Holly Molly... Just diagnosed with MGD grade 4

[Inanna]

Hello all,
A year ago I had refractive surgery on my eyes. I went to an ophthalmologist because I was not seeing well. She told me I had extreme dry eyes and gave cationorm drops to use 10 times a day, and viscotears at night. I had no dry eye symptoms but I did as she said. 2 weeks later I was a mess (dry, bloodshot eyes, pain.... ). I came back to her and I told her I feared I was washing off the oil layer, she said she never heard about it happening.
Turns out I was right. I went to an specialized clinic today and was diagnosed with MGD grade 4. My tear production and my corneal sensibility is normal, so the doctor thinks it has nothing to do with the laser procedure. He also said I have dermatitis in my upper lids, caused by mites infestation.
The truth is... I don't really feel that bad. If I had not been undercorrected, I would have never gone to the ophthalmologist in the first place. The extent to my symptoms was seeing more red veins in dry environments and feeling like sand in my eyes sometime to time.
I would like to know if it is normal to have a lot of dysfunction but little symptoms. Also, the idea of having little arachnids crawling around my face is gross. GROSS, SERIOUSLY. How do you kill these things?

[Faith1989]

He said you had dermatitis from Demodex mites? What did he tell you to do? I am the opposite and have mild signs but bad symptoms. My doctor said it can happen. If your not in pain, just do warm compresses and use artificial tears (I like Soothe) when you need them. Do you have crusting? Where are you from?

[PG]

I'm pretty sure it is not unusual to have a mismatch between the subjective and objective findings (I did). If the "grade 4" diagnosis was not preceded by an attempt to express ALL of your glands, then I would not take this to heart. My first diagnosis was "grade 3+" followed by some dire comments that I won't repeat, and a year later my eyes are feeling pretty good. The doctor must have given you a treatment plan for the demodex?

Bausch and Lomb Soothe is also my favorite artificial tear ... and I do warm wet compress for 10 min 3x day.

[Inanna]

Hey,

Thank you both for your responses! The trearment given is: Drops for the inflamation, for 10 days (sorry I don't remember the brand). After 10 days, cyclosporine (not restasis, the European brand Iverkis). I don't remember for how long I need to use it, I must ask again. For the mites, they told me to buy "sterilid" from Thera once a day. Warm compresses once a day for 6 months, and after 6 months once a week/as needed. I am also to use drops 4 times a day. I have been given oftagel because it is subsidized in Norway, but he said I can use the ones I like best.
I don't have crusting, just some dry waste in my eyelashes in the morning. I think though he is spot-on about the mites, it would explain my skin problems in the rest of my face.
They did not attempt to express my glands.

Will it get worse... or worse before it gets better? Seriously, I was much better without using drops, or anything else.

[PG]

He is giving you Sterilid to kill the mites. I believe it is suppose to get worse before it gets better because demodex release bacteria when they die. The grading is a count of how many of the glands are clogged.

[Inanna]

PG how are you feeling as per today? You mentioned you are much better than a year ago

[PG]

Ianna, thanks for asking; I am much improved but focusing on the lid margin inflammation. They are always pink, but the intensity waxes and wanes. This is the remaining symptom and probably the worst one long term since continuous inflammation leads to gland atrophy. I used to have night time symptoms, as you describe.