Newbie Here with Question about Lipiflow

[EBMD]

Hi! First time posting, although I’ve been browsing for quite awhile.

Just had my annual eye exam today and my long time optometrist is going to contact an ophthalmologist group (that he refers his dry eye patients to) about scheduling me for a meibography and, most likely, Lipiflow.

What can I expect from both of these procedures? Are they painful? How invasive is the Lipiflow? (I hate having anything put in my eyes, so of course I end up with eye problems.) Most importantly, will I be able to drive home after getting Lipiflow or will my vision be affected for a short time after?

Briefly about me: I was diagnosed with EBMD two years ago (eyes felt dry and gritty and doctor could see the dots on my eyes in the slit lamp) and MGD one year ago (doctor had difficulty getting any oil to come out when he expressed my lower glands with his finger while viewing in the slit lamp). I found this forum in between those diagnoses and marvel over how well informed and educated you all are about your various conditions as well as how incredibly supportive everyone is of each other. I’ve found much comfort and many tips from reading all of your stories and am truly grateful to Rebecca for creating this site.

[deep_dry_eye]

LipiFlow is considered to be relatively safe. They just warm up your eyelids and massage the lids (gently). There won't be any side effects or pain, it won't effect your vision at all and you can drive home for sure. The goal of LipiFlow is to remove any internal obstructions inside your glands. However, LipiFlow will not fundamentally fix the underlying issue (i.e., inflammation).

You should definitely supplement LipiFlow with other procedures to tackle the fundamental inflammation behind MGD. You should consider IPL, which for reasons unknown, can reduce the inflammation in your glands and make your glands express better quality oil. Some doctors here in Canada, they recommend 2 sessions of IPL before evaluating LipiFlow is necessary. Additionally, you should consider drugs such as Xiidra and Restasis which can help reduce and control the inflammation behind the MGD.

[Rebecca Petris]

Welcome EBMD!

I'm curious whether you know if you're experiencing more symptoms from the EBMD or the MGD, and if you are on treatment for EBMD. Also wondering if you're pursuing Lipiflow specifically because other treatments have not been enough? Lipiflow is good technology and all that, probably the worst that can be said of it is that it is overused in cases where not necessarily likely to be helpful.

[EBMD]

Thanks for the LipiFlow information, deep_dry_eye.

My doctor didn’t mention IPL, but I have read here that it will increase the quality of oil produced like you said. If the meibography shows that my glands are blocked, wouldn’t it make sense for me to do LipiFlow first to hopefully get them unblocked and then follow up with IPL?

I’ve been on Restasis for two years, but I don’t know if it’s done any good. I know my eyes feel worse now than they did two years ago. The only plus is that it no longer stings when I put it in.

I’m curious to see what a meibography will show. I’ve read how people will do the warm compresses and afterward, they’ll feel the oil flowing or their eyes will feel a little moist. I’ve used the Bruder mask over the years and my eyes have always just felt disappointingly dry afterward. Maybe my glands are too blocked for the heat to have any effect.

[EBMD]

Hi Rebecca! I don’t know which is causing my symptoms. Thankfully, I’ve never had any corneal erosions, just the dry, gritty eyes with occasional burning. It’s annoyingly inconsistent though – one day the right eye will feel worse, the next day it’ll be the left eye. There’s no rhyme or reason.

I’m looking at LipiFlow because my doctor suggested it and he thinks that my glands are blocked, especially in the right eye.

As for treatments, except for the two years of Restasis, everything else has been over-the-counter stuff:

• Drops (preservative free only) provide true relief only for those first few minutes when the eye feels nice and wet. I keep them in the refrigerator so they’re cold too. I’ve tried many different ones (as I’m sure we all have) and some have actually irritated my eyes.
• Bruder mask hasn’t had any effect. A cold mask actually seems to ease the burning somewhat, even though my eyes remain dry.
• Lid hygiene every evening with Occusoft.
• Humidifier in my bedroom and a small one by my desk at work.
• Omega3 supplement daily.
• I drink about 6 glasses of water every day, so I’m trying to keep myself hydrated that way too.
• Moisture chamber glasses - I already wear prescription glasses so I tried the Global Vision Outfitter glasses to wear over them and there were gaps everywhere. I have safety goggles that I can wear at home over my glasses that seal pretty well with just a few slight gaps, but my eyes don’t feel any different wearing them.
• At night I’ve tried Tranquileyes and Onyix. I don’t get a good seal with Onyix and it’s uncomfortable - I feel like it’s too close to my eyes if that makes sense. Tranquileyes is more comfortable, but I’m a side sleeper and it never stays on all night. I don’t know if they slip off or if I unconsciously push them off while sleeping.

[EyesOpen]

I'm glad to have found this discussion, as I have similar symptoms EBMD.

A bit of my story is that I also have EBMD, and Dry-Eye. I started having Recurring Erosions about 5 months ago, after my cataract surgeries. I just had a Lipiview and Lipiflow done about 4 and 3 weeks ago, respectively.
I am still in the discovery stage with my DE, and have a follow-up appt. in about 5 weeks to see how my glands are doing, so I cannot speak to the success of the Lipiflow yet.

I will say that I appreciated the Lipiview, which revealed some reasons that I have DE. I recommend discovery like that exam highly. I also recommend a doctor who listens, doesn't just assume and prescribe. I spent about 6 months dealing with symptoms that brought me to the cataract surgery (narrow-angle closures), and no one diagnosed my DE until afterwards, so it went untreated!
I'm on Xiidra now for about 2 months, and I can't say that I notice a difference. I don't appreciate the cost unless I can see marked difference, but I'm giving it another 2 months.

You seem to be aware of your symptoms and journey, EBMD, which is important.

Rebecca, please explain what you know about EBMD treatments.

[EyesOpen]

Welcome EBMD!

I'm curious whether you know if you're experiencing more symptoms from the EBMD or the MGD, and if you are on treatment for EBMD. Also wondering if you're pursuing Lipiflow specifically because other treatments have not been enough? Lipiflow is good technology and all that, probably the worst that can be said of it is that it is overused in cases where not necessarily likely to be helpful.

Please explain what you know about EBMD treatments, Rebecca--thanks.

[Guest]

EBMD precludes you from lipiflow. If you go to the lipiflow site, EBMD is indicated as s contradiction. The cups that go into the eye could cause an abrasion.

[EBMD]

EBMD precludes you from lipiflow. If you go to the lipiflow site, EBMD is indicated as s contradiction. The cups that go into the eye could cause an abrasion.

Shoot. My doctor hasn't followed up with me yet, but I will definitely let him know that. I'll still go forward with the meibography though and hopefully get more details about what's happening with my glands. And thanks for the PMs regarding my side sleeping and the inconsistency with my eyes burning. I hadn't thought of the possibility of that being related.

[Guest]

Shoot. My doctor hasn't followed up with me yet, but I will definitely let him know that. I'll still go forward with the meibography though and hopefully get more details about what's happening with my glands. And thanks for the PMs regarding my side sleeping and the inconsistency with my eyes burning. I hadn't thought of the possibility of that being related.

No worries, I didn’t either. Once I started protecting my eyes with gel and tape, things got a lot better. Still looking for a good PF gel though. I’m allergic to everything. Good luck.

[Rebecca Petris]

Please explain what you know about EBMD treatments, Rebecca--thanks.

There's quite a range of different ways doctors may choose to handle it depending especially on severity and whether you're having erosions. Common approaches for chronic ebmd include sodium chloride ointment (eg Muro 128) or if severe with frequent erosions, debridement, sometimes stromal puncture. But if it's mild often just lubricant drops are enough.

[EyesOpen]

There's quite a range of different ways doctors may choose to handle it depending especially on severity and whether you're having erosions. Common approaches for chronic ebmd include sodium chloride ointment (eg Muro 128) or if severe with frequent erosions, debridement, sometimes stromal puncture. But if it's mild often just lubricant drops are enough.

Thank you for answer, Rebecca (I'm still not getting notifications). I am severe enough to get erosions continually, and have seen two different specialists for either SK or PTK, the latter of which is the most likely. In the last 2 months, I haven't been as desperate for solution because I've sleeping with damp foam inserts (from TE) in the Onyx goggles. My eyes are actually soothed when I awake!
I'm wondering if you have anything to say about PTK, knowing how invasive it is?

[EyesOpen]

EBMD precludes you from lipiflow. If you go to the lipiflow site, EBMD is indicated as s contradiction. The cups that go into the eye could cause an abrasion.

I have RCES due to my EBMD and corneal dryness, but I had a Lipiflow. The doc knew about my EBMD and DED. I did not have an erosion from the Lipiflow, but I'll admit I wondered about the possibility afterwards.

My EBMD is mostly on the edge of my cornea, not over all over surface; and because I either don't close my eyes completely in sleep, the erosion happens right at that place of EBMD.
I also don't blink completely shut most times, and this can contribute to my DED. I have a follow-up appt. this week on my Lipiflow.

[Guest]

You may not have a true basement membrane dystrophy, it may just be induced by the damage of sleeping with your eyes open. It’s a what came first scenario, the chicken or the egg. Do you have EBMD and that’s causing the erosions, or did sleeping eyes open cause erosions and subsequently, a basement membrane “problem due to inadequate healing.

[EyesOpen]

You may not have a true basement membrane dystrophy, it may just be induced by the damage of sleeping with your eyes open. It’s a what came first scenario, the chicken or the egg. Do you have EBMD and that’s causing the erosions, or did sleeping eyes open cause erosions and subsequently, a basement membrane “problem due to inadequate healing.

I will ask about this coincidence at my Lipiflow follow-up this week. I do know that the eyelid being open creates the dryness within the EBMD, which causes the erosions, but do not know if the dryness could create the inability of the epithelial to anchor to basement membrane.