IPL treatment.

[lizzyk]

Update: I have had 6 IPL treatments - the last one a few weeks ago - unfortunately i cannot report any noticeable difference so far (though i was told that some people can take up to six months to notice an improvement) - i am extremely disappointed not only with the fact that so far this treatment has not worked for me but also how much it has cost me - in terms of the treatment and the considerable travelling expenses I was told that my glands are smaller than normal (?) and even though some were producing oil - it was not enough to keep my eyes lubricated. Some are not working at all and cannot be improved.
I maintain my routine of cleaning every morning with Blepasol and the use of Hylo Forte eye drops as often as i need them during the day, i have also increased my omega to 3 1000mg capsules a day and i use a heated eyebag for 10 minutes daily followed by lid massage. I have recently been prescribed Ikervis by my NHS consultant but i have only been using these drops for a couple of weeks so too early to tell if any improvement, the dosage is one drop at bedtime and it can sting! I still have to avoid long periods looking at the computer/laptop screen, no eye make up and not getting enough sleep!

[pythonidler]

Have you looked into meibomian gland probing? The first few IPL treatments that I had weren't effective because I had scar tissue over the glands. Now that I've had probing done to clear the scar tissue, IPL has been more effective for me.

[lizzyk]

I will give it some thought but it involves more travel and more expense! And the procedure seems quite invasive. Where did you the probing done pythonider?

[MGD1701]

Hi pythonidler

Scar Tissue
How do we know if we have scar tissue or not? Only dr knows, right?
I asked one dr if probing, BlephEx, IPL, expression would help me. Yes, he said.
But the one who performs the first 2 said NO, I dont need them (he did tell me ALL my glands are OPEN (after LipiFlow).
so confusing! Now I need to visit another dr. Thanks!

[lizzyk]

Have you looked into meibomian gland probing? The first few IPL treatments that I had weren't effective because I had scar tissue over the glands. Now that I've had probing done to clear the scar tissue, IPL has been more effective for me.

could you also explain how come you had scar tissue? Thanks

[pythonidler]

I will give it some thought but it involves more travel and more expense! And the procedure seems quite invasive. Where did you the probing done pythonider?

I got it done in Boston by my doctor. There certainly aren't a whole lot of doctors who do it, though.

Your best bet to find a doctor who does it is probably to call the manufacturer of the probes; they should have a list of all the doctors who've purchased a kit. I'm not sure who the manufacturer is, however, if someone else here could enlighten me.

[pythonidler]

I will give it some thought but it involves more travel and more expense! And the procedure seems quite invasive. Where did you the probing done pythonider?

Yes, I will grant you that probing is more invasive than any other meibomian gland procedure (e.g., Lipiflow, IPL, etc.). And it was quite painful as well. But it has definitely helped to get the oil flowing again, when nothing else really did. My doctor believes that probing should be a one-time procedure - you do it once to clear the scar tissue, then you can manage your MGD with regular Lipiflow or IPL treatments.

[pythonidler]

could you also explain how come you had scar tissue? Thanks

My guess is that the chronic inflammation causes the scar tissue to form over the glands. I never really asked my doctor why, I was mostly just interested in if it worked or not. I asked him what % of patients had reported significant improvement after probing, and he told me about 90%.

[pythonidler]

Hi pythonidler

Scar Tissue
How do we know if we have scar tissue or not? Only dr knows, right?
I asked one dr if probing, BlephEx, IPL, expression would help me. Yes, he said.
But the one who performs the first 2 said NO, I dont need them (he did tell me ALL my glands are OPEN (after LipiFlow).
so confusing! Now I need to visit another dr - which takes nearly 7 hrs for the round trip. Thanks!

If your doctor has the imaging device and the ability to recognize scar tissue, your doctor will know. On my next visit, I will ask him what machine he used to detect scar tissue. And I might use the imaging device again, just to make sure that no new scar tissue is forming.

You say that a doctor who can do probing said you don't need it? If he did, then I would probably trust him on that.

[MGD1701]

Thanks pythonidler
for your kindness to ask dr. I am still searching solutions for more improvements.

Expression: when you do probing and IPL, did doctors express glands? Do you think expression plays a role?
Some doctors do NOT express, I wonder why. Thanks!

[lizzyk]

Thankyou for your response pythonidler. I will give the probing some thought.

[lizzyk]

Thanks pythonidler
for your kindness to ask dr. I am still searching solutions for more improvements.
64% & 51% of my glands are gone and oil is still half thick,
and all doctors can do just tell me: do warm compress, massage. drops.There must be more can be done???

Expression: when you do probing and IPL, did doctors express glands? Do you find them important/effective?
Because I know some doctors they do NOT express. Thanks!

When i had the IPL the optometrist expressed the glands immediately afterwards with an expression tool - looked like a large pair of eyebrow tweezers, (best way i can describe it!) it hurts a bit but not unbearable, some thick stuff came out but not a lot, some of my glands were producing oil and some had atrophied and were producing nothing - the optometrist said my gland openings were small. Everyone is different and IPL may work for you. For me, at the moment, i can report no difference. I do the compress, the eye drops, (hylo forte and Ikervis) the fish oil etc. Apart from IPL, Lipiflow (which i also had but didnt work at all) and probing i am not aware of any other treatments - sometimes it just feels hopeless. I will give the probing some thought and if i decide to go ahead and have it i will certainly let you know - especially if it works - we live in hope!

[Hokucat]

Hi. I agree probing is more invasive and painful. But like pythonidler, no treatments or diet changes brought any material or lasting relief to my severe dry eyes, until probing to unblock scar tissue in my glands, and then diet changes to change the oils from thick to flowing so my glands would not get blocked up again. The probing was the prelude to my major turnaround.

At my worse, I had zero Schirmer scores and virtually zero TBUT for several years. I spent thousands of dollars on various specialists and treatments, I tried almost everything. I was literally home bound and had to quit my job.

Finally, I researched probing myself, then contacted Rhein Medical, the manufacturer of the probe. They were able to provide me with a list of doctor offices, contact info, and probe sales-to-date for doctors in my state and adjacent states. I then contacted the doctor offices closest to me who bought the most, and asked how many probing procedures they had performed to-date, and selected from those with the most experience, after double checking any reviews I could find online about these doctors (not necessarily probe-related reviews).

I actually had five probing procedures over two and a half years. When I went for the initial probe consult, the doctor said my glands looked normal, not inflamed at all, but the openings were very small, he was not sure he could get the probes in or if probing would even work. However, when he tried expressing some of my glands, most had nothing come out, and a few had very thick Crisco-like oil. Because of this and since I had tried almost everything and nothing had helped, I asked him if he could give it a try. Well, it turned out he was able to unblock many glands on the upper and lower lids in both eyes, several had scar tissue inside the glands. My eyes immediately felt a little better, but after this first and subsequent second through forth procedures, my glands quickly got blocked up again.

After the fifth probe procedure in late 2015, I started drinking fresh lemon juice in green tea with my already healthy diet, and after about a week, my eyes started feeling more moist. Somehow for me, the lemon/tea is what changed my oils from thick to flowing, for someone else it might be some other food or treatment that helps with the flow. But I have not had to have another probing nor have had a debilitating dry eye day since then. So it could be that your glands have stubborn blockage and/or scar tissue that initially requires more than IPL, because if you have scar tissue, likely no other treatments or diet changes will help. Unfortunately, there's no way to tell if probing will work unless you try it.

You might also want to consider scleral lenses. These are being used increasingly to manage dry eye symptoms. I wear mines 12+ hours a day and it provides increased ability and comfort reading, watching TV, using electronic devices, walking outside, etc., especially since I still have some dryness from loss/atrophied glands. Not everyone can tolerate them, but if you can, it can help a great deal. Here's a good overview of sclerals from the Boston PROSE scleral website, however there are several different brands:

http://www.bostonsight.org/PROSE/PRO...y-Eye-Syndrome

[MGD1701]

Thanks lizzyk,

BlephEx: Have you tried it? it is not just cleaning lashes. it make lidmarign smooth so tear can distribute better.
It is cheap and effective if you have such issues.

[lizzyk]

Scleral lenses were mentioned to me but they are £400, plus more trips to London to have them fitted etc and no guarantee they would be effective. There are also the Blepasteam eye goggles - they are £300 and of course the Probing - im not sure of the cost but would think possibly £200 per treatment, travelling expenses and then the consultation fee on top! I haven't exhausted every possibility as yet but obviously i need to bear the costs in mind. If the change in diet and green tea works for you that's great - unfortunately i do not like herbal/green type teas! I eat a reasonably healthy diet. and incorporate the fish oil. What works for one person doesn't necessarily work for everyone (if only it did!)

As regards the heat pad and expression, i really have no idea if oil comes out - i certainly can't see any - i just massage my eyes as instructed, if there is any relief it is short lived but now its just part of my daily routine along with the cleaning in the morning and eyes drops constantly during the day. I I havent tried Blephex, i would have to look into the cost etc but i would imagine its not cheap and probably only available in certain areas in the UK.