Story time: My first dry eye doc's malpractice

[MGD1701]

Just found this interesting article, dated August 13, 2018

''Caroline Blackie, O.D., medical director for dry eye at Johnson & Johnson Vision and longtime collaborator of Dr. Korb, has been on the front lines of MGD research. Drs. Korb and Blackie have long argued that doctors of optometry should look for MGD first and the management of most dry eye will follow. ....

Based on her research, Dr. Blackie lists the must-knows for doctors of optometry:

• MGD is highly prevalent. "It's everywhere-at least 50 percent or more of your patients are going to have this," she says. "That's based on clinical data."
• MGD is best treated early. "Treating it earlier means you have to diagnose it earlier," she says. "Diagnose MGD at the first sign of compromise (inflammation and lid swelling) rather than wait for late-stage symptoms."
• MGD is best attacked by addressing the obstruction of the glands' pores. "Obstruction is the core mechanism of the disease," Dr. Blackie says. "That means evacuating gland content. Squeeze the dickens out of those things."

"We should be routinely evaluating gland dysfunction and structure on all patients to take control of ocular surface health," Dr. Blackie says.''

More https://www.aoa.org/news/clinical-ey...erstanding-mgd

[Hokucat]

Claddagh , MGD1701 is the expert at using Natrasan and warm compress, so she would be best to give advice on this. I’ve never used Natrasan and rarely use warm compress anymore. However the warm compress I found molded well to the eyes and holds its warmth well was Themalon:

https://www.amazon.com/Thermalon-243.../dp/B004385RPS

As far as probing, it is a quite invasive and uncomfortable procedure, and would try less invasive procedures first like LipiFlow and/or IPL. Assuming you have MGD, have you tried either of those yet? If at some point you look into probing, you’re right it’s virtually unheard of in the UK. However I did find this thread that lists a couple of UK probing doctors:

http://forum.dryeyezone.com/forum/dr...iflow-uk/page3

As far as diet, everyone has different underlying conditions, so the diet that works for one may not work for another. But here is what I typically follow each day ~80% of the time, in case something here helps you:

I limit gluten, dairy, and sugars. These three things always made and still make my eyes feel worse.

BREAKFAST - I've found I need to start off the day with my main meal:
-Drink one cup water as soon as wake up.
-Spinach or dark leafy greens salad. Extra virgin olive oil with fresh grinded peppercorns and a little salt for dressing.
-One cup fresh berries (strawberries, blueberries, blackberries)
-Small portion of protein (usually chicken or salmon, but find a good cut of steak or filet mignon for some reason always makes my eyes feel even better)
-Green tea with juice from 1/6 of medium to large meyer lemon and slice of crushed ginger
-Supplements related to eyes - Ocuvite-type eye vitamin, flaxseed oil, fish oil, vitamin A, bilberry

DURING DAY:
-One cup fresh vegetable juice (or thawed from frozen - I juice once a week and freeze it). A rainbow of colors: Kale, chard, parsley, bok choy, cucumbers, beets, carrots, butternut squash, apple.
-Snack on nuts and fruit (bananas, melons).
-Drink lots of water.
-Green tea with lemon and ginger
-If I’m going to eat something not so healthy like pasta or a sandwich, cookies, chips, etc. I’ll eat a small portion here in the middle of the day, as it seems to have the least negative effect on my eyes, as long as I had my good breakfast.

DINNER:
-Small portion of protein
-Vegetables (usually broccoli, asparagus, etc., something dark green)

EVENING:
-Chamomile tea
-Drink a cup of water right before bed

[MGD1701]

Hi Mgd 1u01 and Hokucat...you both are very knowledgeable and a great asset to this site. I am interested in the effectiveness of Natrasan ....diet and what is the best warm compress you have learnt to adapt after many years of research.

NatraSan pure HOCL spray - please read my earlier post, #9

http://forum.dryeyezone.com/forum/dr...eyelid-hygiene

The best to learn more is from the videos - at least the one I posted above (from Aveonva). Just bear in mind, NatraSan is NOT Avenova. Please learn more first.

compress - have replied to your another posting

[PattiS]

How does one 'get evaluated' for gland dysfunction? what exactly is done to the patient. I have severe dry eye, I believe it comes from from RA, but no tests have been done on my eyes.
Thanks in advance!

[edmunder]

How does one 'get evaluated' for gland dysfunction? what exactly is done to the patient. I have severe dry eye, I believe it comes from from RA, but no tests have been done on my eyes.
Thanks in advance!

Great question Patti.

Find a dry eye doctor who will take pictures of your glands with a special camera. They can also press on your glands snd see which are expressing oil. They can put a dye in your rye, have you blink snd see the oil film on your eye snd see how fast it evaporates called TBUT tear break up time.

Find a good doctor. You may have to drive to a larger city near you if you are ina small town. I would start calling today or tomorrow morning and get one.

The camera is either a Lipiview or Oculus.

[PattiS]

Thank you for all the helpful info edmunder.

[MGD1701]

Hi Patti
first, you must take glands images as even the best doctors can not see glands atrophy from slit lamp, according to the opinion leader Dr/prof. Gupta. She has a patient, only 10% glands left but when she expressed glands, some oils come out. When she first saw the images, she was very surprised too.

2nd, dr must express glands see if any oil comes out, with finger or a tool invented by Dr Korb (see below picture). Gland images could look perfect but no/0 function = no oil comes out when dr express. Dr Korb mentioned this in his old videos 2012 or 2014.
All these info plus other objective data can help decide HOW aggressively treamtments are required to stop progression

MGD is progressive and is much easiler/economical to treat at the earlier stage but the problem is
many doctors STILL do not examine/treat properly
just send us away with (wrong) drops = no treatment = keep progression
Examine glands function only takes 5 seconds with thumb or q-tip as picture show.
so easy WHY doctor do not check????