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Referral to an Ophthalmologist Skilled in Meibomian Gland Dysfunction

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  • Physician
    replied
    Originally posted by indrep View Post

    The tears that are currently on your ocular surface are not the steady state tears, they are the reflex tears. These tears are high in salt content (hypertonic) and with this environment cell apoptosis will create an unstable tear film further exacerbating the issue. I have seen this clear up many times with 90 day punctal occlusion and Oasis TEARS Plus. The goal is to reverse the osmolarity of the tear film by holding more water on the ocular surface.
    Yes, but aren't you actually stating that the Meibomian contribution is lacking ? Please explain more about This "punctal occlusion" therapy, and what is so unique about Oasis Tears Plus compared to all the other ocular lubricants listed. Are the orifices occluded physically or by the Tears Plus ?

    Strange to have "reflex tears" when I feel no irritation or symptoms.

    Leave a comment:


  • indrep
    replied
    Excess tears can be diagnosed as the early stages of ocular surface disease. They are a reflex to something that is creating a trigger mechanism to the brain. Usually, according to the DEWS report (published in April 2007), something has created an elevated osmolarity of the tear film at the ocular surface.

    The tears that are currently on your ocular surface are not the steady state tears, they are the reflex tears. These tears are high in salt content (hypertonic) and with this environment cell apoptosis will create an unstable tear film further exacerbating the issue. I have seen this clear up many times with 90 day punctal occlusion and Oasis TEARS Plus. The goal is to reverse the osmolarity of the tear film by holding more water on the ocular surface.

    Leave a comment:


  • Physician
    replied
    More Rxs recommended; new approach

    Originally posted by Rebecca Petris View Post

    Were you given any other MGD-specific treatments besides Azasite?

    That's a very odd symptom pattern for MGD alone.

    Thank you for your reply.

    MGD specific ? I didn't anything was specific treatment for this ailment.

    I do have an M.D. degree but constructed my start post so that non-M.D.'s will understand. With MBD, one loses the oil component of tears with resultant symptoms.

    Many other RXs have been recommended:

    Baby Shampoo eyelid scrubs
    Ocusoft foam eyelid scrubs
    Tobramycin + Dexamethosone eyedrops
    Systane, Systane Ultra, and I found the Balance by chance.
    Tears Natural
    Blink
    Refresh, Refresh Plus
    Warm to hot eye compresses
    Zithromax
    Months of doxycycline
    Genteal eyedrops

    I have absolutely no systemic disease. This is a localized problem.

    After getting a headache from reading all the websites and papers, two days ago I started two things on my own.

    1. In the shower every morning allowed the showerhead to gently pulsate warm water on my lids, and

    2. Several times a day rub Systane saturated Q-tips over the margins of my lower lids, back and forth about six times. (Too difficult to do it to the top lids)

    Initial results are promising.

    Leave a comment:


  • Rebecca Petris
    replied
    I really like Michael Gagnon MD in Pleasanton. I know many of his patients. He knows MGs. I think the practice name is Valley Eyecare.

    Were you given any other MGD-specific treatments besides Azasite?

    That's a very odd symptom pattern for MGD alone.

    Leave a comment:


  • Referral to an Ophthalmologist Skilled in Meibomian Gland Dysfunction

    I'm not an eye doctor. For the past two months I've had increased tears, never enough to run over my cheeks. I've been to three optometrists and three Ophthalmologists from San Francisco to San Jose, California. Not one of the eye doctors agreed on a treatment, but they all said via slit lamp my Meibomian glands are not functioning properly and appear dry.

    I've tried eight different ocular lubricants, singularly and in combinations, and the best one has been the new Systane Balance. Used a week of Azasite 1% eye drops twice a day. Pataday drops (an anti-histamine eye drop) did not help.

    The two annoying symptoms are:

    • 1. Feeling the excess tears at the lid margins, and
    • 2. Visual blurring only related to and caused by the tear pool.

    There are no other symptoms... no buring, itching, foreign body sensations, pain, etc. Four of those professionals said my NLDs were obstructed, but they are wrong. Fluorescein dye flows well into my nose. The naso-lacrimal ducts are not obstructed.

    Have have prescriptions for oral Azithromycin and Vibramycin but haven't started either. have read many websites on this subject and it seems that this condition is poorly understood and treatments are variable and not definitive.

    Does anyone here have the name of an unusually skilled optometrist or Ophthalmologist, well-trained in MGD, from San Francisco to San Jose, California ?
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