Need some insight from those who know more than I do.....

[jax8it]

I have been to see another doctor. I am trying to have custom moisture glasses made. While with the opticians last week, I spoke with the doctor there and scheduled an appointment with him just to see what he would say. I saw an ophth last week too. This doctor said something totally different from any doctor I have seen so far. He pulled my plugs and he wants me to detox on everything. No OTC drops or Restasis. He said my corneas look good, no dry spots. He said the plugs were keeping "bad stuff" on my eyes and he thinks it keeps me from auto regulating. He thinks my problem is with evaporate dry eye. He said I have non observeable mgd, meaning I don't have the typical thick toothpaste miebum. Rather the actual glands are only working at 30 percent. Any thoughts or input. I am taking a leap of faith. Nothing was helping anyway except moisture glasses. Wish me luck, because I am scared as hell.

[spmcc]

I just googled "non-obvious mgd" and up popped a pubmed abstract. Korb is one of the authors (Korb invented LipiFlow). See here: http://www.ncbi.nlm.nih.gov/pubmed/20847669

Perhaps some more searching on this topic would turn up some good info to take to your next appointment... also perhaps some treatment options that you can start on without a doctor's prescription.

[Rebecca Petris]

He pulled my plugs... he wants me to detox on everything. No OTC drops or Restasis. He said my corneas look good, no dry spots. He said the plugs were keeping "bad stuff" on my eyes and he thinks it keeps me from auto regulating. He thinks my problem is with evaporate dry eye. He said I have non observeable mgd, meaning I don't have the typical thick toothpaste miebum.

From where I stand... those are all reasonable things for a specialist to tell someone even if they've been told very differently by the first half dozen or so doctors (especially those of the traditional plug-&-drop indiscriminate Restasis-pushing meibomian illiterate persuasion and fair to say there's a superfluity of those on the planet). The fact is, the majority of dry eye is NOT aqueous deficient type and all the things he's having you quit are more or less directed at aqueous deficiency. So while I definitely can't say whether all this is "right" for you personally, at least I can say none of it raises any red flags for me. Frankly to me it just sounds like you've stumbled across a truly better diagnostician than you've encountered before.

Nothing was helping anyway except moisture glasses. Wish me luck, because I am scared as hell.

Good then you're not missing anything by quitting drops :-) GOOD LUCK!

[jax8it]

Thanks spmcc and Rebecca!

[bakunin]

jax8it,

For all i have learned reading this amazing forum, I agree with Rebecca. It sounds like your new doctor is probably better than the others.

Good luck
I need a good luck too, to cross this dry winter here. It's been painful, stressful and depressing.

[bakunin]

I just googled "non-obvious mgd" and up popped a pubmed abstract. Korb is one of the authors (Korb invented LipiFlow). See here: http://www.ncbi.nlm.nih.gov/pubmed/20847669

Perhaps some more searching on this topic would turn up some good info to take to your next appointment... also perhaps some treatment options that you can start on without a doctor's prescription.

smpcc,
thank you very much for sharing that piece!

I think that explains why the doctors didn't mind my MG. I guess i have NOMGD. I don't have any visible inflammation in my eyelids, but for sure my MG are not function as they deserve.

[Rebecca Petris]

I guess i have NOMGD.

Aaaaaaaand therein lies the rub. Is it NOMGD, or is it NO MGD? The doctors we want are the ones who recognize the acronym

p.s. nice link spmcc

[spmcc]

Is it NOMGD, or is it NO MGD?

LOL It's ironic, isn't it?!?!

[sunshinelover]

This is so interesting-
I am also wondering if my plugs are doing any good or not. And I do not see any think meibum. I think the gland are just not functioning well, in particular in my left eye where all the eyelids are no extremely short - that started before the dry eye symptoms, so glands must have been off for a while...

[bakunin]

For the first time I had schimer done, by my new doctor I saw this week. It was 10mm in left and 3mm in right eye. I never have red eyes, he said my cornea and my epithelium has no erosion and no problem, no visible signs of bleph, and despite I don't have much melbum when expressing my eyelids he said the mais problem is the aqueous layer (due to low schimer).

Do you think that I could have No Obvious MGD? If he saw some some melbum flowing (less than normal but still enough), could it be NOMGD? Should I talk to him next time about it?

He is a very attentious, caring and gentle doctor (what makes me happy), but he offered me the "old options" of plug-drops-restasis, which made me not so happy.

I don't know if he did TBUT, but other doctors did before and I have TBUT below normal. If TBUT is low it is because of problem in lipid or mucin layer, or could it be that we have lipd and mucin layer ok but we don't have enough aqueous layer so tear film breaks faster?

He said Lasik has nothing do to with my dry eyes since I had no problem after the surgery and the DES onset was six years later.

Any insights I would appreciate.

thanks

[sunshinelover]

Hittills Bakunin ,
Was shirmer with or without anaesthesia ?

[bakunin]

Hittills Bakunin ,
Was shirmer with or without anaesthesia ?

Without anesthesia.
My symptons are the same in both eyes (I don't have an eyes worse than other). So I think it's strange that one eye had schirmer so much lower than other. Maybe Dr. Laktany is right and schirmer is not reliable.