Finally, a Proper Assessment

[farmgirl]

So yesterday I finally went for my first IPL treatment. Well, I went but I didn't get it. Why, because 6 months ago when I booked this appointment apparently there was a laundry list of prerequisite requirements that I couldn't possibly meet. The first one being that you cannot have been in the sun for 3 weeks prior...well duh, I just came back from Panama after being there 5 months and had gone to the beach for a whole day last week, so that was strike one. Then I should not have been using products with Retin A for the same period of time, strike 2, I should not have put cream on my face in the AM, strike 3....so, it is back to the drawing board.

The GOOD news is that I finally had a proper assessment of my eyes including meibography and tear osmolarity testing. That's the good news, the bad news is that my eyes are as bad as I was afraid they were. MY TBUT is one second...sigh and only 3-4 of my upper glands are producing anything that could be expressed, the lowers had nothing. The glands are there but they are badly shortened and I am not sure if they will ever function for the most part.

So for all of you suffers out there this shows you the importance if getting proper treatment early if it is available (it wasn't for me). Mercifully, times are changing and more and more clinics are getting the equipment to do a proper assessment and treatment. For me it took 9 years but none of this was available when I started on this journey so it is a bit late for me but better late than never.

I understand that if the treatments you need are not available in your city it can mean traveling to a location where they are but if you can make that happen, I urge you to do it sooner than later.

I live in Calgary, Alberta and the clinic that finally can treat me properly is called Clarity Laser Vision in conjunction with Seema Eye Care so if there are any of you Albertans out there give them a call.

[pythonidler]

Sounds like you had a mix of both good news and bad news.

Sorry to hear that your glands are shortened. The good news is that if you have a good routine that keeps them regularly unblocked, there's a chance they could start lengthening again (Dr. ****** found gland growth in a certain % of his patients after performing probing, so I assume it'll work for IPL as well).

I feel like I was in the same boat in terms of getting a good evaluation - the first few doctors I saw knew nothing about MGD. And the first doctor who diagnosed MGD completely missed aqueous deficiency.

Here's hoping your IPL treatments go well for you.

[Italyboy]

Sounds like you had a mix of both good news and bad news.

Sorry to hear that your glands are shortened. The good news is that if you have a good routine that keeps them regularly unblocked, there's a chance they could start lengthening again (Dr. ****** found gland growth in a certain % of his patients after performing probing, so I assume it'll work for IPL as well).

I feel like I was in the same boat in terms of getting a good evaluation - the first few doctors I saw knew nothing about MGD. And the first doctor who diagnosed MGD completely missed aqueous deficiency.

Here's hoping your IPL treatments go well for you.

So you think that with probing ( doing constantly ) glands can growth again ?? Can I ask you the link about the % of gland growth ?

Also what about the combination of - IPL- proving - and manual expression with a Q tip or a paddle ?? Could be worth it or too much ?

Also my experience with some of the first doctors that I saw was like : you have nothing , take antidepressant lol ... asked about MGD to one doctor ( old one in the hospital ) he doesn’t even know what was lol ridicoulous .

[pythonidler]

This is the paper published by Dr. ****** that describes the re-growth of meibomian tissue:
http://bjo.bmj.com/content/early/201...ol-2016-310097

It seems about 41% of the lids that he probed had some measurable level of glandular growth. This growth for many was small, but some had significant re-growth, such as the patient below:



I believe (though I'm not aware of any studies that have shown this) that if probing can lengthen meibomian glands, then IPL should be able to do the same as well.

I can't tell you what combination of IPL, probing, or manual expression you should have - it's best to leave this to your doctor to decide. What I can do is give you advice on how to find a better doctor (and I'll tell you right now that you should get rid of any doctor that hasn't heard of meibomian gland dysfunction). You can read some of my post on computers and dry eye (link is in my sig), if you want to have a good idea of what to look for in a competent doctor.

[Jahcpa]

That's interesting. I had 6 IPL treatments and my only prerequisite was no cream or makeup that morning. One time I forgot, and I just washed my face when I got there.

[farmgirl]

I was studying these pictures and noted that on the RH side there is a gland with a significant hook. If you look at the boxes in the middle pictures that is drawn over top of the photos you will notice that the hook is included in the box on the right but is cut off in the box on the left. I think there might be some regrowth but am not sure that it is as significant as the pictures would indicate. Just my thoughts....

[hopeful_hiker]

Thank you for sharing your journey. I hope you find relief with your treatments.

I am also hopeful about the future with plasma injections and lacripep in the pipeline.

Meanwhile, one thing I wanted to mention is humidity. When my TBUT was at my worst (2-2.5 s) I always felt better when humidity was high. West Coast winters (Vancouver and Vancouver island), rainy as they may be, also have excellent humidity. When it is 85% and up, I sometimes feel almost normal. While new treatments are being developed, at least there are some places that are geophysically friendly to the dry eye folks.

[farmgirl]

Partly true about humidity, but sadly not always. I spend my winters in Panama, the humidity can be as high as 95% and never below 75%. What I find though is that, in the tropics, when it is humid, it makes it feel hotter. When it feels hotter you need fans/AC to feel comfortable. Those fans are killer for my eyes and often negate the benefits of the humidity. Now Vancouver, that is a different story, no overhead fans going there in the winter so for sure the increased humidity helps.

[dnivara]

@pythonidler Interesting paper about gland regrowth after probing. Thanks for sharing.