of it---didn't seem like it was doing anything.

I tried a similar method to Dr Latkany's book more than 10 years ago (isnt it very similar to what every opthalmologist advices?).

Yes, they may advise it, but I have never had one actually demonstrate it. So how would one know if they're doing it right? I don't even know if I'm doing it right. But I can imagine a dozen ways of NOT doing it right. I'm not sure my eyedoctor knows how to massage/express meibomian glands. This is a process that doctors talk about sort of "in passing"---"Oh, are you doing lid massage?" I haven't asked him to show me how it's done.

I think Latkany makes this point in his book, if I remember correctly. He says it's hard to learn from a description, but once he shows a patient the right way, they can do it, no problem.

Calli

[Rory]

Rory----about those lid scrubs--

I don't know what a supranette is---but the impression I get from your lid scrub description is that you're "rubbing" the part of the lid next to the eye. It sounds like an attempt to clean/dislodge oil from the blocked glands. The instructions from your doctor about passing your finger "from nose to ear" remind me of a technique described in a web video that someone posted here---it was produced by an doctor's office to demonstrate meibomian gland cleaning, and, like the instruction your doctor gave you, it is over-simplified, not detailed enough, not specific enough.

In the video, the smiling young woman holds a folded wash cloth by the ends and just pulls it back and forth across the closed eyes from left to right and back again several times. (Then the girl smiles---"all cured!").

I would call these methods somewhat crude---the cleaning part is all right--but to stimulate/massage the meibomian glands, I think you need to use more precision---putting pressure at points along the lids (directly under the lashes--lower, and above the lashes--upper). The cotton bud method works well for me, but I have to remove some of the cotton from one end so that it's not so bulky (and so the fuzzy wisps aren't tickling my eye). The other end is OK--for wiping the residue from the lid margin--after the massage part's done.

I could never figure this out or do it properly until I saw the illustrations in Dr. Latkany's book. Before, I was using the wash cloth method, and it was too harsh---rubbing/abrasion in the wrong places. I even dragged out one of my punctal plugs with the cloth. I think the word "scrubbing" really gives the wrong idea---lid massage/ cleaning is more accurate. Have to be more gentle! We're not scrubbing floors!

Several years ago I tried the Sterilid "Scrubs" (a pre-moistened cleaning cloth in a packet)--maybe that's similar to supranettes. Anyway, they were WAY TOO HARSH. They even have a sort of rough texture, so along with the "soap" substance in them, they were too aggressive.

Have you tried Dr. Latkany's method? I recommend it.

Calli

hello calli,

Thanks for the advice.

Supranettes are very gentle lid wipes and dont cause any irritation. I massage from nose to ear fairly gently.

I tried a similar method to Dr Latkany's book more than 10 years ago (isnt it very similar to what every opthalmologist advices?)....however I will give it another go with more of a focused approach towards applying pressure on the blocked glands.

With regards to putting pressure under the lids....do you use a magnifying mirror and actually address each gland? or is it a general application of pressure gradually moving across each lid? I also find it much easier using my finger than a cotton bud.

[brd888]

The thing is do you really need a doctor to diagnose it?

No but it would be nice if doctors were able to. I realise many diseases are very elusive to diagnose 100% accurately.


[/QUOTE]Brrd- have you considered ocular rosacea as a diagnosis because it looks like you have pale skin? You dont need much facial symptoms apparently.[/QUOTE]
No I have not given this much thought. However the treatments are almost exactly the same as blepharitis and I've not had a lot of success treating that possibility.

Cheeers,
Bruce

[calli66]

Rory----about those lid scrubs--

I don't know what a supranette is---but the impression I get from your lid scrub description is that you're "rubbing" the part of the lid next to the eye. It sounds like an attempt to clean/dislodge oil from the blocked glands. The instructions from your doctor about passing your finger "from nose to ear" remind me of a technique described in a web video that someone posted here---it was produced by an doctor's office to demonstrate meibomian gland cleaning, and, like the instruction your doctor gave you, it is over-simplified, not detailed enough, not specific enough.

In the video, the smiling young woman holds a folded wash cloth by the ends and just pulls it back and forth across the closed eyes from left to right and back again several times. (Then the girl smiles---"all cured!").

I would call these methods somewhat crude---the cleaning part is all right--but to stimulate/massage the meibomian glands, I think you need to use more precision---putting pressure at points along the lids (directly under the lashes--lower, and above the lashes--upper). The cotton bud method works well for me, but I have to remove some of the cotton from one end so that it's not so bulky (and so the fuzzy wisps aren't tickling my eye). The other end is OK--for wiping the residue from the lid margin--after the massage part's done.

I could never figure this out or do it properly until I saw the illustrations in Dr. Latkany's book. Before, I was using the wash cloth method, and it was too harsh---rubbing/abrasion in the wrong places. I even dragged out one of my punctal plugs with the cloth. I think the word "scrubbing" really gives the wrong idea---lid massage/ cleaning is more accurate. Have to be more gentle! We're not scrubbing floors!

Several years ago I tried the Sterilid "Scrubs" (a pre-moistened cleaning cloth in a packet)--maybe that's similar to supranettes. Anyway, they were WAY TOO HARSH. They even have a sort of rough texture, so along with the "soap" substance in them, they were too aggressive.

Have you tried Dr. Latkany's method? I recommend it.

Calli

[sazy123]

Hi Stella- thanks for your suggestions.

I have considered hormones in the past, but hormone test showed up normal. The progesterone cream really just works by reducing inflammation,
quote from argentis:

The cross-reactivity between progesterone and corticosteroid receptors in the ocular region is believed to activate corticosteroid anti-inflammatory activity in the glands and on the ocular surface, restoring normal aqueous and lipid production

so it doesnt matter if you have imbalances or not.

The nerve involvement is more than likely, vascular nerve involvement makes sense as well. Would explain why it gets better when other systematical things occur.

[stella]

Sazi - i dont know whether this is helpful or not-- The one thing that seems to help you is progestrogen which would indicate some sort of hormonal imbalance causing your problem
Also you seem to have nerve involvement since your eye problem goes away when you have facial pain
Are those the two keys to understanding the cause of your problem ??
Thats as far as i can contribute

[sazy123]

I think in a lot of cases we use a lot of the wrong treatments - due to poor professional diagnosis. For instance:
-Everyone with dry eye is recommended Omega 3. However surely this only helps if (1) Your diet is deficient in omega 3 (2) The problem is the oil film.
-Restasis is describes in Dr Latkany's book as being very effective in only a small percentage of dry eye patients. Yet dozens of folk on here are prescribed it.
-Warm compressess. Again over used. Surely this is mainly to warm up thickened lipid which are clogging the MG's. Contra to inflammation and allergies.
etc etc.
I think folk like Rory and myself have tried using many of these wrong treatments and become frustrated when not getting consistent benefits. This takes me back to the original post which is great advice for MGD patients. If only we had a doctor to have it diagnosed!
Cheers,
Bruce

The thing is do you really need a doctor to diagnose it? going off the knowledge regarding dry eye that we know which is usually more than most eye doctors, we probably have a better chance of diagnosing ourselves- unless we go to dr latkany or someone really in the know. Ive had about 3 different diagnosis- from allergies to theres nothing wrong. Noone has suggested ocular rosacea because my skin rosacea is very mild, but this can have the same eyelid 'conjunctivitis' appearance as allergies.

I still dont know the cause but certain things make more sense.

Brrd- have you considered ocular rosacea as a diagnosis because it looks like you have pale skin? You dont need much facial symptoms apparently.

[sazy123]

Rory, what doctor are you seeing in london? is he any good?

I agree, hot compresses probably arent the best when theres inflammation, but sometimes thats all that helps you get through a day, so whats one to do!? cold compresses dont really help.

[Rory]

The Dr (PHD Optomerist), I am currently seeing has told me that up to 75% of my meibomiam glands are blocked.

However he did not advise using warm compresses... he merely advised massaging the lids twice daily with my index finger from nose to ear and back, with a supranette wrapped around the outside.,.....saying that heat will exacerbate inflammation. His whole approach is to avoid inflammation as much as possible in the first few months...(therefore wearing protective glasses as much as possible, supplements etc).

I did this for one month and then saw him again.

Apparently the glands are still blocked but that they are now not blocked with such a hardened substance and that it is much softer now.

I am to continue doing this and to take omega (fish oil).

He also suggested that trying to force a gland open with vertical pressure was like trying to open a bottle of wine from the inside? I didnt quite get that one either (but hey ..he is french!)>

I have to admit to never in 15 years having the confidence in any diagnosis..or any treatment plan. Perhaps if i do...and i actually committ to one...i too will find a way to control my symptoms?

I think therefore i WILL try the warm compresses and the vertical pressure (Qtip or finger)....

Perhaps it makes sense to massage the eyelids from nose to ear (ie horizontally) with a supranette, initially to loosen the contents up (first month or two)....and after that to try and unblock them by focusing on each gland and applying upward (vertical) pressure with heat? To initially "attack" hardened glands with heat and pressure may be counterproductive?

Please excuse my stream of consciousness rambling.


Ps .. a question that i have been meaning to ask the forum.

For those of you ...who have had blocked glands for a long time...did you hear a gentle pop when the gland was unblocked? Since using the heat and massage method i have heard the odd pop or two..should i be worried ? I am also concerned as I had punctal plugs inserted over 10 years ago.... and no one can tell me if they are still there or not....i wonder if the finger/Qtip pressure could be aggravating these phantom plugs?

[brd888]

Wrong treatment

I think in a lot of cases we use a lot of the wrong treatments - due to poor professional diagnosis. For instance:
-Everyone with dry eye is recommended Omega 3. However surely this only helps if (1) Your diet is deficient in omega 3 (2) The problem is the oil film.
-Restasis is describes in Dr Latkany's book as being very effective in only a small percentage of dry eye patients. Yet dozens of folk on here are prescribed it.
-Warm compressess. Again over used. Surely this is mainly to warm up thickened lipid which are clogging the MG's. Contra to inflammation and allergies.
etc etc.
I think folk like Rory and myself have tried using many of these wrong treatments and become frustrated when not getting consistent benefits. This takes me back to the original post which is great advice for MGD patients. If only we had a doctor to have it diagnosed!
Cheers,
Bruce