Referral to an Ophthalmologist Skilled in Meibomian Gland Dysfunction

[bvendig]

doctor referral

Hi.
i agree with the comment below..i think Dr Gagnon is the most knowledgeable.
He's in Pleasonton and Livermore.
long drive but might be worth it.
hugs, betty

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 ?

[Rebecca Petris]

Still do not fully understand. If the drainage of tears is impeded, I'll have even more tears. My eyes feel absolutely no irritation or any other symptoms.

I can only talk practically, not scientifically, but I'll throw in my 2 cents again. I have known other people for whom excess reflex tearing was the only symptom of a compromised basal tear layer. It's unusual but it certainly happens. IF your tearing is truly in response to a poor constant tear layer, then theoretically, improving the quality of your tear film (whether by occlusion, by a particular drop, by improving MG flow, or by any of the other myriad dry eye therapies) should reduce your reflex tearing.

If one fiddles with the NLD and scarring occurs, that might require reconstructive surgery. Is there no such scarring as a consequence of placing foreign objects in the MG ducts ?

They don't go in the MGs as IndRep stated. If you stick with true punctal plugs, and get them sized right, the risks are minimal because they can be removed at any time and you can actually see the "caps" in the corners of your eyes. Intracanalicular plugs are another story. I have known many people who have had to have reconstructive surgery, or surgeries, because of durable intracanalicular plugs that went astray. There's several case reports & studies of these if you search, for example, on SmartPlugs in PubMed. I know they work well for some people, but personally, I would want 'foreign bodies' where I can see them. There are however also dissolvable intracanalicular plugs. I think I saw a report in the literature recently about an infection but I don't think I've seen any other complications associated with those.

Has anyone else found Systane Balance to be superior to the many other Systanes ?

If you do a search on this board you'll find there are several people here who have done well with this drop.

Can I place these plugs myself ? (j/k). Who is skilled at installing these plugs ?

Well, no . Any corneal specialist and any optometrist who treats a lot of dry eye probably will have fitted lots. But it might be helpful to contact a manufacturer and ask for names of drs in your area who have fitted lots of their brand.

The tricky part sometimes with plugs is getting the right size... most docs stock one brand, or maybe two, and some people have unusually large or narrow ducts and have a hard time getting the right one, so for some people plugs will fall out or get pushed out. Or (rarely) even fall in, which is more serious.

Also getting the right amount of occlusion for a given individual can be tricky. On this board we have people who are lower plugged (that's the most common), people who are "quadraplugged", people who are upper-plugged only (uncommon) and people who are plugged in the lowers but have partial occlusion plugs in the uppers - all to try to achieve the right balance.

Hopefully though, your current path will yield results and you won't need anything else.

[Physician]

I'm 95% better thanks to Refresh Optive Sensitive and/or Glycerin 0.9%

I'm 95% better now thanks to:

1. Stopping ALL prior eyedrops

2. Using ONLY Refresh Optive Sensitive in each eye, then blotting well, every 8-12 hours.

3. Eyelid massages and pulsating warm water (in the shower) every AM.


I don't use the Optive unless and until I feel excessive tears in my eyes. And YES, the Refresh Optive seems to eliminate the excess tears and my vision is sharp O.U. with none or very little of the previously described double imaging. It does take 30 minutes for the visual blurring (due to the Optive) to disappear and vision normalizes until 8-12 hours later.

HERE ARE SOME COUPONS IN CASE YOU WANT TO TRY REFRESH DROPS: http://www.mytearsmyrewards.com/refr...ESH_coupon.pdf

[Guest]

That's great news that you're doing so much better!

[Physician]

Use of drops even if all feels fine ?

Thank you.

Strange. Today I have used no drops and I'm still 95% better. There's only a slight feeling of tear pooling, but only occasionally. Vison sharp. Is there any evidence that using any topical/eyedrops is important even if a person is asymptomatic or nearly asymptomatic ?

My plan is to consult one or two eye M.D.s in the next 14 days.