DRY EYE - where we are now - II

[browneyesblu]

Hi,

Do the ophthalm in North America really tell the patients what to do at home after the probings and the Lipiflow?

Hi Peter,

Thanks for the info on warm compresses.

Here is what one Lipiflow patient was told to do post-procedure. I'm guessing it varies widely depending on where you have either Lipiflow or probing done, and that along with co-morbidities may account for the varied results.

"This morning, I had a small amount of 'sand' in the corners of my eyes and my eyes felt normal. I took a hot shower and let the water run over my eyes. Then, as instructed by my doctor, I heated my microwave 'hot-pack' and used it for 5 minutes. After the 'hot-pack', I gently cleansed the lid areas with an 'OcuSoft Lid Scrub Plus' Pad. Then, I inserted a drop of prescription 'TobraDex ST' (Steroid Drops) into each eye. I have to continue this regimen every day to ensure that my glands / tear ducts remain open. The TobraDex regimen is as follows: one drop three times a day for a week, two drop a day for a week, then one drop per day for a week."

-blu

[NotADryEye]

So according to dr ****** the steroid injections and the MG expressions right after the probings should make the
differences regarding long term success.
I think it will be very difficult, keeper the glands open after the MG probings and after Lipiflow.

Indeed here in Europe I don`t know any MG probing ophthalm, that does inject steroids or does perform a careful expression of the re-opened Glands.
But the very small quantities of steroids will be squeezed out again by a few forceful blinks?

Do the ophthalm in North America really tell the patients what to do at home after the probings and the Lipiflow?
I have not read, that they do apply Azasite before and after the probings.
Only after the re-openings of the glands, very small quantities of Azythromycin can get into the gland orifices.

Steroid injection and expression are used in more moderate to severe cases, retreatments, multiple co-morbid diseases and chalazion to get best results. Steroid injection and expression are not necessary in all cases. Excellent results are routinely obtained with probing alone. But, in all cases, to get longer duration of benefit requires managing any co-morbid disease such as aqueous tear deficiency, allergy, chalasis, infection, and systemic disease.

The first time I was probed, Dr. ****** injected steriod. It was quite a lot. I couldn't say how long the steriod stayed in the gland, but it helped, no doubt, given how well I responded to the treatment. He has also epxressed my glands, when needed, periodically.

Regarding post-probing instructions, keep in mind that there is also the management and treatment of all of these co-morbidities that is so important. So yes, in my case and I am sure with all of his patients, Dr. ****** instructs very specifically what to do, when to do it and how at every appointment, after every surgery (AMT for chalasis in both eyes), after probing, etc. And always the instructions are specific to my condition at the time. I am not treated like a statistic. I am treated like a patient. Dr. ****** approaches this systematically based also on what I can tolerate, which is very important since I can not tolerate preservatives or most commercially available OTC drops, ointments, etc. I'm sure this creates challenges in treatment, but certainly it is not impossible.

[spmcc]

Note also that unpublished data from Mass Eye and Ear using confocal microscopy shows that with probing the periglandular fibrosis with congestion in o-mgd was relieved.

Hi NotADryEye,

How did you see unpublished data? How can I see it?

Thank you.

[NotADryEye]

They sent Dr ****** the before and after probing confocal microscopy photos. I'm his patient.

[NotADryEye]

I am not a fan of warm compress. I think there is a great risk of overheating and the heat applied will reach the cornea, wheres LipiFlow shields it and then heats backward & outward against the lid. The cornea is extremely sensitive. And most of us have gland/eyelid issues which has nothing to do with the cornea, so using warm compress alot probably would effect the cornea in a cumulative manner I suppose; which doesn't sound good..

You do have to be careful about the temperature of warm compresses. You also have to be careful with how long you apply them and how often. I apply warm compresses only 2x per day and only for two minutes. More than two minutes and it gets terribly uncomfortable. If you're having trouble you might consider experimenting with shorter durations or less frequent applications.