My Visit with the DE Specialist

[MommyandMe81]

Good Morning and Happy New Year!! Let me start off by wholeheartedly wishing everyone here a happier and healthier 2018.

I had my trip to the new specialist this weekend. I tried not to have too high of expectations, and I'm glad I didnt. While she was a lovely and sweet doctor she didn't seem to have the sense of urgency that I was trying to convey to her. She did address every concern I had and did not dismiss any of my requests but I had to do most of the suggesting which waivered my confidence.

She initially agreed to my DES, tested my vision (still 20/20) and went over my daily routine with me. She said I was on the right track and to keep doing all. She did notice "moderate" allergies which she said could be altering my DES symptoms. She suggested Patanol but when I told her they sting my eyes horribly she changed to Alrex. She said these might work more subtly to help with the allergy- and maybe even dry eye.

Before she dismissed me I requested a meibography to check on the condition of my glands. She agreed. Turns out in my right eye I have about 75% in tact, but clogged up. Left eye is a little better with about 80%. Doctor was not as upset as I was about the glands that had died off. She said with my routine I can prevent any further loss of glands.

She stated I was not aqueous deficient just obvious MGD (most likely from computer screen). She agreed to give me the smallest possible prescription to help me with eye strain and forbid me from using the computer outside of work hours. I am looking forward to these. I get to pick them up next week. The optician gave them rave reviews for helping with lighting and computer use.

I go back in a month for a follow up and allergy testing. She said she would not recommend IPL or lipiflow at this time, but they do provide Thermaflow whish is easier on the eyes and pockets. She said depending on my follow up we could discuss that.

So all in all...do i feel hopeful? Not more than I did before BUT I still have options so I'm doing what I need to do and will see her in a month.

Has anyone tried Alrex? Any side effects? I'm noticing more blurriness and dryness an puffier eyelids. I dont know if it has anything to do with these drops or the freezing temps in general.

Does anyone have any suggestions for blurring of vision? More drops? More compresses (currently 2x day)?

[farmgirl]

Thanks for the update:

Gosh, she had the capability to do meibography and didn't offer it without you asking, I understand why you were disappointed. Hopefully what she has suggested you try will help. I would think 75%-80% intact glands, if they are not clogged would be sufficient. What did she suggest to help with that? IPL, lipiflow?

BTW, make sure the Alrex is not preserved with BAK cause that can really do some damage. If it is short term and you can tolerate it not so bad but if it burns...BAD.

[MGD1701]

Thanks for sharing. How about the root causes? partial blinking? inflammation?? any (thick?) secretion flowing out?

What are doctor home regimen recommendations for your clogged glands? Did she show you how to perform compress/massage etc?

[dryirisheyes]

MommyandMe81 just wondering if most of your glands are clogged up and if the specialised advised a way to unclog them? I have the same issue my glands per a meibography are pretty good small about of drop out but as per my specialist they are ‘good cablire’ however they are secreting a very small quality of poor quality oil. Do you have any tips for improving the quality of the oil? The specialist thinks my glands are plugged with poor oil and has proposed probing as the next step im also considering IPL.

[MGD1701]

Hi dryirisheyes

quality oil:
Omega 3 can improve this. If you have tried omega 3, maybe you need higher dose or different brands??
Not all brands are the same and it matters.
Combined with GLA works more effective - many studies support it and it works for me.

probing: your dr recommend it because you have scar tissue?
some doctors in USA do debridement (for capped glands?) to clean the lids.

[mbperso]

Hi MommyandMe81,
Thanks for sharing.
I am pretty much in the same case as you, so I'm interesting to know what was/is mainly your symptoms ?

She did notice "moderate" allergies which she said could be altering my DES symptoms. She suggested Patanol but when I told her they sting my eyes horribly she changed to Alrex.

How and why did she notice allergies ?
You did use Patanol, that means before, you suspected you have allergies ?

She has the device to do meibography and didn't propose you. That's weird ! Was it Lipiview or other device ?
How did she notice the glands are clogged up, using the meibogaphy or on the slit lamp ?
How did she stated you're not aqueous deficient, with a test ?
Why she would not recommend IPL or lipiflow at this time, though the glands are clogged.

[MommyandMe81]

Good Morning Everyone,

I'll try to answer all the questions in one answer. Pardon me if i miss any!

The doctor didn't have too many suggestions about anything in general. She said she sees me clogged up but the best way would be to continue with the warm massages. She did not elaborate how the massage should be. I didn't really ask, as I know every doctor says something different. Using the meibography she showed me images of the glands. I was surprised myself that i had to ask for it. Also, she did not go into how clogged or how condition of the oil. She said, if anything, she would like to start off with Thermaflow first and see how I respond to it. First thing she asked me was my routine and when I told her she said it was perfect. She kept saying i'm on the right track to keep at it.

The first optometrist I saw when this whole ordeal started also saw allergies. He said the lower lid or part of the eyes showed signs of allergies (not sure what exactly) and he put me on Patanol. They stung so bad and made my eyes very red. I stopped taking them. The specialist looked at lower lid and said the same thing- allergies. So far the Alrex has not stung but my eyes do feel puffier. Could this be a side effect? I have to do 3 drops first week, 2 the second and one the following until my follow up visit. She also recommended HypoChlor to clean my lids after massages.

I currently use Theratears Nutrition for fish oil but I am going to try something else. I was between krill oil or fish oil in liquid form (maybe Barlean's) where I can get more quality results. I also recently ordered NAC. Hopefully that might help in thinning out oils, as I have read. That is my worry right now, as I don't see much coming out when I do the massages. I must be getting some oil because my eyes feel moist and when i blink i feel them getting wet. This only lasts a few minutes leaving me to think i'm not getting too much out and its a thin quality. I am definitely up to trying the Thermaflow and seeing how that helps.

As far as the aqueous deficient- when she started poking and probing I started tearing. She said i do have tears but not good quality ones. I agree. I am able to cry just not oily tears.

My main symptoms are inflammation of upper lid, sore eyes and just regular dryness. I have eyelash loss and get headaches from time to time but haven't recently.

I think I will push more on the follow up visit, or I might actually ask to switch doctors within the practice. She is one of 2. Is that something advisable? Honestly, if it wasnt for everything I read here and knew what to ask I wouldve been left with far more questions than answers.

if i missed your question please feel free to ask again. Thank you everyone for your interest. I love that we are all feeling different things and handling it differently but we all look to help each other.

[MGD1701]

Hi, Thanks!

Thermaflow: means warm compress or specific treatment??

Eyelash loss, inflammation/upper lids - did dr check demodex?

Inflammation: is the most important. Did dr check this? with MMP-9 test and results??
or you only have allergies?

[MommyandMe81]

Hi MGD,

Thermaflow is an actual treatment. From what I read its a gentler type of IPL. It does send heat to the eyes to melt the oil. My question for the doctor would be if they help with the expression during the session or if i'm sent home to do more massaging myself.

No, she did not check for demodex. I mentioned it but she said with no flaking and no itching it was unlikely. I have been washing my face and eye region with a tea tree oil cleanser in hopes of remedying this if it was the case.

I did not know there was a test for inflammation. I wish i do as that is my main symptom right now. I'm not sure if its the allergies or the Alrex or what. I feel like my eyes are huge but when i look in the mirror I see just slight puffiness. I did not have this so much before. I feel like they are clogged and I need to get this oil out!! I think i'd feel so much better after.

Do you have any suggestions when massaging? Do you do moist compresses? I started doing so as I read that dry ones might actually just dry the eye out more.
Do you have any recommendations to reduce inflammation? How about fish oil liquid vs krill oil? I am going to Whole Foods on my lunch break to pick something up.

[MGD1701]

Inflammation:
Most MGD suffers have inflammation and some are very minior and hard to detect (even with MMP-9 test) - like me, I suppose, as all doctors (more than 12) said I did not have inflammation in the last 2 years.
My strategies: healthy diet, omega 3 + GLA + effective/safe lid cleanser (tea tree oil + pure HOCL).

Compress
If you feel good afterwards, then you are doing correct.
If you have (bacteria) inflammation then warm compress is not good.
I like moist but eyes closed as it can remove debris on lashes more effective.
I recently read an interesting article from a famous eye dr in USA, she said most people perform compress incorrectly.
Well, it took me some months to realize the tricks - constant/enough heat and time. that dr mentioned 42C, 10 min. otherwise useless. But for thick oil, 42.5C (like LipiFlow) - or a bit higher and 15 min were more effective - for me.

krill oil- Once I read an article from American dr who said it is NOT effective.
He recommended cold pressed, bio flaxeed oil. Combined with GLA works more effective.
only quality fish oil helps with dry eye (according to my research).
if you have not taken omega 3, you need higher dose, according to that dr - based on my experience, it is true too.

Allergies: if you wear make up, I suspect source is from chemicals??
many comestics expecially eye make-ups/removers, water-proof products are bad for eyes.
Dr Laura Periman and Dr Leslie O’Dell wrote several articles on this issue.

[dryirisheyes]

MGD1701 thanks so much for the info. I am using omega 3 supplements from scope opthalmics - they are called omega eye. I think my oils have improved since using them and also a tetracycline antibiotic as when I am doing the compress I can see small droplets of oil on my lid margin not on all glands but on some. A few months ago I never saw any oil so I feel that it’s improving albeit very slowly. Regarding probing i believe some of my glands are plugged / capped hence the probing.

Regarding getting oil flowing - is a tetracycline antibiotic good for this? I have been on such antibiotics for 3 months now (primarily for roseacea) and i am unsure whether to continue them I think they have helped somewhat. I am contemplating keeping going with them until the 6 month mark and reassessing then. Just wondering if you have any experience with these?

[MGD1701]

Hi dryirisheyes
Great to learn omega 3 helps. if you combined with GLA, even better for
1) thin the oil
2) control inflammation
3) increase tear production

My strategies to control inflammation: healthy diet, omega 3 + GLA, effective/safe lid hygiene (= tea tree oil products + pure HOCL)
All 12 doctors said I did not have inflammation in last 2 years.

Antiotic might develop reistance. low dose doxy 50mg/day x2/day (or even lower) seems work better than higher dose, as I have read (from American doctors) - many doctors use it to thin the oil & for roseacea. I dont know about tetracyline.

Roseacea: good to pay attention to demodex issue.

[MommyandMe81]

Hi MGD,

I picked up some Barlean's Ultra High Potency Fish OIl at Whole Foods just now. Pricey it is, at $30! Im hoping this will be more functional than the Theratears Nutrition. It states that one tablespoon has 1500 EPA/DHA per serving. I would think 2 tablespoons daily should be enough?

Additionally...i take one tablespoon of hemp oil daily for some GLA. Is this enough?

As far as the allergies- I stopped wearing makeup over a month ago. I wouldn't link the allergies to that. I have significant allergies in the spring (to mother nature in general) so it wouldn't surprise me that I have winter allergies too. I found out those were a thing a while back.

Did you notice that the oils started expressing more as time went on? Did you manage to reduce the viscosity with just heat? I just feel like they are stuck in my eyes and I am not getting them out successfully!

[MGD1701]

Omega: I dont know Barlean, if it is recommend by dr, then should be ok.
I only know NOT all supplements are the same and if poor quality maybe do more harm than good. I have read an article from American dr some time ago saying his patient improved considerably after switching to better quality brand (PRN, I guess, as most dr in USA recommend this + another one Hy----, forgot the full name) from a cheaper brand + adding GLA.

massage: some doctors still do not recommend it as we are NOT skillful. if your oil is very thick, glands are clogged, maybe Thermaflow would be more effective/safe and let the dr express glands. Compress just helps to melt the oil to flow - to change oil quality need healthy diet/omega 3, (or doxy?) etc, I think

allergies: even some (eye) creams/lotions contain chemicals which are bad to eyes/glands.

omega 3, GLA: I combine them with fruit/salad/nuts (Vit. E, C), x2/day is better than x1 - this should work better.

[mbperso]

Hi all and thanks for the info.

Mommyandme81: Do you mean MiBo Thermoflo ? (not Thermaflow)
Which brand of tea tree oil cleanser are you using ?
I read that Alrex drop is for pollen allergy.

Compresses: a doctor told me the heat has to be moist to be transferred inside the eyelid effectively.
To do that, the best way I found out is to put cotton rounds very wet on the eyelids and then put the Meibopatch in a plastic freezer wrap.
In this way I have a very moist heat during at least 10mn.

Massage: some doctors said to do massage upward/downward motions while others said only to press on the edges of eyelashes.
video saying only press: https://www.youtube.com/watch?v=9oR8SpSNz6I
I say to myself that if there is a clog deeper in the gland, the only way is to push along the eyelid.
So I prefer massage upward/downward motions and to end I push on the edges. (like a tube of toothpaste)
Please everyone, I'm curious to know what did your doctors recommend ?

Inflammation:
MGD1701, warm compress is not good If you have inflammation, this info is new for me !
Why ?? Heating is the basis of the treatment, if we cannot do it how to treat !

Antibiotic: from what a professor told me, Doxycycline (=tetracycline family) is used only for the anti-inflammatory activity.
From what I read there is no resistance under 100mg and can be used for years. I felt relief after 2 weeks.
I intend to take it for at least 4 months (3 courses of 6 weeks, and pause 2 weeks between courses, I don't remember why stop after 6 weeks)
https://www.ncbi.nlm.nih.gov/pubmed/26347083

Allergies: I have one irritation that still there since spring despite Lipiflow. A new doctor (not MGD specialist) prescribed me anti-allergic and I'm experiencing it, seems to feel relief but it stings eyes.
Does anyone know how long I need to use anti-allergic drops to be effective in case of allergy ?

Omega3: an MGD specialist told me that cod liver oil is better than pills.
One tablespoon 10ml contains : total omega3=2000mg, EPA=700mg DHA=1000mg + vit A,D,E.
Does that seem good ?