IPL treatment.

[MGD1701]

Thanks a lot. I assume you are right.
Since I do not have inflammation issue, 4 doctors confirmed it in the last 13 months. Probably I have a good diet.

[pythonidler]

Thanks a lot Pythonidler. That is interesting to know. It was nice you remember my question.
Only my last dr (a professor) told me I do NOT have scar tissue - who did not take meibography.
I did ask if probing, IPL, BlephEx etc would help me.
I told the dr, what is strange that I did not have scar tissue since many glands are gone.
I wonder HOW such scar tissue develop, from diet, inflammation??

Does it mean probing only help if you have scar tissue?

I think there's a definite relationship between inflammation and scar tissue. Just google those two phrases and you'll see lots of articles pop up.

Probing is probably only going to be helpful if:
1. You still have a decent amount of meibomian glands left (i.e., they haven't fully atrophied), and
2. You have a significant amount of scar tissue blocking those glands. I'll let the doctors define what is "significant" in this case.

[MGD1701]

Thanks a lot Pythonidler. That is interesting to know. It was nice you remember my question.
Only my last dr (a professor) told me I do NOT have scar tissue - who did not take meibography.
I did ask if probing, IPL, BlephEx etc would help me.
I told the dr, what is strange that I did not have scar tissue since many glands are gone.
I wonder HOW such scar tissue develop, from diet, inflammation??

Does it mean probing only help if you have scar tissue?

[Hokucat]

Thanks Pythonidler. That is invaluable information to know scar tissue is visible from meibography. Often patients like you and me try everything else before probing, and not until we've spent thousands of $s and have been suffering a long time, did we turn to probing and find we had scar tissue during the procedure. This could help people get the right treatment earlier in the process.

[pythonidler]

In case anyone was wondering, I talked to my doctor and found out that meibography is also used to determine whether a patient has scar tissue or not. Some doctors may not be trained to spot this, however.

My doctor said a patient who has scar tissue will have dark spots in their glands, marking the scar tissue of those glands.

[lizzyk]

crucially, i forgot to mention that all 4 of my puncta are plugged - this has made a big difference since i first experienced the dry eye symptoms years ago, i get very little tear spillage/overflow except if im outside in the wind. Punctal plugs have been critical in helping me manage my symptoms.

[lizzyk]

Pythonidler have been told i have some functioning glands and that my gland openings are small. some of my glands are producing oil but i guess it must be the quantity and the quality that is the problem?

Believe me hokucat i would try almost anything if i thought it was going to help!
There are very few NHS docs in the UK who are actually sympathetic/interested in trying new treatments (limited funds i guess) so i have had to pursue the treatments i have had myself.
Im happy to provide support/information to anyone who wants it.
Will update in due course if i decide to have any other treatments.
If anyone in UK (or anywhere else!) can provide me with info on treatments or recommendations i would be very grateful. Thanks.

[Hokucat]

Hi Lizzy. Yes, I totally agree what works for one does not necessarily work for someone else, and costs and distance to travel for treatment certainly need to considered. I think most of us in this forum are just trying to share what worked for us since often much of this information is not provided by doctors, and we also want to provide support.

Good luck on your journey. I hope you will find some relief soon.

[pythonidler]

lizzyk,

I was just wondering - have you had meibography done (pictures of your meibomian glands)? If your glands have fully atrophied, then probing would probably not be worthwhile. If, however, you still have some functioning glands left and they are blocked by scar tissue, then you would be a good candidate for probing.

[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.

[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.

[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

[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!

[lizzyk]

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

[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!