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My name is Jelena Ristic and I'm former dry eye patient because my dry eyes as well as some Chalazia have been cured with MGP (Meibomian Gland Probing /******g Probe) alone. I managed to have all my glands unblocked and have them remain unblocked (almost a year now) and also have 3 prominent chalazia reduced to almost nothing with the same procedure. I was so thrilled by the whole experience I decided to write an article about it. I'm a college professor, so research and writing are right up my alley! I used only reputable medical sites to do my research for this article which deals with the benefits of MGP exclusively;however, I'm in the process of writing a book (e-book) that I hope to publish by the end of this year which will contain just about everything you could ever wish to know about dry eyes in one place. It will include all the causes and available options to treat dry eyes and how to work with your medical professionals to secure a cure instead of just a litany of band-aid solutions. If you've had MGP or would like to know about it. I'd love to hear from you, so please send me and e-mail at dryeyeinfo@gmail.com.
Below I've included the article I wrote on why I think MGP should be the first option for treating dry eyes both (Aqueous and Evaporative) as well as chalazia.
Wishing you all the best with your dry eyes!
Sincerely,
Jelena
Why MGP Should be both the Patient’s
and Ophthalmologist’s First Choice in Treating Dry Eyes and Chalazia
Before I begin, I would like to both introduce myself and my motivations for writing this article. My name is Jelena Ristic and I am a college instructor of writing and grammar in Toronto, Canada as well as a former sufferer of dry eyes. I am also a patient of Dr. Gulani who works and resides in Jacksonville Florida. Yes, that’s right, my ophthalmologist is in Jacksonville, and I live in Toronto. This surprising fact brings me to my motivations for writing this article.
a. I am positively astounded at both the instantaneous and long term results MGP has achieved in treating my dry eyes and three quite prominent chalazia at once on the same eyelid and wish to share my experience with patients and ophthalmologists alike.
b. I am equally astounded that more ophthalmologists in the U.S. and as far as I know, any in Canada have not adopted MGP into their practices given its phenomenal results in addressing all manner of dry eyes and their symptoms, including chalazia.
In this article I will discuss the following:
a. What MGP is and what it can achieve for dry eye sufferers.
b. What is involved from a patient’s perspective in MGP. This means details like what to expect before treatment, during and after. For the type who appreciates a spoiler, I promise MGP does not hurt a bit. In fact I’m quite positive that even before getting up out of the ophthalmologist’s chair, patients who undergo MGP will develop uncontrollable grins on their faces from ear to ear because they’ll already have felt the relief they’ve been hoping for... likely for years.
c. Why MGP from my point of view as a patient should always be attempted to treat chalazia before chalazion surgery is even considered.
d. A brief personal account of my experience with MGP.
What is MGP?
MGP stands for meibomian gland probing, a procedure by which a patient’s meibomian glands are cleared of a build up of their own dried up tears, and in the case where chalazia are present, some backed up sebum, in order to allow the lipids produced in the patient’s meibomian glands to freely flow re-entering and rebalancing the patient’s unbalanced tear film – always the cause of dry eyes and their associated complications. However, before a patient can appreciate how ingenious, simple, and most importantly, effective meibomian gland probing is as a treatment for all cases of dry eyes, and chalazia, it’s important that the patient understands a little about what causes both.
Causes of Dry Eyes:
Depending on how far back one wishes to go to identify a cause, it can be said that many conditions from grave autoimmune disorders to very natural and expected hormonal deficiencies such as those experienced by menopausal women, or even antihistamines often taken for common allergies can cause dry eyes along with all of their very irritating symptoms, and very often they do. (Mayo Clinic 2010) However, also, many times such conditions may be present even though the common dry eye symptoms are not because either the gravity of the condition or the ability of the individual’s body to deal with it is such that it does not unbalance the tear film enough to cause obvious symptoms such as excess tearing, redness, itching and a gritty feeling that would alert the individual that there was indeed a problem developing. So, considering this, it is most accurate to say that dry eyes are caused when an individual’s tear film becomes unbalanced for any reason with or without symptoms that are detectable to the patient alone.
The two main sources of imbalance come from the suffering individual’s inability to produce:
a. Enough tears to adequately lubricate the cornea. This is known as aqueous tear deficiency. (NEI, 2009).
b. Adequate or good quality lipids to prevent tears from evaporating from the cornea. This is known as evaporative dry eye. (NEI, 2009).
In either case, meibomian gland probing is of great use in rebalancing the tear film and reducing and or eradicating the symptoms of dry eyes. In the case of aqueous tear deficiency, when meibomian glands are functioning at an optimal instead of impaired capacity due to build up along, or blockages in the meibomian glands, the lipids that flow from them are then more efficiently and abundantly deposited into the tear film to hopefully prevent enough of the now more scarce tears produced by the tear ducts from evaporating off of the cornea to mitigate the symptoms of aqueous dry eye. In other words, MGP, by optimizing the flow of these lipids should set into motion a positive domino effect whereby the increased flow of protective lipids into the tear film results in the decreased evaporation of the already scarce tears being produced in the case of aqueous tear deficiency, which in turn allows the eye surface to remain more lubricated and consequently, diminishes dry eye symptoms such as feelings of grittiness, itching, burning, soreness and foreign body sensation, as well as predisposition to styes and also chalazia. (Begley, Caffry, Chalmers, Mitchell)
Now, let’s do a quick re-cap just to be perfectly clear. In the case of aqueous tear deficiency MGP should achieve the following:
a. work to prevent excess evaporation of already scarce tears from the cornea
b. increase overall lubrication of the cornea
c. reduce and or eliminate dry eye symptoms such as grittiness, itching, burning, soreness and foreign body sensation.
d. reduce the patient’s predisposition to styes and chalazia
In the case of evaporative dry eye, the results are even better because unlike in the case of aqueous tear deficiency where MGP works very effectively to support the patient with the original problem, in this case, MGP directly addresses the original problem. Evaporative dry eye is caused by meibomian gland dysfunction. This is the clinical term for chronically obstructed meibomian glands that do not produce enough, or produce a poor quality of lipid that consequently cannot be deposited onto the tear film at an adequate rate to keep tears from excessively evaporating from the surface of the cornea and hence cause dry eyes. (Norfleet 2011) In patients who suffer from evaporative dry eye, there is no better, nor less labour intensive approach on their part to deal with their dry eyes. Literally, their trapped tears are freed to resume their job in lubricating and protecting their corneas instantaneously. (Gulani, 2011)
What is even more impressive is that MGP does not require the patient, like most dry eye treatments do, to remain a perpetual slave to eye drops and hot compresses in an effort to do for the body what it can very well do for itself - produce lipids, hang on to tears and keep the tear film balanced.
Causes of Chalazia:
In short, chalazia are caused by completely obstructed meibomian glands. When a meibomian gland becomes completely obstructed with dried up or poor quality lipids, or due to inflammation from blepharitis or a stye, a chalazion forms. Chalazia are formed by lipids that back up into the meibomian gland and cause it to swell simply because they cannot exit the eyelid. The longer a Chalazion is left untreated and the gland remains blocked, the larger the chalazion grows and the more damage it does to the tissue of the patient’s eyelid. Very large chalazia can cause permanent scarring that can only be corrected with surgery; however, with patient education and a quick response by an ophthalmologist proficient in performing MGP, there is no need for chalazia to ever grow so large. At early onset of a bump on the eyelid, the glands can simply be cleared allowing the backed up lipids to drain and thus prevent any permanent damage to the eyelid that might later require surgery to fix.
MGP – The Procedure from the Patient’s Perspective:
Since the procedure is a manual one whereby the ophthalmologist inserts a tiny probe into each meibomian gland with which to scrape away blockages and debris, freezing is obviously necessary. However, the freezing does not come in the traditional form of a needle full of lidocaine inserted near each eye, but in the far more interesting and non-invasive approach of applying lidocaine laced jojoba butter onto the eye lids. It feels a little greasy and messy, and the patient can’t see much at all once the butter is applied because it makes his or her vision very blurry, but it works like a charm and the patient feels absolutely no pain whatsoever. The jojoba oil is the same consistency as the lipids in the meibomian glands, so the glands easily and readily soak it all the way up into the lids carrying the lidocaine with it, and voilà, after a little waiting, the eyelids are completely frozen.
The next step is having a seat in the ophthalmologist’s chair and leaning one’s head firmly into the band for the forehead, to give the ophthalmologist a little resistance so he or she can better get at the eyelids and glands with the probe. The ophthalmologist uses a magnifying lens to get a good view of the glands to be cleaned and one by one inserts the probe in each and works away in it until the lipids start to flow freely again. It’s at this point that most people will likely start smiling uncontrollably because they’ll literally feel their lids get lighter and their eyes become more moist and comfortable. The best part is when they take a look in the mirror and see bright shiny eyes staring back at them instead of the dull tired ones they likely sat down in the chair with initially. The results are both instantaneous and lasting.
The after care is simple. Due to the glands having been probed and having been a little irritated, it’s important to ensure they are protected from infection and soothed. For these reasons some eye drops will be prescribed. They will be used for about ten days, two times a day along with a five minute hot compress with a face towel, as warm as can be tolerated, simply lain over the whole face. The after care is actually relaxing. After those ten days, all that is required to maintain results is the same warm compress twice a day for five minutes only, preferably morning and night. No more eye drops unless exposure for several hours to excessively dry environments (such as airplane cabins) is unavoidable, nor incessant hot compresses for fifteen or twenty minutes each time, four times a day, nor humidifying goggles, nor whatever else was being employed in desperation to lubricate and protect the eyes the way only a person’s own tears can.
Why MGP Should Always Be Attempted to Clear Chalazia Before Chalazian Surgery is Considered:
From my point of view as a patient, there are four clear reasons why I would always opt for MGP as the first approach to trying to clear chalazia, even large ones, before I would ever consider chalazion surgery. They are listed and explained below in order of importance from my perspective as a patient.
Potential for Trauma:
Although I realize chalazion surgery is quite routine and generally has a low incidence of complication, I’m sure anyone would agree that, nonetheless, a tiny probe used to gently scrape away debris from inside of clogged glands allowing them to drain naturally, has a much lower potential to cause trauma to the eyelid than a scalpel used to cut clear through the underside of the eyelid to get at a chalazion within it. A person neither has to be a doctor nor a rocket scientist to appreciate this.
Every medical procedure comes with risks, benefits and a consent form to sign, but no rewind button nor ‘undo’ option. Once tissue has been cut with a scalpel, no one can predict how that tissue will heal in response. It may heal up just fine as many people’s does, or like in the case of a very dear friend and colleague of mine, a severe infection may develop that immediately requires a second surgery adding to the initial trauma, and results in excess scarring to the eyelid that not only leaves it permanently disfigured, but also more susceptible than ever to dry eye as the glands that are meant to protect it from dry eye have been damaged and the lid itself can no longer completely close over the eye’s surface. Or perhaps a person might land somewhere mid way on this admittedly dramatic continuum. But,...why? Why risk this even if it is a one in a million occurrence when a much less traumatic alternative exists? It simply doesn’t make sense when no one can predict, nor would be willing to promise which patient anyone might be, the routine successful kind, or the one with the unexpected response riddled with complications, some, potentially irreversible. (Bupa’s Health Information Team Aug 2011)
Permanent vs Temporary Solutions:
Meibomian gland probing addresses the problem of dry eyes; chalazion surgery skirts it. It’s that simple. That is my second argument for treating chalazia with meibomian gland probing instead of chalazion surgery. Put another way...If a person were locked in his or her house because the lock on the front door jammed, should that person call a locksmith to come fix the lock in order to get out, or should that person call a demolition company to arrive with a crane and wrecking ball to put a hole in the roof and be dragged out? Which of the two options would solve the problem most accurately, expediently, elegantly and permanently? Clearly, I’m assuming the answer is self evident.
Chalazion surgery removes chalazia and leaves the eyes in the exact same state they were in, which incidentally, caused the chalazion to form in the first place. That is why many people end up having several chalazion surgeries. Chalazion surgery only removes the symptom and does nothing to address the problem because it does nothing to address the blocked glands which cause... chalazia. Meibomian gland probing on the other hand, addresses the problem and with some patience and attention from the patient via hot compresses and letting a few months go by, even very large chalazia can naturally clear, and much more likely, never return.
Time is On the Patient’s Side:
Finally, if MGP does not manage to clear a chalazion, surgery can be performed at any time to improve the appearance of the eyelid. In the meantime, what can be expected is the prevention of recurrence of any dry eye symptoms, including more chalazia. I have friends who themselves, or for their children, have waited months for chalazia to disappear on their own, and most often they have. It can take many months and I’ve read on some blogs where people post advice and their own personal experiences, even up to a year or more for very large or stubborn ones to disappear, but they can and often do.
Quality of Life Post Procedure:
Here again, MGP comes out on top, hands down. After about ten days of drops and adopting a regime of short five minute hot compresses, a completely normal active life can be resumed. This means in exchange for applying a warm face towel to the eyes for five short minutes twice a day, morning and night (incidentally, a nice opportunity to reflect or relax at the beginning and end of the day), patients can wear make-up, go out in the sun, exercise and sweat worry free and most importantly, emancipate themselves from the slavery of the ‘old’ long daily hot compresses every four to six hours in a losing battle to keep symptoms at bay. They can also expect not to experience any more symptoms of dry eyes such as tearing, itching, grittiness, blepharitis, styes or chalazia.
In the case of chalazion surgery, it’s a whole other story. Patients can expect to experience quite a lot of pain and soreness in the eyelid that was operated on for a few days. They can also expect to feel discomfort from the scar tissue that will form on the underside of their eyelid and rub up against their cornea after the surgery. This scar tissue diminishes in time, but it can be bothersome enough to cause the eye to constantly tear even as long as several months after the procedure because it constantly feels as though there is something in it. Finally, patients can expect all of their other dry eye symptoms to return because their dry eye has not been addressed, and hence, they will also be instructed to diligently keep up with their hot compresses and avoid eye make-up altogether to try to prevent the recurrence of more chalazia as having had one, it has now been determined they are predisposed to them.
Given the four reasons I have discussed above, I cannot think of any reason why a patient, if the option is available to them, would opt for chalazion surgery over MGP when MGP is a. less invasive, b. offers a cure versus a temporary treatment c. allows the patient cosmetic options and d. offers a much improved quality of life post procedure.
This brings me to how I ended up choosing Dr. Gulani to be my ophthalmologist when I live in Toronto, Canada and he lives and works in Jacksonville, Florida.
My Personal Experience With MGP:
After two cases of infectious blepharitis, an internal stye, one unsuccessful cortisone shot, two severe allergic reactions to antibiotics, four consecutive months of relentless hot compresses, three rock hard chalazia firmly parked on the inner corner of my upper left eyelid and countless hours logged furiously searching for solutions on Google, I found myself sitting in an ophthalmologist’s chair in Jacksonville Florida face to face with Dr. Gulani who was intently listening to me recount my patient history. At the end of it, instead of giving his opinion right away, he did something unusual. He asked me why I had chosen to fly all the way to Jacksonville specifically seeking out MGP. What did I think it could do for me? My answer was the abridged version of what I have already written above. It went something like this. “I’ve done a lot of research on dry eyes, chalazia, chalazion surgery and after stumbling upon a video of you performing MGP, researched it as well, and I’ve come to believe that it not only has real potential to clear my chalazia, but also to cure me of the severe dry eye condition I have that caused them in the first place. I’m terrified of running into the complications of chalazion surgery, so would prefer to exhaust all my options before even putting that on the table, and in Toronto, chalazion surgery along with frequent hot compresses for the rest of my life was the only option offered to me, with very low probability that a. my chalazia would not come back and b. that my dry eyes would be improved, let alone cured.” In other words, but I didn’t say it quite like this despite how intensely I was feeling it at the moment, I felt that choosing to be treated by Dr Gulani with MGP was quite sincerely my only hope for a decent quality of life and perhaps even a normal eyelid again.
Dr Gulani was pleased with my official answer, but protectively doubtful of my optimism as far as clearing the three chalazia was concerned. He did not wish to raise my expectations too high given the state my eye was in. That state was truthfully, quite bad. After extensive inflammation due to infection and the stress of two prolonged allergic reactions, the tissue of the affected part of my eyelid felt more like cartilage than skin. Furthermore, my left lid was drooping over my eye to easily a third of the way closed, and my left eyebrow was arched clearly above the point where it should have fallen in line with my right, causing him to strongly suspect that the cortisone shot I had received had caused ptosis (permanent drooping of the eyelid). Ever the consummate professional, he shared his view of my situation by first reassuring me it was all very fixable but perhaps not with MGP alone. He wholeheartedly agreed that MGP was the correct first step as my glands were so blocked nothing was coming out of them upon palpation (pressing) which verified that indeed my dry eye was very severe. He then went on to say that the ptosis could be fixed with a very common and successful oculoplasty procedure and furthermore, that if six months after the MGP procedure my chalazia were still large enough to be cosmetically bothersome, I could return then and have chalazion surgery performed. Needless to say, I wasn’t jumping out of the seat with joy after hearing all of this, but my stubborn belief in what I thought MGP could do and Dr. Gulani’s absolute confidence in what he could do for me managed to ease my rattled nerves and we got down to business.
It only took about half way through the procedure before that grin I mentioned at the beginning of this article began to emerge on my face. By the time the MGP was over, I couldn’t stop smiling because I felt such immense relief. My eyes felt as though they’d been engulfed by warm liquid satin and when I looked in the mirror they were more shiny than I could ever remember them being. It made me forget for a little while about the still swollen ridge of scar tissue on my drooping left eyelid. Five days later at a follow up visit I proudly showed Dr. Gulani that the scarring on my left lid was already noticeably diminished. It was, just a little, but a little is a lot when for months you’ve suffered repeatedly to only get progressively worse. In that context, the improvement was akin to a victory to me. He was pleasantly surprised and sent me on my way asking me to keep him posted on my progress. That day was May 28th of 2011. This Christmas, I sent him an update stating that I definitely would not be needing chalazion surgery. The cartilage-like scarring on my left eyelid is now gone and what is left is a little uneven texture just under my skin which is except to me, invisible and absolutely nothing worth taking a scalpel to. My left eyebrow has resumed its proper position across from my right, and my left eyelid now remains open just as widely as my right. So, thankfully, no ptosis! Instead, I’m wearing lots of mascara and big satisfied smiles.
In my case MGP was wildly and unexpectedly successful even though I showed up late in the game after considerable damage had been done. Needless to say, ideally, a patient should be treated as soon as the formation of a chalazion begins in order to reap maximum benefit as far as the procedure’s efficacy goes in clearing chalazia. Had I known about MGP and had easy access to it as soon as my first chalazion had begun to develop, I would have been spared the great stress of chasing various non-surgical solutions to finally hear that I might likely have to have not one, but two surgeries to correct the damage that had been done in the process.
Final Words:
The bottom line is MGP is an elegant, highly efficient and effective procedure that not only addresses the symptoms of dry eyes, but works to cure them. It is easy on the patient and offers the patient a more improved quality of life than any other approach available for dealing with dry eyes.
Sadly, however, very few ophthalmologists have incorporated it into their practices so that only those patients who are savvy enough to have discovered it themselves, and also financially well off enough to (likely) fly to another city far from their own to have it performed may benefit from it.
Because I am not familiar enough with the medical and insurance systems of the U.S., I am restricting myself to commenting on the financial inefficiency this reality I imagine must cause the Canadian health care system where most treatments for dry eyes are paid for by the government through programs such as OHIP. I must have visited an ophthalmologist, doctor’s office or emergency room a total of 20 times in four months for all the issues I cited above, and I’m quite sure the visits would have only continued given the extreme state of my dry eyes had I not had MGP performed. I surely would have had at least one chalazion surgery, if not more over the next several months or years, each with follow up visits of course. MGP requires an ophthalmologist’s magnifying lens, a few gauge probes to choose from, some jojoba butter, lidocaine, and certainly, the cost of training. I’m pretty sure all but the training is very affordable or already available, and even if the training would cost a few thousand dollars to complete, given that millions of people suffer from dry eye in North America alone, I can only imagine the savings to the Canadian government in technically unnecessary visits to already overburdened specialists offices would have to be considerable. (Gulani 2011) Furthermore, the chairs that former dry eye suffers would leave empty could be filled with patients suffering from other forms of ocular disease and degeneration who really do require frequent ongoing care which would then result in money being much better spent.
MGP is a very viable answer to millions of dry eye suffers’ quests for a real and long lasting solution for their dry eyes and in Canada, it seems very likely it would help to address at least one aspect of a strained health care system.
If you found this article informative, I hope you will look forward to the release of my e-book which will comprehensively discuss the issues of dry eyes, styes, chalazia and their various causes and cures later on this year. Both in the absence and presence of MGP there are many actions you can take to diminish symptoms and maximize results. If you send me an e-mail at dryeyeinfo@gmail.com, I’ll be sure to keep you updated.
References
Mayo Clinic staff. " Dry Eyes." MayoClinic.com. Jun12th, 2010. http://www.mayoclinic.com/health/dry...SECTION=causes. (accessed Oct 23, 2011)
"Facts About Dry Eye." National Eye Institute Aug, 2009. http://www.nei.nih.gov/health/dryeye/dryeye.asp#1 (accessed Oct 24, 2011)
Begley C., Caffry B., Chalmers R. , Mitchell L. "Use of the Dry Eye Questionnaire (DEQ) to Measure Symptoms of Ocular Irritation in Patients with Aqueous Tear Deficient Dry Eye ." http://research.opt.indiana.edu/Libr...html.(accessed February 24, 2012)
"Consensus Findings On Meibomian Gland Dysfunction Published In Investigative Ophthalmology & Visual Science" Medical News Today. Apr 1st, 2011. http://www.medicalnewstoday.com/releases/220942.php (accessed Oct 24,2011)
Gulani, Arun. "Dry Eye Treatment." May 27, 2011. http://www.youtube.com/watch?v=VfJc5DrW_8A. (accessed February 23, 2012)
"Chalazion Removal." Bupa. Aug, 2011. http://www.bupa.co.uk/individuals/he...d-cyst-removal (accessed Oct 24, 2011)
My name is Jelena Ristic and I'm former dry eye patient because my dry eyes as well as some Chalazia have been cured with MGP (Meibomian Gland Probing /******g Probe) alone. I managed to have all my glands unblocked and have them remain unblocked (almost a year now) and also have 3 prominent chalazia reduced to almost nothing with the same procedure. I was so thrilled by the whole experience I decided to write an article about it. I'm a college professor, so research and writing are right up my alley! I used only reputable medical sites to do my research for this article which deals with the benefits of MGP exclusively;however, I'm in the process of writing a book (e-book) that I hope to publish by the end of this year which will contain just about everything you could ever wish to know about dry eyes in one place. It will include all the causes and available options to treat dry eyes and how to work with your medical professionals to secure a cure instead of just a litany of band-aid solutions. If you've had MGP or would like to know about it. I'd love to hear from you, so please send me and e-mail at dryeyeinfo@gmail.com.
Below I've included the article I wrote on why I think MGP should be the first option for treating dry eyes both (Aqueous and Evaporative) as well as chalazia.
Wishing you all the best with your dry eyes!
Sincerely,
Jelena
Why MGP Should be both the Patient’s
and Ophthalmologist’s First Choice in Treating Dry Eyes and Chalazia
Before I begin, I would like to both introduce myself and my motivations for writing this article. My name is Jelena Ristic and I am a college instructor of writing and grammar in Toronto, Canada as well as a former sufferer of dry eyes. I am also a patient of Dr. Gulani who works and resides in Jacksonville Florida. Yes, that’s right, my ophthalmologist is in Jacksonville, and I live in Toronto. This surprising fact brings me to my motivations for writing this article.
a. I am positively astounded at both the instantaneous and long term results MGP has achieved in treating my dry eyes and three quite prominent chalazia at once on the same eyelid and wish to share my experience with patients and ophthalmologists alike.
b. I am equally astounded that more ophthalmologists in the U.S. and as far as I know, any in Canada have not adopted MGP into their practices given its phenomenal results in addressing all manner of dry eyes and their symptoms, including chalazia.
In this article I will discuss the following:
a. What MGP is and what it can achieve for dry eye sufferers.
b. What is involved from a patient’s perspective in MGP. This means details like what to expect before treatment, during and after. For the type who appreciates a spoiler, I promise MGP does not hurt a bit. In fact I’m quite positive that even before getting up out of the ophthalmologist’s chair, patients who undergo MGP will develop uncontrollable grins on their faces from ear to ear because they’ll already have felt the relief they’ve been hoping for... likely for years.
c. Why MGP from my point of view as a patient should always be attempted to treat chalazia before chalazion surgery is even considered.
d. A brief personal account of my experience with MGP.
What is MGP?
MGP stands for meibomian gland probing, a procedure by which a patient’s meibomian glands are cleared of a build up of their own dried up tears, and in the case where chalazia are present, some backed up sebum, in order to allow the lipids produced in the patient’s meibomian glands to freely flow re-entering and rebalancing the patient’s unbalanced tear film – always the cause of dry eyes and their associated complications. However, before a patient can appreciate how ingenious, simple, and most importantly, effective meibomian gland probing is as a treatment for all cases of dry eyes, and chalazia, it’s important that the patient understands a little about what causes both.
Causes of Dry Eyes:
Depending on how far back one wishes to go to identify a cause, it can be said that many conditions from grave autoimmune disorders to very natural and expected hormonal deficiencies such as those experienced by menopausal women, or even antihistamines often taken for common allergies can cause dry eyes along with all of their very irritating symptoms, and very often they do. (Mayo Clinic 2010) However, also, many times such conditions may be present even though the common dry eye symptoms are not because either the gravity of the condition or the ability of the individual’s body to deal with it is such that it does not unbalance the tear film enough to cause obvious symptoms such as excess tearing, redness, itching and a gritty feeling that would alert the individual that there was indeed a problem developing. So, considering this, it is most accurate to say that dry eyes are caused when an individual’s tear film becomes unbalanced for any reason with or without symptoms that are detectable to the patient alone.
The two main sources of imbalance come from the suffering individual’s inability to produce:
a. Enough tears to adequately lubricate the cornea. This is known as aqueous tear deficiency. (NEI, 2009).
b. Adequate or good quality lipids to prevent tears from evaporating from the cornea. This is known as evaporative dry eye. (NEI, 2009).
In either case, meibomian gland probing is of great use in rebalancing the tear film and reducing and or eradicating the symptoms of dry eyes. In the case of aqueous tear deficiency, when meibomian glands are functioning at an optimal instead of impaired capacity due to build up along, or blockages in the meibomian glands, the lipids that flow from them are then more efficiently and abundantly deposited into the tear film to hopefully prevent enough of the now more scarce tears produced by the tear ducts from evaporating off of the cornea to mitigate the symptoms of aqueous dry eye. In other words, MGP, by optimizing the flow of these lipids should set into motion a positive domino effect whereby the increased flow of protective lipids into the tear film results in the decreased evaporation of the already scarce tears being produced in the case of aqueous tear deficiency, which in turn allows the eye surface to remain more lubricated and consequently, diminishes dry eye symptoms such as feelings of grittiness, itching, burning, soreness and foreign body sensation, as well as predisposition to styes and also chalazia. (Begley, Caffry, Chalmers, Mitchell)
Now, let’s do a quick re-cap just to be perfectly clear. In the case of aqueous tear deficiency MGP should achieve the following:
a. work to prevent excess evaporation of already scarce tears from the cornea
b. increase overall lubrication of the cornea
c. reduce and or eliminate dry eye symptoms such as grittiness, itching, burning, soreness and foreign body sensation.
d. reduce the patient’s predisposition to styes and chalazia
In the case of evaporative dry eye, the results are even better because unlike in the case of aqueous tear deficiency where MGP works very effectively to support the patient with the original problem, in this case, MGP directly addresses the original problem. Evaporative dry eye is caused by meibomian gland dysfunction. This is the clinical term for chronically obstructed meibomian glands that do not produce enough, or produce a poor quality of lipid that consequently cannot be deposited onto the tear film at an adequate rate to keep tears from excessively evaporating from the surface of the cornea and hence cause dry eyes. (Norfleet 2011) In patients who suffer from evaporative dry eye, there is no better, nor less labour intensive approach on their part to deal with their dry eyes. Literally, their trapped tears are freed to resume their job in lubricating and protecting their corneas instantaneously. (Gulani, 2011)
What is even more impressive is that MGP does not require the patient, like most dry eye treatments do, to remain a perpetual slave to eye drops and hot compresses in an effort to do for the body what it can very well do for itself - produce lipids, hang on to tears and keep the tear film balanced.
Causes of Chalazia:
In short, chalazia are caused by completely obstructed meibomian glands. When a meibomian gland becomes completely obstructed with dried up or poor quality lipids, or due to inflammation from blepharitis or a stye, a chalazion forms. Chalazia are formed by lipids that back up into the meibomian gland and cause it to swell simply because they cannot exit the eyelid. The longer a Chalazion is left untreated and the gland remains blocked, the larger the chalazion grows and the more damage it does to the tissue of the patient’s eyelid. Very large chalazia can cause permanent scarring that can only be corrected with surgery; however, with patient education and a quick response by an ophthalmologist proficient in performing MGP, there is no need for chalazia to ever grow so large. At early onset of a bump on the eyelid, the glands can simply be cleared allowing the backed up lipids to drain and thus prevent any permanent damage to the eyelid that might later require surgery to fix.
MGP – The Procedure from the Patient’s Perspective:
Since the procedure is a manual one whereby the ophthalmologist inserts a tiny probe into each meibomian gland with which to scrape away blockages and debris, freezing is obviously necessary. However, the freezing does not come in the traditional form of a needle full of lidocaine inserted near each eye, but in the far more interesting and non-invasive approach of applying lidocaine laced jojoba butter onto the eye lids. It feels a little greasy and messy, and the patient can’t see much at all once the butter is applied because it makes his or her vision very blurry, but it works like a charm and the patient feels absolutely no pain whatsoever. The jojoba oil is the same consistency as the lipids in the meibomian glands, so the glands easily and readily soak it all the way up into the lids carrying the lidocaine with it, and voilà, after a little waiting, the eyelids are completely frozen.
The next step is having a seat in the ophthalmologist’s chair and leaning one’s head firmly into the band for the forehead, to give the ophthalmologist a little resistance so he or she can better get at the eyelids and glands with the probe. The ophthalmologist uses a magnifying lens to get a good view of the glands to be cleaned and one by one inserts the probe in each and works away in it until the lipids start to flow freely again. It’s at this point that most people will likely start smiling uncontrollably because they’ll literally feel their lids get lighter and their eyes become more moist and comfortable. The best part is when they take a look in the mirror and see bright shiny eyes staring back at them instead of the dull tired ones they likely sat down in the chair with initially. The results are both instantaneous and lasting.
The after care is simple. Due to the glands having been probed and having been a little irritated, it’s important to ensure they are protected from infection and soothed. For these reasons some eye drops will be prescribed. They will be used for about ten days, two times a day along with a five minute hot compress with a face towel, as warm as can be tolerated, simply lain over the whole face. The after care is actually relaxing. After those ten days, all that is required to maintain results is the same warm compress twice a day for five minutes only, preferably morning and night. No more eye drops unless exposure for several hours to excessively dry environments (such as airplane cabins) is unavoidable, nor incessant hot compresses for fifteen or twenty minutes each time, four times a day, nor humidifying goggles, nor whatever else was being employed in desperation to lubricate and protect the eyes the way only a person’s own tears can.
Why MGP Should Always Be Attempted to Clear Chalazia Before Chalazian Surgery is Considered:
From my point of view as a patient, there are four clear reasons why I would always opt for MGP as the first approach to trying to clear chalazia, even large ones, before I would ever consider chalazion surgery. They are listed and explained below in order of importance from my perspective as a patient.
Potential for Trauma:
Although I realize chalazion surgery is quite routine and generally has a low incidence of complication, I’m sure anyone would agree that, nonetheless, a tiny probe used to gently scrape away debris from inside of clogged glands allowing them to drain naturally, has a much lower potential to cause trauma to the eyelid than a scalpel used to cut clear through the underside of the eyelid to get at a chalazion within it. A person neither has to be a doctor nor a rocket scientist to appreciate this.
Every medical procedure comes with risks, benefits and a consent form to sign, but no rewind button nor ‘undo’ option. Once tissue has been cut with a scalpel, no one can predict how that tissue will heal in response. It may heal up just fine as many people’s does, or like in the case of a very dear friend and colleague of mine, a severe infection may develop that immediately requires a second surgery adding to the initial trauma, and results in excess scarring to the eyelid that not only leaves it permanently disfigured, but also more susceptible than ever to dry eye as the glands that are meant to protect it from dry eye have been damaged and the lid itself can no longer completely close over the eye’s surface. Or perhaps a person might land somewhere mid way on this admittedly dramatic continuum. But,...why? Why risk this even if it is a one in a million occurrence when a much less traumatic alternative exists? It simply doesn’t make sense when no one can predict, nor would be willing to promise which patient anyone might be, the routine successful kind, or the one with the unexpected response riddled with complications, some, potentially irreversible. (Bupa’s Health Information Team Aug 2011)
Permanent vs Temporary Solutions:
Meibomian gland probing addresses the problem of dry eyes; chalazion surgery skirts it. It’s that simple. That is my second argument for treating chalazia with meibomian gland probing instead of chalazion surgery. Put another way...If a person were locked in his or her house because the lock on the front door jammed, should that person call a locksmith to come fix the lock in order to get out, or should that person call a demolition company to arrive with a crane and wrecking ball to put a hole in the roof and be dragged out? Which of the two options would solve the problem most accurately, expediently, elegantly and permanently? Clearly, I’m assuming the answer is self evident.
Chalazion surgery removes chalazia and leaves the eyes in the exact same state they were in, which incidentally, caused the chalazion to form in the first place. That is why many people end up having several chalazion surgeries. Chalazion surgery only removes the symptom and does nothing to address the problem because it does nothing to address the blocked glands which cause... chalazia. Meibomian gland probing on the other hand, addresses the problem and with some patience and attention from the patient via hot compresses and letting a few months go by, even very large chalazia can naturally clear, and much more likely, never return.
Time is On the Patient’s Side:
Finally, if MGP does not manage to clear a chalazion, surgery can be performed at any time to improve the appearance of the eyelid. In the meantime, what can be expected is the prevention of recurrence of any dry eye symptoms, including more chalazia. I have friends who themselves, or for their children, have waited months for chalazia to disappear on their own, and most often they have. It can take many months and I’ve read on some blogs where people post advice and their own personal experiences, even up to a year or more for very large or stubborn ones to disappear, but they can and often do.
Quality of Life Post Procedure:
Here again, MGP comes out on top, hands down. After about ten days of drops and adopting a regime of short five minute hot compresses, a completely normal active life can be resumed. This means in exchange for applying a warm face towel to the eyes for five short minutes twice a day, morning and night (incidentally, a nice opportunity to reflect or relax at the beginning and end of the day), patients can wear make-up, go out in the sun, exercise and sweat worry free and most importantly, emancipate themselves from the slavery of the ‘old’ long daily hot compresses every four to six hours in a losing battle to keep symptoms at bay. They can also expect not to experience any more symptoms of dry eyes such as tearing, itching, grittiness, blepharitis, styes or chalazia.
In the case of chalazion surgery, it’s a whole other story. Patients can expect to experience quite a lot of pain and soreness in the eyelid that was operated on for a few days. They can also expect to feel discomfort from the scar tissue that will form on the underside of their eyelid and rub up against their cornea after the surgery. This scar tissue diminishes in time, but it can be bothersome enough to cause the eye to constantly tear even as long as several months after the procedure because it constantly feels as though there is something in it. Finally, patients can expect all of their other dry eye symptoms to return because their dry eye has not been addressed, and hence, they will also be instructed to diligently keep up with their hot compresses and avoid eye make-up altogether to try to prevent the recurrence of more chalazia as having had one, it has now been determined they are predisposed to them.
Given the four reasons I have discussed above, I cannot think of any reason why a patient, if the option is available to them, would opt for chalazion surgery over MGP when MGP is a. less invasive, b. offers a cure versus a temporary treatment c. allows the patient cosmetic options and d. offers a much improved quality of life post procedure.
This brings me to how I ended up choosing Dr. Gulani to be my ophthalmologist when I live in Toronto, Canada and he lives and works in Jacksonville, Florida.
My Personal Experience With MGP:
After two cases of infectious blepharitis, an internal stye, one unsuccessful cortisone shot, two severe allergic reactions to antibiotics, four consecutive months of relentless hot compresses, three rock hard chalazia firmly parked on the inner corner of my upper left eyelid and countless hours logged furiously searching for solutions on Google, I found myself sitting in an ophthalmologist’s chair in Jacksonville Florida face to face with Dr. Gulani who was intently listening to me recount my patient history. At the end of it, instead of giving his opinion right away, he did something unusual. He asked me why I had chosen to fly all the way to Jacksonville specifically seeking out MGP. What did I think it could do for me? My answer was the abridged version of what I have already written above. It went something like this. “I’ve done a lot of research on dry eyes, chalazia, chalazion surgery and after stumbling upon a video of you performing MGP, researched it as well, and I’ve come to believe that it not only has real potential to clear my chalazia, but also to cure me of the severe dry eye condition I have that caused them in the first place. I’m terrified of running into the complications of chalazion surgery, so would prefer to exhaust all my options before even putting that on the table, and in Toronto, chalazion surgery along with frequent hot compresses for the rest of my life was the only option offered to me, with very low probability that a. my chalazia would not come back and b. that my dry eyes would be improved, let alone cured.” In other words, but I didn’t say it quite like this despite how intensely I was feeling it at the moment, I felt that choosing to be treated by Dr Gulani with MGP was quite sincerely my only hope for a decent quality of life and perhaps even a normal eyelid again.
Dr Gulani was pleased with my official answer, but protectively doubtful of my optimism as far as clearing the three chalazia was concerned. He did not wish to raise my expectations too high given the state my eye was in. That state was truthfully, quite bad. After extensive inflammation due to infection and the stress of two prolonged allergic reactions, the tissue of the affected part of my eyelid felt more like cartilage than skin. Furthermore, my left lid was drooping over my eye to easily a third of the way closed, and my left eyebrow was arched clearly above the point where it should have fallen in line with my right, causing him to strongly suspect that the cortisone shot I had received had caused ptosis (permanent drooping of the eyelid). Ever the consummate professional, he shared his view of my situation by first reassuring me it was all very fixable but perhaps not with MGP alone. He wholeheartedly agreed that MGP was the correct first step as my glands were so blocked nothing was coming out of them upon palpation (pressing) which verified that indeed my dry eye was very severe. He then went on to say that the ptosis could be fixed with a very common and successful oculoplasty procedure and furthermore, that if six months after the MGP procedure my chalazia were still large enough to be cosmetically bothersome, I could return then and have chalazion surgery performed. Needless to say, I wasn’t jumping out of the seat with joy after hearing all of this, but my stubborn belief in what I thought MGP could do and Dr. Gulani’s absolute confidence in what he could do for me managed to ease my rattled nerves and we got down to business.
It only took about half way through the procedure before that grin I mentioned at the beginning of this article began to emerge on my face. By the time the MGP was over, I couldn’t stop smiling because I felt such immense relief. My eyes felt as though they’d been engulfed by warm liquid satin and when I looked in the mirror they were more shiny than I could ever remember them being. It made me forget for a little while about the still swollen ridge of scar tissue on my drooping left eyelid. Five days later at a follow up visit I proudly showed Dr. Gulani that the scarring on my left lid was already noticeably diminished. It was, just a little, but a little is a lot when for months you’ve suffered repeatedly to only get progressively worse. In that context, the improvement was akin to a victory to me. He was pleasantly surprised and sent me on my way asking me to keep him posted on my progress. That day was May 28th of 2011. This Christmas, I sent him an update stating that I definitely would not be needing chalazion surgery. The cartilage-like scarring on my left eyelid is now gone and what is left is a little uneven texture just under my skin which is except to me, invisible and absolutely nothing worth taking a scalpel to. My left eyebrow has resumed its proper position across from my right, and my left eyelid now remains open just as widely as my right. So, thankfully, no ptosis! Instead, I’m wearing lots of mascara and big satisfied smiles.
In my case MGP was wildly and unexpectedly successful even though I showed up late in the game after considerable damage had been done. Needless to say, ideally, a patient should be treated as soon as the formation of a chalazion begins in order to reap maximum benefit as far as the procedure’s efficacy goes in clearing chalazia. Had I known about MGP and had easy access to it as soon as my first chalazion had begun to develop, I would have been spared the great stress of chasing various non-surgical solutions to finally hear that I might likely have to have not one, but two surgeries to correct the damage that had been done in the process.
Final Words:
The bottom line is MGP is an elegant, highly efficient and effective procedure that not only addresses the symptoms of dry eyes, but works to cure them. It is easy on the patient and offers the patient a more improved quality of life than any other approach available for dealing with dry eyes.
Sadly, however, very few ophthalmologists have incorporated it into their practices so that only those patients who are savvy enough to have discovered it themselves, and also financially well off enough to (likely) fly to another city far from their own to have it performed may benefit from it.
Because I am not familiar enough with the medical and insurance systems of the U.S., I am restricting myself to commenting on the financial inefficiency this reality I imagine must cause the Canadian health care system where most treatments for dry eyes are paid for by the government through programs such as OHIP. I must have visited an ophthalmologist, doctor’s office or emergency room a total of 20 times in four months for all the issues I cited above, and I’m quite sure the visits would have only continued given the extreme state of my dry eyes had I not had MGP performed. I surely would have had at least one chalazion surgery, if not more over the next several months or years, each with follow up visits of course. MGP requires an ophthalmologist’s magnifying lens, a few gauge probes to choose from, some jojoba butter, lidocaine, and certainly, the cost of training. I’m pretty sure all but the training is very affordable or already available, and even if the training would cost a few thousand dollars to complete, given that millions of people suffer from dry eye in North America alone, I can only imagine the savings to the Canadian government in technically unnecessary visits to already overburdened specialists offices would have to be considerable. (Gulani 2011) Furthermore, the chairs that former dry eye suffers would leave empty could be filled with patients suffering from other forms of ocular disease and degeneration who really do require frequent ongoing care which would then result in money being much better spent.
MGP is a very viable answer to millions of dry eye suffers’ quests for a real and long lasting solution for their dry eyes and in Canada, it seems very likely it would help to address at least one aspect of a strained health care system.
If you found this article informative, I hope you will look forward to the release of my e-book which will comprehensively discuss the issues of dry eyes, styes, chalazia and their various causes and cures later on this year. Both in the absence and presence of MGP there are many actions you can take to diminish symptoms and maximize results. If you send me an e-mail at dryeyeinfo@gmail.com, I’ll be sure to keep you updated.
References
Mayo Clinic staff. " Dry Eyes." MayoClinic.com. Jun12th, 2010. http://www.mayoclinic.com/health/dry...SECTION=causes. (accessed Oct 23, 2011)
"Facts About Dry Eye." National Eye Institute Aug, 2009. http://www.nei.nih.gov/health/dryeye/dryeye.asp#1 (accessed Oct 24, 2011)
Begley C., Caffry B., Chalmers R. , Mitchell L. "Use of the Dry Eye Questionnaire (DEQ) to Measure Symptoms of Ocular Irritation in Patients with Aqueous Tear Deficient Dry Eye ." http://research.opt.indiana.edu/Libr...html.(accessed February 24, 2012)
"Consensus Findings On Meibomian Gland Dysfunction Published In Investigative Ophthalmology & Visual Science" Medical News Today. Apr 1st, 2011. http://www.medicalnewstoday.com/releases/220942.php (accessed Oct 24,2011)
Gulani, Arun. "Dry Eye Treatment." May 27, 2011. http://www.youtube.com/watch?v=VfJc5DrW_8A. (accessed February 23, 2012)
"Chalazion Removal." Bupa. Aug, 2011. http://www.bupa.co.uk/individuals/he...d-cyst-removal (accessed Oct 24, 2011)
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