Severe MGD - I need Help & Advice

[BradC26]

Hello I've got considerable Meibomian gland dropout. I have had Lip flow but didn't feel any better. I've been seeing this 'dry eye doctor' he said when he presses on my lids he can see my meibum coming out without squeezing. I'm currently using blephasteam goggles, omega 3 supplements, and I use blephaclean wipes in the morning and at night. I also use a lube ointment at night and systane balance during the day. I drink plenty water and have a good diet. Currently also on doxycline and fml drops.

I'm having no improvement in my symptoms, is there any hope for me? Thank you!

[jack1988]

Hello I've got considerable Meibomian gland dropout. I have had Lip flow but didn't feel any better. I've been seeing this 'dry eye doctor' he said when he presses on my lids he can see my meibum coming out without squeezing. I'm currently using blephasteam goggles, omega 3 supplements, and I use blephaclean wipes in the morning and at night. I also use a lube ointment at night and systane balance during the day. I drink plenty water and have a good diet. Currently also on doxycline and fml drops.

I'm having no improvement in my symptoms, is there any hope for me? Thank you!

It takes time to see an improvement. Which country are you in? IPL works much better than Iipiflow for MGD

[BradC26]

It takes time to see an improvement. Which country are you in? IPL works much better than Iipiflow for MGD

Hi I'm from the England

[jack1988]

Hi I'm from the England

Same as me. I would go to the Dry Eye Centre in London. They are very good

[anteloper]

BradC26 we need more info to potentially be able to say something helpful (this also applies to a lot of posts in this forum).

When did your dry eye symptoms start? Was it a sudden thing, how did they progress? Do you have any guesses as to what caused it? Have you ever had any sort of eye procedure before? Ever took meds for acne? Do you have any history of skin issues, inflammatory issues, or auto-immune issues? Any history of hormonal issues? Roughly how old are you?

Any guess as to what subtype of MGD you have (hyposecretory, hypersecretory)? Did you ever notice any history of clogging? Usually gland dropout doesn't just suddenly happen one day.

When did you get Lipiflow? It takes weeks to months for some patients to notice an improvement afterwards, and symptoms will often get worse immediately after Lipiflow. What was the consistency of your meibum like prior to Lipiflow?

Re: blephaclean, nighttime lube ointment, doxycline, and FML drops, how long have you been on each of these? Did you start them all at once? Did your doctor say you have severe blepharitis or demodex? Make sure not to add irritation to your eyes/eyelids by cleaning/cleansing too much. Also, make sure you're using preservative-free eye drops. If you are willing/able to try a different eye drop I would try Retaine MGD.

Steroids like FML are not for long term use and I would be cautious about using them, especially if you haven't recently had some acute eye trauma (injury, surgery). Not knowing anything else, I would worry that you are over-medicated.

[hopeful_hiker]

I agree about IPL. Have the doctors diagnosed you with anything specific like rosacea? Partial blinking?

Have they measured your TBUT or inflammation? Osmolarity?

Also, I would recommend getting a mirror with led light (10x zoom like Fancii brand from Amazon) and a 20x mirror. I use this to actually see the oils when doing a light massage after compresses. This will also let you see better how the oils are doing.

Also, symptoms and signs are two different things. It took me a while to see improvement in how I feel, even after the doctors could see progress.

It also takes a while to find a doctor you can really trust. A few of them told me that I didn’t have dry eye, some didn’t know about any treatments.

[BradC26]

hopeful_hiker I was diagnosed with rosacea too. I've had to go private as I didn't get any grading or detailed information from them. Apparently my grading is slightly improving as I've been doing blephasteam 3 times a day. But still getting foreign body sensation in the corners of my eyes which is driving me crazy.

[BradC26]

anteloper Hi I'm not sure about the sub type of it. I have eczema on my face but not around my eyes. I was just told at first its just 'dry eyes' use these drops and you'll be fine. As time has gone on and symptom's worsen I went to a private dry eye person. Lipiflow was 2 years ago, I just need something more affordable. I have blephasteam are they any good for MGD? I'm yet to feel much relief from it. My glands are truncated and dropout and shortening according to the scanner. I'm just housebound for now.

[hopeful_hiker]

hopeful_hiker I was diagnosed with rosacea too. I've had to go private as I didn't get any grading or detailed information from them. Apparently my grading is slightly improving as I've been doing blephasteam 3 times a day. But still getting foreign body sensation in the corners of my eyes which is driving me crazy.

In my experience, I had a multitude of symptoms that seemed to come and go without any particular signs. I had really bad foreign body sensation, too. In part, because I always get a hardened oil patch on a couple of glands but even with lid cleaning by the doc, I would still have that sensation. Then one week it just went away. At the start of dry eye the foreign body sensation bothered me in one spot even with closed eyes. It was bad. At that time the steroids helped.

Eyes are weird!

Overall, a bunch of things helped including serum drops and also IPL for rosacea. Did they tell you if you have staining in the corners of your eyes? I hope your new doc is better. Public healthcare was useless for me apart from getting serum prescription.

[hopeful_hiker]

Also, sometimes I would go through my regimen and try to find any offending contributors. For example, the ointment made my eyes worse. I’m not saying that’s your case but maybe try to see if anything coincided with the foreign body sensation. Similarly, I felt better after quitting Xiidra. I kept a meticulous log via google forms to keep on top of what is going on since I tried so many things.

But again. Eyes are weird in terms of sign and symptom mismatch.

[BradC26]

hopeful_hiker Thank you for getting back to me. it seems as if its getting worse as time goes on. He used the yellow dye and tested my tear quality which was lower than normal people have. the amount of drops I put in is ridicules and it doesn't make much different when I do. I can't plan anything for my future I feel so ill with it. What do you suggest the treatment is for severe side of the mgd with gland loss?

[anteloper]

hopeful_hiker I was diagnosed with rosacea too.

Normal rosacea or ocular rosacea? It's important that you see an IPL doctor who can diagnose ocular rosacea. Not all dry eye doctors have a good understanding of ocular rosacea. If you are able to share photos of your eyelids and lid margins here or in private messages, we may be able to help.

I just need something more affordable.

I hear you paying for these treatments is tough. Have you tried discussing this with your doctor? I shared my financial challenges with my doctor and we were able to skip some of the tests that other patients usually get. Lipiflow is hard because most of the $$$ goes to the company that makes it, not your doctor.


If you have ocular rosacea, and you've already had Lipiflow and it didn't seem to help, and the consistency/texture of your meibum is closer to oil (more runny) than white/pasty, IPL seems more likely to help. BUT it is very important you find a good IPL doctor. Not all IPL is the same, some doctors use different machines and protocols. I have had good results with the Lumenis M22 and the Periman and Toyos protocols.

[BradC26]

anteloper if I have few can I open them glands left can I return my eyes back to new normalise way with less symptoms. I just have seborrhoeic dermatitis but it’s under control with ocular rosacea. The glands are still blocked and these bletyhasteam doesn’t seem to be helping

[fionaberger65@gmail.com]

Hello
Thanks for letting me join your forum.
I have dry eyes with some permanent blocked ducts according to my eye doctor, who has not been very empathetic.

I also have blepharitis and Ocular rosacea.

I have had eye plugs put in.
I didn't like those .one has already fallen out
I don't have mites ony eyes my eye doctor said, through she still put me on doxycycline which I could only stand for 3 weeks ,dues to having sibo, stomach issues.

I have had a blephex treatment

She gave me hyloforce eye drops which is better than the drops I had before.

I was also given evo tears drops which I only used once a few days ago and I used 5 drops ,because I didn't know you are only meant use one drop.
The evodrop have made my eye's terrible and I don't know whether to go to the Aand E because I used 5 instead on one and may have cause issues.
I don't really know what to do now !
Is the doctor right ?I won't get the tear ducts back that have gone?

I wondered also where the best place to go in London UK? is I really want to change doctor!Thank you.

[jack1988]

Dry eye centre is a good place to start. See Conan, he will help you