Gland expression!?!?

[robster]

Haven't started a thread in a while(by my standards anyway!) so here goes. I have had dry eye issues since last August due to LASIK(MGD being one of the culprits). My eyes have improved from unbearable to bearable to where they are now which is that they have a scratchiness(is that even a word) to them. An improvement certainly but I have set my MG's high standards to meet!

If I want to get my eyes to where I want them I think I am going to have to be far more persistent and aggressive with my gland expression.

Currently I use an eye bag for a couple of days and after using the bag I rub my finger over my eyelid like it says in the instructions. This seems to do nothing and so I stop after a couple of days then start again in a weeks time.

Having seen some videos online I don't think I can do the method where I push my eyelid hard against my cornea due to my LASIK. So a few questions?

1. What is the best method of gland expression for a LASIK patient?

2. I have a x15 magnifying mirror but I still can't see my glands(various optoms have been able to see they are blocked without using any magnification!) I know where they are supposed to be(edge of eyelid) but I can't see the pesky critters! How do I even see my glands and what on earth do they look?

3. I'm supposed to be looking for clear oil but can't see anything coming out. I know something is coming out as when i squeeze quite hard after using my eyebag my vision gets cloudy which I know is the oil going onto the surface of my eye. Do I need more magnification in order to see the oil?

Maybe I'm being greedy but once I started seeing improvements in my dry eye I wanted more and more improvements. Human nature I guess.

As always any advice greatly appreciated.

[Rebecca Petris]

Hiya Robster!

Currently I use an eye bag for a couple of days and after using the bag I rub my finger over my eyelid like it says in the instructions. This seems to do nothing and so I stop after a couple of days then start again in a weeks time.

Important: What's your yardstick for how you'll know when it's doing something? I think this is where MANY people break down in dry eye treatments of all kinds, i.e. if I don't feel better and/or look better within days/weeks, I quit. But one of the little factoids to keep in mind about dry eye (of all varieties, but when I use the term I really mean MGD because that is the vast majority of dry eye after all) is that results are not immediate AND 'clinical' improvement tends to precede symptom improvement. That means that in a perfect world with a perfect doctor who has all the whizmo-gizmos to measure your progress, they may be seeing you improve while you still feel like !@#$. Having that objective feedback can be sooo important to making the right decisions about whether to quit or continue. Instead we're ruled by pain, understandably.

...Which leads me right onto another favorite soapbox: getting mental separation between dry eye treatment and sensation/pain management so that we're not making decisions about the one that have an adverse knock-on effect on the other.

Having seen some videos online I don't think I can do the method where I push my eyelid hard against my cornea due to my LASIK.

Are you worried about your flaps? I wouldn't be. Takes a lot more than a strenuous gland expression to dislodge those babies. Having said that don't be TOO rough.

3. I'm supposed to be looking for clear oil but can't see anything coming out. I know something is coming out as when i squeeze quite hard after using my eyebag my vision gets cloudy which I know is the oil going onto the surface of my eye. Do I need more magnification in order to see the oil?

I never see anything come out of mine either and I've never been motivated to try to replicate the tools a dr. has in my own home. But for those who don't have a dr that can give them a reliable, accurate progress report now and then on their little gland-i-poos, I understand and I'm sure there are some magnified-mirror connoisseurs on the board to help.

[robster]

Thanks Rebecca. I think I am being too precious in my gland expression for fear of dislodging my flap. I wouldn't even call what I do an expression it is more like a gland stroking!

The fact that i have seen some improvement in my dry eye the last couple of months has motivated me to start an expression regime and actually stick to it for a while. I agree that it is very easy to become disheartened when you don't see a quick improvement.

Being able to see my glands would help me as at least I would have some idea of where to focus my expression efforts.

On a side note I am absolutely thrilled that I now have a second green bar! I'm being serious I feel like one of the family now, thanks to anyone who has given me positive feedback. Now I know how to give positive feedback myself I will certainly be doing so.

[Hopeful2]

Hi robster,

I find that I can see oil coming out of my glands with light expression. What I do is, use a warm compress, get a 12X magnification mirror (or greater), pull your lower lid away from your eyeball, dry of the lid and press gently around the lash line. I hold pressure on the area for about five seconds and I can see little pools of oil. I think that if your lid is against your eye, the oil just ends up going onto eyeball, rather than pooling on your lid.

The upper lid is certainly a lot trickier to be able to see the oil. Do you feel wetness when you rub along your lower lid? I didn't start to feel wetness till about six months post lasik.

[robster]

Yes I feel wetness when I rub my lower lid. Does anyone have any tips on how I can view the oil coming out of my glands or even see the glands themselves? My magnifying mirror seems as useful as a chocolate teapot at the moment!

[littlemermaid]

I still can't see my glands(various optoms have been able to see they are blocked without using any magnification

I think the glands are the yellowish stripey lines passing down through the eyelids, quite long, which you can see inside your lower lid. It's worth realising that there are loads of other useful glands around the eye, some exiting around the eyelash follicles. And very important lacrimal glands. So maybe a gentle rub after warm compress is all that's needed if you're trying to get MGs moving without damaging other functions.

To me, excellent daylight is more important than magnification and if you stand right up to a wall mirror it's the best. I've got twins, one MGD, one not. I press gently with 2 fingers slightly upwards under the lower eyelash line and look closely along the eyelid edge, which, this way, is now slightly off the eye surface. In a good eye it hardly takes any pressure to see a tiny row of clear dots of expressed oil (looks like baby oil). With clogged glands there is a slight release of more whitish substance.

Now sometimes, in the good-eye twin, I can't see clear meibom - in fact I'm more likely to actually see it on a good meibom day in the dry-eye twin who's used to all this. However, even without seeing dots of oil on the eyelid margin, the good-eye twin will have blurry vision from expressed oil in the tear film.

To reduce the daily pressures on the glands and keep things moving, and contact around the eyes, we are using Blephasteam goggles every day. She still gets occasional chalazia from acne rosacea but all this helps. So we don't need to use antibacterial eyedrops unless infection's bad.

With us, if the glands are not infected and inflammation around the eye is well controlled, getting clear meibom then depends on making the good stuff in the first place by using good diet with oils and eliminating the cloggers in food.

It seems any inflammation, including allergy, prevents glands doing their thing. So we need to think about whether treatment or products eg detergent or eyedrop formulations are making things better or worse. We don't use warm compress in flareup because Job 1 is bringing down the inflammation either with cool compress, tear substitute drops from the fridge, or if unavoidable, meds. We are finding the MGs are not restoring till the eyes have weeks of 'quiet'.

Without regular warm compress, and on good days without any other problems it doesn't need more than an eye rub in a warm shower as Dr L says, we get chalazia then eye surface damage. For comparison, this MGD is caused by LM's rosacea-type skin which has sebaceous and vascular inflammation then infection but is also hypersensitive.

As Dr L tells us, if you've just rubbed your eyes or done expression there won't be any more for a while. He has posted that he is wondering why some of us are so keen to express the good stuff that's needed. For LM, it's about keeping things moving gently.

The ophth are telling me if we don't see oil dots, see if we get blurry vision, as you say, Robster.

It's also about doing the other things at home that help and allow a cycle of healing of all the functions - protecting the eye surface, increasing humidity, reducing allergens, blinking.

[robster]

Thanks for your answer LM. I thought the stripey things could well have been my glands and I thought the fact I could see them meant they were blocked but from further research apparently you can always see those stripey lines even on people without MGD. Now that I know where to look and what to do hopefully I can try and get my MG's unclogged!