My experience with IPL with Dr. Sanjay Kamat

[NeedMyEyes]

Hi, Irish Eyes, yes this process has been a bit confusing for me...

I went to the eye center at Walmart to get a prescription for Wiley's. There I asked them to look at my MG's in the slit lamp. This was after Lipiflow I think. She said my glands made good oil and yes I DID have a few little vessels on my eyelids but that was just because I had very fair skin... so basically she couldn't really see any meibomian gland dysfunction. I'll admit that since it is Walmart maybe she is not an expert at Meibomian glands.

Then I went to Dr. Toyos and that is what he said - severe disease. And I looked at the DVD recording of my eyelids and I agree that it is pretty bad. So that's all I can say.

My glands open then close then open then close. And the little vessels seem to have been there since the beginning of this process (now about a year ago). So I don't know if the inflammation / vessels are better or worse. The glands open and close. And I have had capping of glands for at least a few months, maybe before that - I'm not sure.

Dr. Toyos said the following about my previous stuff - he said that I *should* have toothpaste in my glands because my disease is so bad. However, he thinks that the IPL / Lipiflow / probing that I had done have prevented that from happening and he saw several glands making normal secretions. So clearly the things I was doing were helping according to him.

[irish eyes]

You are very good to have posted all this stuff - thank you.

I'm a little curious about what you said in an earlier posting in June:

"....I think my Meibomian Glands are getting to the point where an eye doctor won't be able to find any dysfunction unless they knew me from before......"

This was with someone called Dr Kamat.

You say that Dr Toyos:

"........ examined my glands and showed them to me on a TV screen. He said I had "severe disease" with meibomian gland capping, tons of little telangectasia on my eyelids as well as little meibomian gland "cysts" especially on my upperlids. Also, many, many blocked glands.....".

Presumably Dr Toyos could see that you had previously had IPL?

Since watching the videos of gland expression, I cannot think of my glands in the same light again! My upper lids are very bad.

Thanks

[NeedMyEyes]

4th IPL treatment - this time with Toyos

For various reasons (vacation week, had the money and the time, etc.), I decided to go see Dr. Toyos in Memphis for my 4th IPL treatment in Memphis...

His office is near Germantown (a nice suburb of Memphis) in an nice office building with a few other non-medical businesses (law offices, etc.). Dr. Toyos is the MD and there are a few OD (optometrists) there also as well as a few administrative folks and assistants, etc. Everyone was really nice, of course. Actually, if you have seen the IPL DVD that Dr. Toyos made several of the staff are on the DVD.

There were 2 parts of the clinic - the main lobby and main front desk and an adjacent area of a similar size for LASIK surgery (I think he only does this on Fridays).

As soon as I got there, it was clear this was the place that IPL was born. I think they had 4 or 5 other patients receiving IPL that morning. You could tell who was there for IPL that morning - fair skinned patients most with a bit of acne or rosacea. The staff was unusually knowledgeable about IPL and had obviously seen patient after patient with IPL.

The treatment was a bit different here than with Dr. Kamat:

First, Dr. Toyos examined my glands and showed them to me on a TV screen. He said I had "severe disease" with meibomian gland capping, tons of little telangectasia on my eyelids as well as little meibomian gland "cysts" especially on my upperlids. Also, many, many blocked glands.

I have to be honest - I have never really seen my eyelids this close up and it really, REALLY gave me an appreciation for my condition and what I am up against. And I have to say - it's bad, it's really really bad.

I have done my own research on this condition and have seen lots of pictures on the internet and my eyelids could be published in any journal or textbook in the world as "severe posterior blepharitis with meibomian gland dysfunction". Here are some pics I found on the web that look sort of like my lids:



except my lids are a little lighter in color and tons more little vessels on the margin.

After this, I had a microdermabrasion and then the IPL.

Dr. Toyos did the IPL on some higher settings than Dr. Kamat and I could definitely feel it this time. Actually, it hurt and was pretty uncomfortable. Dr. Toyos thought this was because of the blood vessels I have under my skin that were absorbing the light. I hope that's what it was, because that means the treatment is going to work.

Then came the lid expression which was pretty hard and definitely hurt but wasn't as hard as I thought it would be. He video taped this and I have to say when I watched the video, I was disappointed at how much came out of the glands - basically nothing.

Well, but I don't have ANY toothpaste or silly string. I have buttery oil, clear oil, and some crystals. So maybe if you don't have toothpaste, you don't see anything? I'm not sure.

After that Dr. Toyos took a little needle and popped some of my capped glands and meibomian gland cysts. I watched the video and I'm glad he popped them, of course, but I want to see the video next time to see if they came back. I found a video on youtube that looks just like what he did:

Well it wasn't exactly like this. Dr. Toyos used a needle and he just popped the glands and then popped very easily. Also, he popped maybe 5 or 6 total.

Then he put in several drops and prescribed several medications including some antioxidant vitamins and some others.

[Angela]

NOOOOO he totally did the lower ones too lol. He just one pass on each of the uppers and then I needed to take the contacts out so he put the sticky shields on and did 2 passes on each of the lowers.

Woah those videos are something else. Honestly if I didn't have this condition I would probably be disgusted but I'm actually thrilled to see so much stuff come out of the MGS haha. Looks like very thorough expressions too. The first one is like something out of a sci-fi special. Those secretions are probably what mine look like because I get those stringy things just from washing my face or rubbing my eye.

I really wish I was feeling better but I don't feel any difference after the first treatment which I'm sure is common. Actually my upper eyelids look even more purple swollen and saggy =( I really think I have something else going on too because I am getting really thick white discharge coming out of my nose and my breathing and headaches are worse. Kamat told me I should follow up with another ENT but I can't afford to be going to millions of different doctors.

[NeedMyEyes]

Toyos videos on Youtube!

Hi, Angela. Of course post away. It gets lonely on a thread when I am the only poster ;-) Wait, so he only did the upper eyelids? Not the lower ones?

Dr. Toyos just posted these videos on Youtube about a month ago:

[Angela]

Just going to post here rather than start a new thread..hope that is okay by you NME.

I went to visit Dr. Kamat yesterday morning. His office is in a nice neighborhood, in a small but very comfortable office. He saw me right away and spent about an hour and a half total with me. First he examined my eyes, and confirmed that I have Meibomian Gland Dysfunction. We briefly discussed how this all started with blepharitis and progressed to severe lid swelling and mgd. He used that yellow dye in my eyes and told me that my right eye was worst than my left and that my blinking really wasn't lubricating my eyes much at all. He then used the jumbo qtip to do an expression to find out what kind of secretions I was producing. Like Dr. Latkany, he told me that my glands produce a thick white discharge, some even yellow..no clear oil whatsoever. He also told me that he had to apply a decent amount of pressure to get the gunk out, and that some don't put anything out at all. After this we discussed IPL and the potential benefits that it might have for my case. He told me that it can help reduce the lid inflammation which is the main source of my mgd. He told me that it doesn't happen instantly, I would need several treatments, and there is of course no guarantee that this will help. He was very upfront and honest and I appreciated it.

The treatment:

I decided to have my upper lids done because that is where most of the swelling is (my bottoms are swollen too but not as evident). He told me that this wasn't standard but that if I really wanted it I needed to know that losing eyelashes or eyebrows was a potential risk due to the size of the hand piece. Taking this into consideration, I still went ahead with it. He had to put metal contacts into my eyes for protection. Once they were in, I could not see anything. It was like being blind. My eyes were completely open but I saw black. This gave me anxiety and I told him I was not comfortable. We waited a few seconds until I calmed down and he went ahead with treating my uppers. He only did once pass on each. Afterwards I asked if he could remove them for the rest of the treatment, and he did. He was VERY understanding. The rest of the treatment was easily tolerated, and very quick. It felt like small warm zaps, it was not painful at all for me. Afterwards he did another expression and was honest about it not making a difference secretion wise. That was it. He prescribed Azasite for me and gave me samples of Lotemax eye drops to be used for the next few days. He is a very good doctor and I plan on continuing treatments with him. How do I feel the next day? Not much different but at least I begun treatments. I was hoping that I'd see a reduction in my lid swelling but there is no change.

[Anthony16]

Im happy u are doing well needmyeyes.
I wish these treatments were available in Europe
Dry eye treatment is really really lacking here.
Looking forward to my follow up in New york city next week

Dr. Kamat is very up front and honest with you about the possible after effects of the IPL. He will tell when he knows and when he doesn't know (and probably no one knows) about the side effects of the procedure.

I personally didn't see any swelling after the procedure at all. I couldn't even tell anything had happened afterwards.

But I do know that everyone's skin react differently to IPL. I have not had a lot of sun exposure in my life and I've read that is a good thing as far as how your skin reacts to IPL. Also, I am a Fitzpatrick type 2.

Oh, on the beefy eyelids - I have no idea if this is the kind of eyes that Dr. Toyos or Dr. Kamat likes to treat with IPL. I don't have those though. That was the weirdest thing about this whole dry eye thing - every doctor said I had "inflammation in my eyelids" - and they didn't look any different than before! My lids eventually got thick with little veins - but I am pretty sure that was an allergic response to my eye drops.

Like I said earlier - the day after my first IPL session, all the swelling in my eyelids that had been there for months disappeared like magic...

I really hope you don't get dry eyes. If you do, I hope you can take care of it as soon as possible.

[NeedMyEyes]

Dr. Kamat is very up front and honest with you about the possible after effects of the IPL. He will tell when he knows and when he doesn't know (and probably no one knows) about the side effects of the procedure.

I personally didn't see any swelling after the procedure at all. I couldn't even tell anything had happened afterwards.

But I do know that everyone's skin react differently to IPL. I have not had a lot of sun exposure in my life and I've read that is a good thing as far as how your skin reacts to IPL. Also, I am a Fitzpatrick type 2.

Oh, on the beefy eyelids - I have no idea if this is the kind of eyes that Dr. Toyos or Dr. Kamat likes to treat with IPL. I don't have those though. That was the weirdest thing about this whole dry eye thing - every doctor said I had "inflammation in my eyelids" - and they didn't look any different than before! My lids eventually got thick with little veins - but I am pretty sure that was an allergic response to my eye drops.

Like I said earlier - the day after my first IPL session, all the swelling in my eyelids that had been there for months disappeared like magic...

I really hope you don't get dry eyes. If you do, I hope you can take care of it as soon as possible.

[Angela]

I wish I could say that I still don't have dry eye...but I can't. I'm pretty sure that I've started to develop it because my eyes feel like there are razors in them and the whites are not so white anymore :/

My biggest fear is the swelling increasing after IPL, I wonder how many people have had that experience?

Dr. Bloom in Long Island told me he doesn't treat the uppers, why is it that some do and some don't? I just want to know how risky it is. I feel like the skin on my eyelids is already so loose and saggy and I'm afraid of it getting worse. I guess I will bring all of this up to Kamat.

Has your lid thickeness improved? In one of your posts you mentioned "thick, beefy eyelids", and I can really identify with that right now...

[NeedMyEyes]

Upper eyelids and swelling

Well, here is what happened:

After the first treatment, I noticed a dramatic decrease in the swelling in the areas he treated. Another poster said somewhere else that happened for them after IPL also.

The swelling goes down in the areas he treats and maybe an inch away also. I forgot that my face used to be thin until I woke up the day afterwards and found all the swelling had gone down.

But then it came back.

A couple months later, I realized I was allergic to my eye drops and stopped using them. So the swelling went away permanently at that point.

But you and I may have different diseases, so you might get different results.

Actually, I think Dr. Kamat will do the upper eyelids for you on the first session if you tell him you are there for the upper eyelids. I remember you said you don't have dry eye and you are really looking for a way to decrease the swelling and MGD in the upper eyelids. So, it would make sense that he will do it.

Oh, and Dr. Kamat uses Corneal Shields made of steel so there is no way the light can reach your iris or your cornea and you have no fear of any damage to those structures.

[Angela]

Just had my third IPL session with Dr. Kamat.

Before the session, he did the usual counting of the glands and measuring the TBUT.

I had 60% open on the left and 80% open on the right. They make normal clear oil. My TBUTs were 8 and 8. I started with 20% open and TBUTs of 4 in each eye.

It's hard to say if this improvement is from the first 2 sessions or if Lipiflow or probing had something to do with it. Personally, I think the most effective so far has been Lipiflow > IPL > Probing. But that's just a guess.

He turned up the settings a bit this time, since I told him I was getting a little impatient with my symptoms.

He even did the UPPER lids this time... He puts steel contacts in my eyes before performing IPL so, I felt like it was a safe procedure. I hope it will open up more of the upper glands.

Oh, and afterwards, he did a pretty thorough expression and he used tweezers to "pop" the additional capped / blocked Meibomian glands.

I started counting the uppers in the mirror and I estimate 80% on the left and not sure abou the left.

I think my Meibomian Glands are getting to the point where an eye doctor won't be able to find any dysfunction unless they knew me from before...

Am I feeling any better? Okay, I guess so. I have been a good bit more comfortable at work recently and don't really use drops that much. Maybe I am just ignoring the pain. Maybe I am just telling myself I feel better because I can see the glands open in the mirror? Not sure.

Wow it is really great to hear that you're feeling better!! I really wish I had the money for Lipiflow because it sounds like it's been a huge help. As for IPL, I have recently emailed Dr. Kamat to inquire about starting treatments with him. After seeing Dr. Bloom in Long Island who told me that he didn't think IPL could help my case, I decided to go to someone who seems like they are willing to try different things depending on the patient. I plan to take a trip out to see Toyos as well, maybe for my 3rd or 4th treatment. After getting your upper lids treated, were they swollen? As you know my main symptom is swelling so this is a huge concern of mine, I don't want to imagine the swelling being even more severe than it is now. But it is my upper lids that are the most troublesome so I wonder if I should take the risk. I am amazed to hear about the state of your Meibomian Glands, it makes me feel really hopeful. How has your swelling been in general since your MGs have improved? What about the Blepharitis (erythematous lid margins, redness, etc.) Oh and doesn't treating the lids directly cause zapping of eyelashes? He'd probaby not consider doing my uppers until a few treatments anyway I gather.

Anyway I am very happy to hear about your success, I hope it only gets better from here.

[NeedMyEyes]

3rd IPL treatment with Dr. Kamat

Just had my third IPL session with Dr. Kamat.

Before the session, he did the usual counting of the glands and measuring the TBUT.

I had 60% open on the left and 80% open on the right. They make normal clear oil. My TBUTs were 8 and 8. I started with 20% open and TBUTs of 4 in each eye.

It's hard to say if this improvement is from the first 2 sessions or if Lipiflow or probing had something to do with it. Personally, I think the most effective so far has been Lipiflow > IPL > Probing. But that's just a guess.

He turned up the settings a bit this time, since I told him I was getting a little impatient with my symptoms.

He even did the UPPER lids this time... He puts steel contacts in my eyes before performing IPL so, I felt like it was a safe procedure. I hope it will open up more of the upper glands.

Oh, and afterwards, he did a pretty thorough expression and he used tweezers to "pop" the additional capped / blocked Meibomian glands.

I started counting the uppers in the mirror and I estimate 80% on the left and not sure abou the left.

I think my Meibomian Glands are getting to the point where an eye doctor won't be able to find any dysfunction unless they knew me from before...

Am I feeling any better? Okay, I guess so. I have been a good bit more comfortable at work recently and don't really use drops that much. Maybe I am just ignoring the pain. Maybe I am just telling myself I feel better because I can see the glands open in the mirror? Not sure.

[patrick]

hi,

i'm very curious about your experiences with lipiflow.
since it has been approved here in europe and therefore also available i'm very interested in having this procedure done.
do you know a bit about the results and safety? and how many follow up treatments you normally need before the results begin to show?
i can't find very much information about this particular procedure.

thanks in advance,
patrick...

[NeedMyEyes]

Well, I am around 2 weeks out from my second treatment and I won't really be able to tell about how I am doing from the IPL because I just got Lipiflow around a week ago. So that is kind of going to mess with the results.

I can say that several more glands have opened up and I honestly don't know for sure, but I think it is from the Lipiflow.

However, I DO plan on going back for my third session with Dr. Kamat. He is a really nice guy and will try to accomodate you as best he can. I can recommend him for IPL from what I know so far. Ask him to use the corneal shields on you for extra protection for your eyes.

If you are going to do IPl, my advice is to get started as soon as possible. The hardest part about IPL is waiting until the next treatment which is always a month since the last one. And you may not get any benefit from the first couple treatments, so that's why I say get started as soon as you can.

Good Luck! Feel free to ask any other questions.

[Sevenmigirl]

Curious to see how your second treatment has gone? I am considering the same treatment.