Overwhelmed About Options- Please Help

[Kabuto]

Hi all.

So I'm at a crossroads.

I can choose Lipiflow, IPL, or another eye treatment. But I'm on a fairly low budget- I want the most for my buck and I want to make my decisions count.

I'm considering Lipiflow. I'm considering it because it's the treatment my doctor personally recommended after looking at my glands- and I believe I trust her medical opinion.

Any suggestions would help- thanks!

[deep_dry_eye]

Both do different things, I highly urge you to do both. Sometimes you don't know which one will work until you do both. It may require both tgt to help as well. Yes, it costs a lot of money, and yes drs are making a lot of money off us, but tbh, its money well spent if it can help cure ur eyes. If you don't cure it, you can end up with permanent damage, and impact your career, which can have a even higher impact financially.

[deep_dry_eye]

Are you on Restasis or Xiidra, I urge you to get on both of them, they greatly helped my MGD imo.

[Kabuto]

I suppose I can start with Lipiflow then, see how it goes.

Not on Restasis/Xiidra. As mentioned, a bit overwhelmed.

[deep_dry_eye]

LipiFlow can remove any blockages inside the glands, however it may not help any underlying cause of the inflammation. Xiidra, Restasis and IPL can control the inflammation. You need to treat by both removing blockages and the cycle of inflammation.

[MGD1701]

First, you need all necessary objective tests/data to identify causes.
Only right order, combination, timing can achieve the best results and save money.

Treatment Options for MGD
(Below is a summary I prepare, based on my daily learning/experiments & experience, in the last 2 years, from various American opinion leaders - seems many doctors, even in USA, still do not know all?? Surely, there are more - following are just NEW/basic/common tools.

BlephEx, Debridement, Probing
(these are for inflammation (demodex/bacteria), capping, scar tissue, occur surface issues)

Manual expression (by doctors-- this is the cheapest)

Mibo, IPL, *LipiFlow (only to remove blockage of glands)

*TrueTear...*FDA approved, only available in USA at moment
increase ALL layers production
works particularly effective for chronic pain

Probing
Dr Toyos says if one does IPL, probing is not requried (as the light is strong enough to get hard secretion out)

Debridement
Dr Korb does it on a regular basis for some patients and study shows it help (tear can spread evenly).

If you have Inflammation (bear in mind, some are (low) inflammation - hard to detect (by slit lamp), based on my own experience).

1) first BlephEx then LipiFlow
Many opinion leaders in USA NOW employ such combination for a better result, kind of 1+1=2 or 3. Some people complain LipiFlow does not help, but other issues are to blame (e.g. inflammation (demodex/bacteria), partial blinking, CCH/folds etc). BlepEx + LipiFlow = IPL, my own interpretations.

2) IPL - particularly effective for people with rosacea/demodex
According to opinion leader, Professor Preeya Gupta (from USA)
most successful for patients with
*advanced MGD, (mild to serve) evaporative DED
*+/- Rosacea or Seborrheic Dermatitis
*Telangectasia lid margins

. a non-laser light source
.suitable for almost any patient
(Dr Toyos, 1st dr who applied IPL to treat dry eye, mentioned in one of his videos that there is NEW model which suits for (almost) all skin types, I recalled)
--------------------------------

However, you better & still need to:
-Master warm compress (not easy - one American dr even says most people do it wrong - the tricks are constant heat, 45C, reheat (= enough heat & time) &
should feel 1) oil flowing & great aftwards, these are my own findings.

-Add omega 3 (+ GLA works more effective - that is why most doctors in USA recommend HydroEye). My understanding is GLA increases production of ALL layers including the goblet cell - interesting??

-perform Lid hygiene (with pure HOCL, like *Avenova) + healthy diet etc.
These help me put my condition under control - fit enough to work again!
Besides, they will not develop resistance so safer than antibiotics.

Good to use *Restasis at least. If necessary, add *Xiidra - they work in a different way & both are FDA approved. Prof. Sheri Rowen prescribes restasis at the very early stage. I think this is right approach/treatment in order to stop progression. No doctors prescribed me though - I wish I knew this earlier.

[mbperso]

What is the difference between Restasis, Xiidra and Doxycycline ?
Why use one rather than an other ?

[deep_dry_eye]

What is the difference between Restasis, Xiidra and Doxycycline ?
Why use one rather than an other ?

At a high level, these drugs reduce inflammation. Any1 telling you why one is better, is probably lying. We still don't know exactly how these drugs work but only have hypothesis and theroies. It's really a trial-and-error kind of thing, get yourself on these drugs, 3 month followup, see if your glands have produce better tears. That's the experience from drs I've been to.

[mbperso]

these drugs reduce inflammation. It's really a trial-and-error kind of thing, get yourself on these drugs, 3 month followup

drugs
Do you mean I should try the three? I only used Doxy for MGD.

Inflammation
I'm trying to understand the effectiveness of one drug on which kind of inflammation :
If you/someone can lighten me

-Which ones are suitable for MGD or Aqueous Deficient, and why ?
-Which sort of inflammation is related to such drug ? (Meibomian gland, lacrimal gland, eyelid, conjunctiva,...)

[Rebecca Petris]

What is the difference between Restasis, Xiidra and Doxycycline ?
Why use one rather than an other ?

Doxycycline is an antibiotic in the tetracycline family - very different from both Restasis and Xiidra (which are also pretty different from each other). Doxycycline is typically prescribed for MGD, especially if you have rosacea. Restasis and Xiidra are more commonly prescribed if your lacrimal tear production is low.

[Kabuto]

Sounds like doxycycline may be a good solution (or at least, a good supplemental one) Is it typically covered by insurance?

[deep_dry_eye]

doxy is typically covered by insurance or very cheap, doxy is perhaps one of the most prescribed antibiotics (generics available).

xiidra and restasis are also very commonly prescribed for MGD in Canada, the theory is that MGD is caused by inflammation and all of these drugs can help reduce inflammation. if each treatment can help u 10%, a few of these treatments together can help you 50%.

pls give them a try, medicine is different per person and the theories are rapidly changing; you won't know till yo utry.

[Guest]

Sounds like doxycycline may be a good solution (or at least, a good supplemental one) Is it typically covered by insurance?

The reason I can't use doxy, and thankfully don't have to yet, is because it upsets my stomach so bad it ends up making things worse. If my gut is off, my whole body is off including my eyes.

If you havent tried azasite yet, you could always try that first. The recommendation is to clean your hands, put one drop on your finger and rub it together with the finger on your other hand. Then pull down your lid and apply it across the bottom lid, then close your eyes and rub it into your lashes. Two weeks of that with warm compress and lid hygiene with avenova, you should feel a lot better. You may need a steroid just to stop the inflammation for a bit while you get things working again.

Doxy is the gold standard for lid disease. You can always give that a shot too but again, I'd prefer a topical as not to disrupt my gut. The azasite burns too, but again, I prefer it. However, as my dr said, doxy is the only way to combat this disease from the inside. The azasite is only used for two weeks then discontinued...whereas the doxy is a long term medication. You literally have to take the doxy forever for it to continue to work. Doing things forever is kind of the name of this game. You cannot stop, you will not cure this, you can and will get better if you work at it. But it requires constant maintenance.

Really hope you find a solution, you sound so lost in this mess, sorry about that.

MGD1701 always has great advice...read what he wrote up there....you must become a master of the hot compress (not easy). One of the best pieces of advice you can get. Become a master of the hot compress. Too hot, you cause more inflammation, not hot enough and you don't melt the oil. When I did my compress right for the first time after doing it wrong for 2 months I had glue come out of my lids. When I tried to open my eyes, my eyelashes were glued together. That glue came out for two weeks before it slowed down, now it's rare I get sticky oil.

[MGD1701]

Only one dr prescribed me doxy (100mg/day) to thin the oil -
I stopped after 4 weeks as it upset stomach. Dont find it that useful - omega 3, combine with GLA, healthy diet etc can serve the same purposes & much safer - they work for me.

Dont like antibiotics for its side effects. Dr Paul Karpecki mentioned that low dose doxy is better/safer (something like 20-30mg, twice a day--not 100% sure??).

[deep_dry_eye]

azithromycin is better than doxy, try topical azithromycin (azasite if u are US, azyter in EU) or u can make it via a compounding solution.

omega 3 does not have the same mechanism as antiobiotics , while they might all help reduce inflammation , their potency and pharmacology is very different. of course every patient is different, but go google and read the research literature of azithromycin and mgd, it seems to correlate quite well.