IPL with Dr Toyos

[cristiandryeyes]

I think it might depend on how blocked the glands are, he expresses them VERY hard after IPL, which will make the caps pop and loosen, over time with ipl they become less solidified i guess.

I have heard before that IPL has helped those with rosacea that have ocular rosacea, from other websites, and DR toyos noticed that Ocular rosacea befitted from IPL when they were using it ONLY for the face... that is why he started using it in the first place. However, i think this may have halped those who have milder symptoms and glands arent as blocked.. you may need the expression as well if glands are really blocked, although IPL may still help.. over time.

I have inflamed (conjunctivitis), of inner eyelids not eyes, Dr toyos said it was a different mechanism, so it might not be improved by ipl to the face.. it wasnt. But its still ocular rosacea as far as im concerned no other explanation.. allergies dont make sense.

So basically, Dr Toyos technique consists on hard expression...but the IPL session itself does not differ from any regular facial IPL session...am I wrong? I have nothing against this Dr but what I don't like is the fact He must instruct on how to do this procedure, the question is...would it be the same if I express my own glands after the lady gives me a couple of shoots or do I need him to do that ? Would that make a difference? I know I can press hard too.

[Guest]

I'm not sure if he expresses the glands the same for everyone, but Ive heard from others here that Dr. Toyos puts a q-tip (I assume it must be a sterile q-tip, unlike the ones we buy in the store) on the inside of the lid, and then applies pressure to the outside of the lid to express the gland... (please someone correct me if I'm not describing it properly!!)

It sounds pretty uncomfortable!!

[Lucy]

Reading through this thread is really interesting. Putting the IPL aside, what do doctors have against expressing the meibs? Anybody who has studied (and became) an eye doctor is equipped to squeeze your glands. I believe the docs have been coming to the conclusion they are above doing such mundane work as squeezing the crap out of your glands.

Have any of you asked your doc to "express your glands?" You should and see what he says. I did ask my doc one time and he did do the expression. unfortunately between having Lasik and then Sjogrens, there wasn't much of anything to come out. Good luck to all of you. Lucy

[Guest]

I'm a bit of a wimp... after hearing how Dr. Toyos expresses the glands, I'm a bit scared to ask for the same treatment Is that the standard method that most docs use to express the glands??

[Michael2]

besides the facial area, the IPL by toyos and assil is done on and right below the eyelid. i'm convinced this is one of the major factors in getting the oils moving again, especially on the upper lids which i've noticed make a big difference in comfort when i do lid massages

[Aaron77]

how often are toyos and assil giving out Azasite along with the ipl and gland expression? after the ipl it might be these other things that are making the biggest difference for patients.

[sazy123]

So basically, Dr Toyos technique consists on hard expression...but the IPL session itself does not differ from any regular facial IPL session...am I wrong? I have nothing against this Dr but what I don't like is the fact He must instruct on how to do this procedure, the question is...would it be the same if I express my own glands after the lady gives me a couple of shoots or do I need him to do that ? Would that make a difference? I know I can press hard too.

OK the thing is, and i have thought of this as well.

I think the difference is.. i dont believe us patients will be able to express hard enough ''safely''. Dr T uses a medical cue tip, he uses numbing drops, he puts the q tip inside the eyelid against the inner eyelid, and he presses the other side of the eyelid against the cue tip with his finger so when he expresses the glands he is not pressing on the actual eye itsself- onyl against the cue tip, this allows for much harder expression than one can do with a cue tip on the outer eyelid which will press the eye its self.

My first treatment he didnt do the cue tip not sure why, he just pressed- but was not anywhere near as hard and i didnt see thick oil on my eye after wards that i saw with the following sessions. The last session i had, another doctor did the expression and he didnt press hard at all as he said oil was coming out thinner...

So i would say if you can, go to tennesee and have this done as you are ensuring the most benefit if your glands really are blocked. However, has the price gone up? If you have milder dry eye or your glands arent that blocked it might be more worthwhile seeing a good dermatologist and doing light expression (as DR L suggests) afterwards.

That is my take on it. I wouldnt cut corners and try to do it yourself unless its just the normal expression.

Dr T also does get closer to the lower eye lash line than other dermatologists will, unless i guess you can show the other derms DR T's work and that he goes closer ( BUT HE DOESNT GO RIGHT ON THE EYELASH LINE) he only goes just on/ up to where the eyeball meets the check in my experience anyway.

[sazy123]

I'm a bit of a wimp... after hearing how Dr. Toyos expresses the glands, I'm a bit scared to ask for the same treatment Is that the standard method that most docs use to express the glands??

It hurt i have to say, but i felt it was worth it to get oil out.

[rhad]

does Dr. Toyos use the Mastrota meibomian Paddle. I have one, and use it to express mine, when they feel very inflammed..it's works well.

[beatles116]

i dont really think you can express your own glands, at least not properly, toyos has done mine twice, and it did help, its intense but the pain subsides quickly....tantamount to getting teeth cleaned.....

after 2 ipl treatments my eyes are much better, i had 100 percent blockage

[rhad]

It is only available to doctors, but I got a hold of one..bought it brand new. They work very well, i can express any gland I think is clogged, im not just wondering if my glands clogged, cause hot compresses just don't work, and your never sure if you "melted" the oil in your glands, just expressing them is far less irritating than hot compresses, and you definately get the oil out, this stuff is seriously like tooth paste, it is bad..other times it's not as thick. i have found a lot of relief using it from time to time.

I don't know why they limit these to just doctors, it doesn't take a genius to use them, just someone with common sense and good judgement. but i can understand their are some pretty dumb people that could probably hurt themselves..haha.. I wish that everyone could get a tool like this to use to express their glands, and just get rid of the hot compress, they just irritate your eyelids more than anything, and their ineffective in my experience.

[irish eyes]

Are these `paddles' of uniform size? It's difficult to tell from the image but I imagine they must be similar to a Q-tip.

What about sterilising it between use - do you just boil it in water?

Wonderfully simple idea though.


See images of Mastrota paddle + Gutierrez expressor


http://www.guldenophthalmics.com/MG%20Expressor.pdf

[irish eyes]

This link may have been posted before - it shows the paddle being used.

There are some pretty gross pictures of secondary MGD but hold your breath and scroll down to figure 8

This particular paddle looks like glass as opposed to titanium

http://www.eyesite.co.za/magazine/se...utton=columns4

[irish eyes]

I spotted that but couldn't get it to work.

Is it images of the procedure?

[sazy123]

does Dr. Toyos use the Mastrota meibomian Paddle. I have one, and use it to express mine, when they feel very inflammed..it's works well.

would most doctors have these in the US to give out? I agree hot compresses just irritate the eyelids (especially if you have roscaea)i think they could make rosacea on eyelids worse and thus worsen dry eye. I used one the other day (havent in ages) it was not hot, but it really irritated my left eyelid, and i think it made rosacea worse coz now it feels more sensitive ever since!!

The expression got alot of thick oil out, but i cant say the next day my eyes felt much better, i guess the oil just thickened again because of the inflammation which was still there. Compresses never improved it either because it doesnt treat inflammation, i find they are quite ineffective also.

So far of reports from DEZr's after seeing Dr T, about 70% have reported improvement (beyond minimal, some very significant i.e. autumn), and about 30% (me included, have reported only minimal improvement). I think that is pretty good. I have been on the DEZ for a long time and so far the only treatments that have had 'alot' of good feedback in improving dry eye (not just alleviating symptoms for management) have been:

Restasis (not for MGD though)
Azasite (this seemed to get very good response in the threads)
and IPL

I dont believe fish oils and hot compresses are that effective beyond management (but if you can get that- nothing to be sneered at) I believe fish oils help in improving overall health, with could really help for mild dry eye (same as diet adustments). Same goes for eliminating an environmental cause like allergies, but again these seem to be a minority not a majority. Not scientific i know, but it seems postive for this treatment, if your cause is blocked glands, mine isnt which was my concern in the first place.