Retest results following IPL

[farmgirl]

Today I went back to test my eyes following my 4th IPL last week. I have not had the easiest week as I am still recovering from the trauma of having my glands squeezed but that should settle soon. The good news is that the test results I have are as follows bearing in mind my right eye always feels better than my left but the glands look better in the left than the right.

(LLT stands for Lipid Layer Thickness)

April 30/18
Tear Osmolarity: Left/326, R/325
LLT: Left/87, R/71
Minimum LLT: Left/57, R/48

August 29/18
Tear Osmolarity: Left/334. R/278
LLT: Left/+100, R/+100
Minimum LLT: Left/58, R/77

Overall I am thrilled that the osmolarity in the right eye now qualifies as normal even though the left went up somewhat and that the lipid layer is now well within the range of normal in both eyes. On the graph the blinks shoot up well into the 100+ range where as before nothing went into that area of the graph. That explains why I was feeling so much better after the 3rd session. Overall the glands look about the same size but fluffier. The lowers are more dramatically full.

So here is a picture that tells the story. On the first page I had 7 blinks. The oils started off flat and ended flat and were well below the gray 'normal' area. The second page I had 15 blinks and look how the oils start just outside of the normal area and sweep consistently well up into that area...kinda like a well oiled machine wouldn't you say...lol

[deep_dry_eye]

I am really happy for you! Are you going to do more IPL sessions? I am personally on monthly-IPL, there is some scant anecdotal evidence that if you can control the inflammation (i.e., via IPL), you can get tissue regrowth.

While I haven't gotten any tissue regrowth, my doctor claims that my glands have shown structural improvement in the meibography.

This could be worth a try in your case!

[farmgirl]

I asked the Dr today and he said that he wants to see me again in 6 weeks and make sure they have settled. I guess we will play is by ear depending on how they are feeling. I did start the Xiidra today though and am hoping that helps with the inflammation and stimulates more tear production given that my principle problem is that I am aqueous deficient. Was your oil increase as dramatic?

[deep_dry_eye]

I asked the Dr today and he said that he wants to see me again in 6 weeks and make sure they have settled. I guess we will play is by ear depending on how they are feeling. I did start the Xiidra today though and am hoping that helps with the inflammation and stimulates more tear production given that my principle problem is that I am aqueous deficient. Was your oil increase as dramatic?

Xiidra seems like a good medication, I just talked to another Ophthalmology fellow , and he claims that Xiidra is prescribed much more common than Restasis now,

I can't pinpoint it as I'm on multiple treatments , my LLT never really improved much , but I do feel symptomatically much better.

I suspect you to have a complicated case, maybe there are nerves involved as well.I would recommend you to do Prokera (AMT) as well. It costs around 1.5k CAD / eye. The idea is that your nerves might be damaged, and your nerves control your glands (oil and aqueous) . If you heal the nerves, you might not only heal your cornea (and symptomatically feel better), but also the nerves can regulate your glands better. I've definitely felt improvement after I did my Prokera (AMT). It's a really safe procedure, takes only a few minutes for insertion, and they keep the tissue (in a contact lens) on your eye for a few days for your eyes to absorb the tissue. You definitely might want to give it a try, its really low risk and might help you as well.

[farmgirl]

My first diagnosed problem was Sjogrens and it seems like everyone went, nope nothing we can do about that, here are some plugs. It was 8 years before anyone said you have MGD here is something we can do about it. I even had a lipiview done in 2010 when this first started but they have refined it with the meibography so sadly I have no pictures of my glands. The oils were much better on that test than on my first test this go around. At that time I was told I had some dropout but that the glands were producing and lipiflow wasn't necessary.

In retrospect followup through the years would have been helpful.

[MGD1701]

Thanks Farmgirl for sharing great news.

Did dr comment why tear osmolarity are such big difference Left/334. R/278??
Any discomforts for this bad/left eye?

I also have one bad eye but dont feel much difference.

[MGD1701]

Hi deep_dry_eye

Nerve damage
how to detect this? staining? symptom would be pain or more?
After LipiFlow I still had pain but about 2 months later, no more, until now.

Thank you.

[ebi1368]

farmgirl I am so happy for you. I am also going to do IPL as well. LLT for my left eye is 38 nm. I do not know if IPL will help me or not.

Did you have blocked gland as well?
I can see little dots on my eyelid. I guess it means they are not blocked.

[Guest]

Wow, impressed and super happy you got that 100% oil flow lol. That's great! This alone has personally changed my mind on IPL. Still not sold on lipiflow but these results are great. Did doc say how long these results will last?

May I ask, was anything else done other than IPL? Antibiotic, steroid, gland expression etc.

super cool!

[farmgirl]

Hi Dowork, yes for sure he did expression with q-tip after every session, no steroids or antibiotics though. The only other thing I had added about the month before was the heyedrate lid and lash cleanser am and pm. I also have been doing hot compress at least once a day. My oils were thick and some toothpaste and they still was room for improvement when expressed during the last session. This testing was done a week after the last session. Not sure how long the results will last but for sure I will be doing more for maintenance if nothing else. Have you had IPL or are you considering it?

Ebi I think the little dots on your lash line means that the oils are really thick and yes mine were blocked. What did your glands look like on the meibography? normal, stunted, dropout? If your LLT is only 38 you will surley experience improvement on your scores, if not on your comfort level. I am happy for you that you can access this treatment now and don't have to wait 10 years like I did....sigh.

HI MGD, no he didn't comment on the difference in the osmolarity but I will say that my right eye is consistently more comfortable than the left.

[hopeful_hiker]

farmgirl thank you for sharing your results! It’s crazy how light can affect the glands.

What kind of machine does your doc use for tests? I am curious about my LLT.

[farmgirl]

The test results say Lipiview/TearScience. I think anyone who does lipiflow can do them but not sure about the meibography cause that was not available the first time I did the lipiview but it was part of the test this time and I think is important. 8 years ago my scores were much better but I was much worse, so go figure. I regret that I had to wait 8 years for treatment because I am sure that my glands suffered dramatically, especially on the lowers. Thank God I got treated now, better late than never.

[MGD1701]

Hi farmgirl
Indeed, geat you finally got treated and with great success. All your effort paid off.
I still wonder why it took 8 years - dr did not examine properly or they did not have the tools?
Did dr prescribe you restasis, doxy, etc.

Compress
I dont feel much difference if once or twice a day but definately once a day is a must for me regardless what doctors say.
1 year ago, one dr from Uni. hospital recommended 2-3/week (as my oil quality was good) and I followed it, but later I found it was not good. So I better stick to 1-2 a day.

[farmgirl]

They never looked at them again after that and the only reason they looked at them then was at my request. I just figured MGD was not part of my problem given I am Sjogrens....was I wrong!! T\Also the IPL machine is new for his office so that treatment was not available and at the time lipiflow would not have made a difference so that is what I was being assessed for. I have been on restasis but quit cause it didn't really help that I could notice and was $$$. I can't tolerate tetracycline so Doxy has been suggested but it out of the question for me.

[ebi1368]

Ebi I think the little dots on your lash line means that the oils are really thick and yes mine were blocked. What did your glands look like on the meibography? normal, stunted, dropout? If your LLT is only 38 you will surley experience improvement on your scores, if not on your comfort level. I am happy for you that you can access this treatment now and don't have to wait 10 years like I did....sigh.

I was told I have healthy gland except the one in right eye lower lid. The pic shows I do not have any gland there but it is so weird because I score 72 on my right eye this eye is the one I have least problem with. When I asked she said it either because of the picture or maybe you were rubbing this eye more. Anyway I am going to take another pic. Anyway, except that one eyelid, all my gland look healthy.

I have been also on Doxy for one month now, I do not know if it helps or not. It does not seem doing anything for me so far.

Do you feel comfortable now having LLT of 100?