IPL with Dr Toyos

[autumnn]

FIRST OF ALL I WANT TO THANK SAZY FOR POINTING OUT THIS DOCTOR AND HIS TREATMENT!!!!!!

Well, I finally had the appointment today with Dr. Toyos. I am exhausted and will write something more comprehensive tomorrow. But, I have to say that I definitely like the doctor. He seems very professional, intelligent, and caring. The office was the most amazing doctors office I have ever been to...beautiful...

Anyway, Dr Toyos spent 2 hours with me, exclusively (not running between patients like other doctors do) he read my long letter and I let him know my concerns about my glands due to a short run of accutane 15 yrs ago and Lasik 10 years ago. Then, he examined my eyes and skin and stated that I was an ideal patient for his treatment with fitzpatrick 1 skin, tenelgesia and rosacea signs, as well as 90 percent of my meiombian glands were blocked. I couldnt believe it-90 percent blocked? With all the treatments I was doing this was hard to believe. Dr. Toyos stated that he could often get 60-and usually 90 percent of the lower glands open and functioning and this was enough for symptom relief. He believed that treating the tiny vessels that made my glands inflammed would also help the functioning of the glands.

Dr. Toyos also went over my entire regimin and made changes- for now-no drops (and I just started the Freshkote) he stated he could see signs of a slight allergy component and he wants no pets in my bed, no sleeping mask, and for me to wash my hair before bed and keep my linens very clean. Dr. Toyos also said no compresses or steaming until he tells me otherwise- I think he sees no point in this until he gets the glands open and pumping. He also said to eat salmon 5 times a week, take flax powder, eat red grapes and drink tons of water.

As far as if this will relieve my pain- Dr Toyos said that he cant guarantee that but he said that 90 percent of my glands being blocked is making the surface of my eye very compromised, dry and irritated. The obvious answer would be that if he got these pumping again then yes, Id feel alot better.

As for the treatment, it was a bit painful. I was so glad though to feel just how close he got to the lashline, if not in the lashline itself. The warmth/burning was worth it because after when he examined my glands he muttered to himself, "great" and "excellent" while pushing on my glands. He told me my glands were responding as he hoped.

So, that was it. I am scheduled to go back in a month for another treatment. Today I paid $375.

I asked him many of your questions and the ones I missed he said to email to him. I will write more tomorrow.

I am shocked about all my blocked glands but hopeful for this treatment.....oh, and the bonus is that he said it would make the skin under my eyes look better too

Still, it is scary to give up my DE routine- even though simplifying seems tempting in and of itself....

[odydnas]

Hi autumn! Thanks for the description. I am looking forward to hearing more about your appt. i am sure I don't qualify, since I am skin type 3, probably 4. I hope you feel relief very soon! How soon are you supposed to feel a difference?

Also, do you have telangectasia on your scleral, inner eyelids, or lid margins? Is he targeting the telangectasia on your lid margins or inner eyelids? I have a TON of telangectasia on my inner eyelids...

[sazy123]

Hi autnum that is very Encouraging! Im glad you had a good experience.

Im sure you will be posting again but i had a few questions:

You say your surprised at the amount of blocked glands.... to you how obvious are your blocked glands, can you see them? and did he say that they were blocked by inflammation and vessels or were they blocked as in 'caps', lumps, toothpaste consistency.

I don't have any blocked glands or toothpaste consistency- the functioning of my glands is purely blocked by inflammation, i.e 'turned off'

Could you email him a question asking this - if a persons glands are not blocked, but just not functioning due to inflammation/vascular of inner eyelids (conjunctivitis)- would IPL help- since there wont be any ''melting'' going on?

Any noticeable improvement after the first treatment, or maybe its to early to tell?

Due to my inner eyelid conjunctivitis seemly causing it im not sure if it will help.

I am also fitzpatric skin type 1 and have some rosacea, but dont have much tangelsia (tiny bit on upper eyelid), i was hoping you would have a good experience as im hoping to come out there next month.

[calli66]

Can't hurt to try the Toyos treatment---sounds very hopeful. Get those glands OPEN---yes!

Positive thoughts sending to you,

Calli

[autumnn]

Ok- I am going to try to answer some of the questions everyone had.

From my experience the only side effects seemed to be the bit of discomfort and oddness of the procedure (which lasted about 10-15 minutes- I had had IPL before on my face so it wasnt too intimidating for me) and I know that IPL is safe for sensitive skin. As far as darker skin, Dr. Toyos said that he is working on something that in the future may be able to help darker skin. As I mentioned, he gets CLOSE to the eyelid...so much closer than I imagined he'd get. He treated the tengelesia that I have outside the lower lid (which I couldnt see to the naked eye- unlike my upper lid) and targeted the blocked glands- he mentioned it was like the ultimate hot compress to get things moving. He mentioned that after 4 treatments his patients are no longer symptomatic and return every 3 months to every year for one maintenance treatment. In terms of conditions like Sjogrens or post lasik dry eye, if blocked glands are part of the equation then his treatment could help...but, his treatment is primarily for dry induced by MGD. There is no recovery or down time. I was just fine and looked just fine right afterwards. My only precaution is that I need to protect the skin very with sunglasses and sunscreen. As I mentioned, he changed my whole DE routine- so no- you dont necessarily continue your previous treatments after this treatment. I asked him about atrophied glands and he said that word was a misnomer- but didnt go into detail about wht his theory on that is. He said that mine were just blocked. Please note that I have had some doctors say my glands are blocked and other say they werent. I have even had close to normal TBUT scores at times. To me, to the "naked eye" they didnt seem capped and I thought the oil was thin. I was convinced that they were not producing enough oil and that was the only problem. Sazy- he may surprise you when you see him- things may be far different than what you have heard/think. You may be just like me- totally blocked with tengelesia (remember, I cant see mine). For me, to hear that 90 percent were not open was SCARY- but reassuring at the same time- it was something to work on! I wish I could get another treatment TODAY! In terms of which patients are better suited for this as compared to others all I know is that he said I was a very good candidate because of my fair skin, signs of rosacea and tengelesia and blocked glands. He said the tengelesia and the blocked glands are a vicious inflammation cycle....those are what he is targeting with this therapy.

The questions I wished I asked him were why I got MGD in the first place (though he said infants can have MGD as well as 80 year olds) and if I had caps or toothpaste like issues and if the treatment can unclog the glands and get them to pump enough healthy oil that will remain healthy on their own. I will email him today about this. I will also ask him about what others asked- MG's not producing due to inflammation/vascularization of the inner eyelid and if IPL will help.

I dont know if it is too soon to see results but I feel pretty good today. My right eye (the good one) was way more moist yesterday after the treatment. The darn left wasnt but today doesnt feel so bad.....I am home today though and taking it easy so that helps...I dont want to make any conclusions too early. He did say that patients notice some improvement after the 1st treatment. I still feel odd about abandoning my DE routine and I miss my dog in bed and eye mask terribly. But, I will follow exactly what he says.

Last thing.....Dr Toyos read my note very carefully and saw that I had plugs flushed out in the past. He wanted to check himself to see if they were gone. He spent quite a bit of time attempting to irrigate them out and his conclusion is that they are more than likely still in there. I was amazed at the total attention he paid to my eyes- plugs arent normally his concern. He said with MGD he doesnt like plugs and that we will have to work around this. He said that when we get my MGD's stable the plugs shouldnt affect anything.

Lastly.....like I said, he spent 2 hours with me. When I was checking out he was told that his other patient had left because she couldnt wait any longer. I was so amazed that he put everything on hold to tackle my "tough case".

Odnyess- He targeted the tengelesia on the outer eyelids- I didnt even think it was there- you cant see it with the naked eye...

AND, AGAIN, THANKS TO SAZY FOR RESEARCHING AND FINDING OUT ABOUT THIS DOCTORS TREATMENT.

[kimby2007]

Sounds good

Sounds good so far. I suffer from MGD due to Sjogrens. According to Dr. Foulks who presented at the sJS conference they go hand in and. Good to know there are novel treatments out there. Good luck, I will be following this thread closely.

[bernmee]

This is really exciting!!

In terms of your diet I would do a little research into "farmed" versus "wild" salmon, I don't think its a good idea to eat farmed salmon 5 times a week.

Also with the flax, to buy your own and grind it in a coffee grinder is the best way of getting it fresh. It you can't do this make sure you buy some that has been stored properly. Too much heat and you lose the goodness, I grind a weeks supply and store it in the freezer to throw in my smoothies.

Let us know how you are gettting on as the days go by. This is really exciting!!

Bernadette

[jenny2008]

I am curious. What is tengelesia? thanks

[stephgurl1986]

Wow, Autumn, this sounds great. I'm so excited for you. Please keep us up to date - maybe this is a solution for a lot of people out there?!
(Maybe even for me, but if I'm a candidate I think I would have to do "something" (like an internship, au pair etc.) in the States as you have to return every month - that wouldn't be possible if you live in Europe)
Does he do this somewhere else as well? Probably NYC? That is only a 8 hours flight away...

[sanna]

stephgurl,

Hi, I have read some threads You´ve been writing and what is your biggest problem dry eye or red eyes? I hate my eyes because they now are red, a little dry but not a big problem. I am looking for away to remove the veins maybe laser, maybe surgery do not know. I do not want to make it worse.
I have heard that mybe you could use laser to remove veins but I do not know if thats a good idè. I have heard that there is a Doctor in Belgium that could do this I am going to sen him an email i think.

[irish eyes]

I am curious. What is tengelesia? thanks

Taken from http://www.eyeworld.org/article.php?sid=2698

We suspect IPL treatment improved meibomian gland production due to either meibomian gland stimulation or effectively decreasing telangiectasia.

Taken from http://en.wikipedia.org/wiki/Telangiectasia

Telangiectasias are small dilated blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter

[sazy123]

Autumn your welcome! im glad i could bring this to the DEZs attention, and really hope you and others experience relief as a result!

In terms of whats blocking my glands, they are certainly blocked by inflammation/vascularization. And for the most part anyway not blocked by toothpaste of caps or lumps- other words nothing as such is visible. The fact that you said your blocked glands are not visible either is encouraging for me. I know that the inflammation of inner eyelids or glands is blocking the production of oil because my glands function very well when im sick (and thus the inflammation of eyelids goes right down!). But also like you i have not had improvement from compresses and much of anything else (which i based this on no actual blockage- nothing to solidify). Compresses do not tackle inflammation. I do seem to be a weird case of MGD because they function when im ill so im not sure how i will fair. But the whole thing revolves around inflammation and vascularization disrupting the production of oil, my only fear is that it might be originating from the wrong side of the eyelid for this treatment to help (inner eyelids, rather than in the glands or the outer) but we shall see.

Also it is somewhat encouraging that he said you had tangelisa in the lower eyelid that you couldnt see, maybe i have some- i know that i have some purple colour under eyelashes, and a tiny bit of obvious tanglesia on top eyelid.


Stehgirl- I have also considered the 'au pair' route in the summer months, but not sure if that would work with my eyes being bad.

[autumnn]

Hi Sazy- Yes, thanks again. D
As for me, I had no idea that the blockage or vascularization was as bad as it is. Also, I didnt know the tengelesia (sp?) contributes to inflammation and further blockage but apparantly it does. Anyhow, I hope that tackling it will be what it takes to get rid of this darn problem for us! I still cant figure out why for now he wants me to abandon compresses though....all I can think is that maybe he thinks they are useless until the glands are open? I believe that he may be the answer for you, especially based on what you described you have in your last post. Also, it is promising that he is working on a method to eventually treat the upper lids- that is where I have the most tengelesia and there are supposedly more glands there as well.
I
Sazy are you coming out here to try this? I wish I had an extra bedroom to offer but it is just me and my boyfriend and 3 dogs in a 1 bedroom condo
I would however love to meet up with you and even go with you to your first appointment.

[calli66]

salmon?

Autumn,

One part that I question---about the Toyos regimen-- "He also said to eat salmon 5 times a week."

Advisory:
"FDA's Recommendation on Fish and Salmon

In March 2004, FDA and EPA revised its advisories on mercury in fish for pregnant women and young children. Generally they are advised to eat no more than 2 meals of low-mercury fish per week - one can of salmon or half a salmon steak is considered one meal."
(this advisory applies to women who might become pregnant, also)

This is from a website here.

Just a thought.

Calli

[autumnn]

Thanks Calli- I wonder if this applies to wild salmon?