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How often should I go to the doctor to get manual expression?

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  • How often should I go to the doctor to get manual expression?

    I came back to the USA from China and saw a doctor that had the Oculus Keratograph and did a manual expression.

    When he did the manual expression he said on my eye that is painful and has the TBUT (tear break up time) of 2-3 seconds the oil was like toothpaste. He expressed the glands, which I think all expressed oil, but he said it stood up like little pillars of thick oil, then fell over. On my eye that is livable the oil came out a bit thicker than said was good but it came oil as a liquid. That eye has a tear break up time of 6-7 seconds but again, if both eyes were like that my life would be OK.

    So I guess how often should I go to get that done? One issue is that the only doctors who seem to have any knowledge about bad oil glands are almost a two hours drive from my home. Which in goggles and no AC in a heat wave was not that pleasant. My eye did feel great after the expression, really good.

    I tired today to do the warm compress for 20 minutes and I couldnt get any oil out of the bad eye expressing the glands myself, while on the right eye it was much better than previously which Im very happy about. Im trying to figure out what to do with this knowledge.

    Other info: Im in the process of ordering the Klarity-C Drops with cyclosporine from ImprimisRX because my insurance doesnt cover Restasis and buying from the Canadain pharmacy said it would come from Mauritius which seems strange. Still from that location the Restasis was 270$ for 3 months while the Klarity-C drops which have twice as much cyclosporine are $150 for 3 months.

    The ophthalmologist also gave me a sample of Xiidra so I will use that. As far as I know my insurance will not pay for Xiidra, though it will pay for some of blood serum drops

    I also got some bad news that my eye are Map Dot Fingerprint Dystrophy which also leads to easier tearing of the cornea and he said i use Muro 128 ointment at night to increase water levels in the eye at night to reduce tearing and improve healing.

    Im not sure what to do with the info that one eye has toothpaste oil. Get on cyclosporine drops will start later this week I hope when product arrives. Im doing warm compress 4-5 times a day for 20 minutes trying to keep that stuff liquid on the bad eye. All the glands are there but are not straight as have some loss in length. All expressed toothpaste oil.

    Im guessing to try and keep getting expressed maybe every two weeks? Just do the drive and listen to a lot of audiobooks.

    Should I be waiting until I do cyclosporine for a while before I try lipiflow or IPL?

    The reality is I met a good doctor in another city but the doctors in my area dont even know what manual expression is. I had a local ophthalmologist tell me just use some drops and dont worry about gland loss. I was speechless. I am more informed than that medical doctor.





  • #2
    since u are usa based, get on azasite, restasis , xiidra and ipl. also do lipiflow to clear any obstructions.

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    • #3
      Edmund, even though your oil is like toothpaste, itís good news at least there is some form of oil still expressing, and that gland expression made your eyes feel better. You need to keep those oils flowing, stimulate your glands, and keep them unblocked, so your glands donít atrophy. I agree with deep_dry_eye that you should try LipiFlow or IPL, given what you described above. LipiFlow is more widely available and seems to help those who have earlier stage MGD. IPL seems to help both early and later stage, from what Iíve read in this forum.

      Gland expression is good to unblock, but am not sure how much it stimulates your glands, if you also need that. If you go that route, ask the doctor how often he recommends. The glands only produce so much oil, so you would not want to express it all out.

      I would not wait to do LipFlow, IPL, or another expression until you do Cyclosporine for awhile. Plus you likely will need to do these procedures several times to get the full effect.

      For Map Dot, scleral lenses are often used to protect and help heal the eye surface, since the dome shaped lens bathes the cornea in saline continuously. Serum Tears may also help as it is known to heal the eye surface and nerves, plus its natural with no side effects to my knowledge. I actually put a few drops of serum tears in my sclerals along with the saline...I recently got serum tears again to see if I could get further improvements, and because I was using my eyes more than usual and they started to feel a little dry.

      http://www.bostonsight.org/PROSE/For...s-PROSE-Treats
      Last edited by Hokucat; 12-Jul-2018, 15:20.

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      • #4
        azasite can turn ur toothpaste to liquid secretions quite quickly. however azasite cant be used long term, so get urself on xiidra and restasis which can be. additionally ipl can reduce inflammation and liquify ur secretions. lipiflow is needed to remove any internal blockages

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        • #5
          I have appointment on august 7th for the cornea specialist at the univ of Mi kellogg eye center. Problem is its a 4 hour drive one way. Then after the consultation i have to make a different appointment for the IPL treatment. Yikes. So there and back twice. Im looking for a relative to drive me there and back. Just pay them.


          My Klarity-C cyclosporine drops are in the mail will arrive next week. Im taking Xiidra now. Luckily it doesnt burn. Just the bas taste in my mouth/sinus bad effect.


          Next week wednesday consultation with local doctor about blood serum drops.


          Next week friday General practionter about blood tests for thyroid, auto immune and low testosterone.

          I didnt get steroids or azisite. Still on 100mg Doxy.

          I may schedule a lipiflow treatment for next week. At $1000 its much more expensive than IPL which i csn get at univ of MI specialists for $400 in 5-6 weeks.

          Comment


          • #6
            Originally posted by edmunder View Post
            I have appointment on august 7th for the cornea specialist at the univ of Mi kellogg eye center. Problem is its a 4 hour drive one way. Then after the consultation i have to make a different appointment for the IPL treatment. Yikes. So there and back twice. Im looking for a relative to drive me there and back. Just pay them.


            My Klarity-C cyclosporine drops are in the mail will arrive next week. Im taking Xiidra now. Luckily it doesnt burn. Just the bas taste in my mouth/sinus bad effect.


            Next week wednesday consultation with local doctor about blood serum drops.


            Next week friday General practionter about blood tests for thyroid, auto immune and low testosterone.

            I didnt get steroids or azisite. Still on 100mg Doxy.

            I may schedule a lipiflow treatment for next week. At $1000 its much more expensive than IPL which i csn get at univ of MI specialists for $400 in 5-6 weeks.
            1k is still cheaper than what's available in canada

            Shop around for LipiFlow, I find that many drs are willing to negotiate on price. Its almost pure profit for them.

            Doxy 100mg is good, but I prefer Azithromycin.

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            • #7
              Welcome back to the USA, edmunder! Sorry to hear you're still struggling, but it sounds like you're getting help. Keep us posted.

              So does anyone recommend actually using the manual expression tool? My optometrist said she saw lots of oils come out of my glands after Lipiflow but I have not since been able to replicate that. I can't seem to get oil out by massaging or any other physical technique (other than Lipiflow apparently). Just wondering if the tool might help since I don't want to pay for Lipiflow every month obviously.

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              • #8
                Originally posted by diydry View Post
                So does anyone recommend actually using the manual expression tool?
                NO please!! These are medical devices restricted to use by medical professionals, with good reason
                Rebecca Petris
                The Dry Eye Foundation
                dryeyefoundation.org
                800-484-0244

                Comment


                • #9
                  Thanks, Rebecca! Maybe it is worth it for me to directly ask my doctor about whether they can or should express them for me. Honestly were it not for this forum I never would've heard of gland expression at all (although to be fair I believe Lipiflow is a form of gland expression and I have had that).

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