No announcement yet.

My experience with MGD (part 2)

  • Filter
  • Time
  • Show
Clear All
new posts

  • My experience with MGD (part 2)

    Hi everyone.
    I started a thread about my experience with probing and lipiflow a while back. But it quickly became quite chaotic so I thought I'd start a new one. Also, I feel like my understanding of MGD has progressed a lot and I don't necessarily back all of the statements I made in the previous thread anymore. And I wanted to give you guys an update on my progression too.
    I apologize in advance to those who already know me a bit, as Iím going to start from the beginning.

    So here goes:

    I'm a 20 year old engineering student from Belgium. At the age of 15, I started wearing contacts. I could wear them all day, every day, without problems. But after a bit more than a year, my eyes started to get dry towards the end of the day. Until I could only wear them from time to time and eventually not at all anymore.

    At that point, I just thought that I had abused my eyes by wearing them too much. My thinking was that my eyes were 'dried out', whatever that meant, and that I just needed a break. But my contact lens intolerance didn't go away as the months progressed, so I went to see an ophthalmologist (just at the local hospital). He didn't have any answers for me and he just set me on artificial tears and said that I should swap contact brands if necessary. Surprise, surprise, no change. But heck, I thought, if that's my only problem, then so be it. I had almost no other symptoms.

    But a year later, that all changed when my eyes began to feel dry even without the contacts. I felt overwhelmed and angry. But I was still convinced it would go away. Of course it didn't, although I still had more good days than bad days back then and even a few weeks without any symptoms. On one particularly bad day, I went to another local ophthalmologist, and he set me on steroids for a few weeks. That seemed to help, but only for a short time.

    I decided this was getting out of hand so I made an appointment at the university hospital in Leuven. If those people canít solve my problem, then no one can, I thought. I saw two different professors specialized in tear ways and ocular surface but neither of them could give me a proper diagnosis, let alone a treatment. In the mean time I had thoroughly searched the internet for a cure myself. And I quickly discovered cyclosporine, azithromycin, IPL, probing etc... But these people at the hospital hadn't heard of a single one of these treatments. It seemed to me they lagged behind at least 10 or 20 years. They just set me on vitamin A ointments, steroids again, anti-allergetic drops etc... None of this was helping and I was getting more desperate as with every month passing, my condition worsened. By that time I was 19.

    So my next step was to go to Quinze Vingts in Paris, the most prestigious ophthalmology hospital in France, to see Dr. Baudouin. I didn't get to meet him, but one of his doctors did all kinds of tests and eventually diagnosed me with evaporative dry eye. He didn't bother to look at my eyelids or meibomian glands much though, but just prescribed an anti-allergetic drop and a steroid (again!) If that wasn't working, I could come back and he would prescribe cyclosporine.

    I had to take those two drops for about 6 months, but halfway through I realized this wasn't going to do a thing. I started getting interested in new treatments like probing and lipiflow but I thought America was the only place to get that done. However, I learned from someone on this forum that Dr. Geerling at the university hospital of Duesseldorf offers these treatments.

    So only a few months after I went to Paris, I now sat in a chair in Germany. They had Lipiview (to measure the thickness of your oil layer) and a keratograph for meibography, staining etcÖ They looked at my eyelids and for the first time, somebody tried to express my glands. There was nothing coming out. And for the first time in three years, my condition was diagnosed: I had MGD. They put a whole sheet of test results in front of me. My TBUT was 3 or 4, (under 10 is dry, under 5 is very dry) and my lipiview score was 40 on the left and 20 on the right (under 75 is bad). Apparently, my glands were closed by tissue and they proposed to perform gland probing, followed by Lipiflow. At that time, I was also taking doxycycline.

    I was very excited about this treatment and my diagnosis. In fact way too much. Because my subjective symptoms did not change one bit. I felt devastated. So many people had some kind of relief, why not me? After three months I had to go back for a checkup. This time I got to see Dr. Geerling himself. They did all the tests again and despite my lack of subjective improvement, there was still some good news. The lipiview score for my right eye improved from 20 to 40, although my left eye stayed the same (also 40). But more importantly, my glands were open and working and when Dr. Geerling put pressure on it with a q-tip, he said he could see oil coming out of them.
    He was honest with me and said he wasnít too sure how he could further improve my situation, but he set me on cyclosporine. He also said that my eyelids are very red and inflamed on the inside.

    So I ordered some boxes of Restasis from America and started this treatment with mixed feelings.
    How was it possible that my eyes felt exactly the same even though my glands had opened?
    I felt that something was missing. And I remembered what Dr. Geerling said about my eyelids and searched the web some more. And I stumbled across IPL. It had never crossed my mind that this could actually help. To me, IPL was just another expensive rip off to make quick money, just like Lipiflow. But I began to understand the biology of it and it started to make sense. Apparently, the light around 500nm gets absorbed by the hemoglobin in the blood, which overheats the small telangiectasia in and around the eyelids, so they close. And once they are gone, they can no longer feed the meibomian glands inflammatory mediators so the glands will start working better. And I read all about this treatment and how Dr. Toyos discovered it. But unfortunately, there are no doctors in Europe that follow Toyosís procedure. However, one doctor in Reims, Dr. Malbrel, had apparently worked together with E-SWIN, one of the biggest manufacturers of IPL devices, to design and calibrate a device specifically for MGD patients.

    I went to see this doctor Malbrel and I had one wonderful IPL session. He confirmed almost everything I already thought about MGD and what was causing it to me and said he sees a lot of good results with his IPL device. However, Reims is a four hour drive for me and he advised me to contact a dermatologist in the area. Now there is a very professional dermatological practice in my town, and after hearing my story and contacting the necessary people to confirm it, even French ophthalmologists and colleagues of Dr. Malbrel that had worked with IP, they said it might be worth a try to do a series of laser treatments. They just sold their last IPL device, so they couldnít offer exactly what I wanted. Most dermatologists these days are switching to laser as itís more effective. But this laser works at around 500nm, which is the necessary wavelength. So long story short, I tried my first treatment two weeks ago and Iím having another one next week. But no real improvement yet.

    But just after my IPL session in Reims, I also went back to Duesseldorf and I had some very good news. My lipiview score had improved from 40 to almost 50 in both eyes and my TBUT was now 5s on the left (still 4s on the right). My glands were definitely open and clear, fluent oil was coming out easily. This news confirmed my presumption that the mechanical part was effective and that I now need to tackle the inflammation of my eyelids through IPL. And for the first time, my subjective symptoms have also improved somewhat. Not much, but I can go to some classes now. For me this is a big change compared to the previous semester, when I couldnít go to classes at all. And Iím gradually starting to reintroduce some other things in my life.

    But TBUT scores of 5 are still very low and I still have serious discomfort every day. But at least I have some hope now. And hopefully things will get better from here on.

    So thatís my story up till now. I probably left some things out. For example, I also tried azithromycin drops a while back, but I couldnít tolerate them. But overall, I think thatís about it. I apologize for this very long post, but I had to summarize 3 years of suffering and all kinds of treatments. And I didn't even get into the effects of dry eye on my personal life. It has been a very long and rockey journey so far. But I hope this will help some of you guys with MGD. And please, feel free to ask me anything or to start a discussion about IPL/probing/lipiflowÖ as long as itís on topic.

  • #2
    Hi, were there any physical indications that the mg were blocked by tissue? If the glands were producing meibum that couldnt escape wouldnt this result in swelling or styles? Or perhaps the mg cease production if they are blocked? Was the probing painful? Anyone know of a good doctor in australia / nz that does probing and ipl and lipiflow?


    • #3
      I don't know if it is possible to detect plugged meibomian glands. I only know that prior to the probing, my eyes and eyelids were examined and they told me nothing is coming out of the glands. And during the procedure, you could hear a "plop" sound every time the probe was inserted and the resistance gave away. The doctor that performed the procedure also said that as far as he could tell, my glands were very plugged. FYI, the probe itself is only 1 or 2mm long, so it is almost impossible to damage anything other than obstructing tissue at the opening of the gland.

      Probing is not really pleasant, to say the least. It hurt quite a bit, even with the topical anaesthetics.

      Apart from the States, I only know of one practice offering probing in Europe, the one were I went, but none in Australia.
      But I'm sure there must be someone.


      • #4
        Haden - In Sydney there is Dr Jim Kokkinakis at the eye practice who offers IPL and Lipiflow. I don't know if he offers the probing procedure but there is an ophthalmologist in Bondi that does the probing, at least that was true two years ago (google, you'll find him). I think he only uses the 1mm probe (they are made in 1, 2, 4 and 6 mm). In my opinion this is probably a good thing - it is very difficult to stay co-linear with the duct canal when going deeper into the gland so the relatively sharp and inflexible wire end probe might cause damage to the duct and/or adjacent acini. But then again you might be able to break a deeper obstruction that would otherwise never be removed, its a difficult trade off.


        • #5
          Originally posted by Haden View Post
          Hi, were there any physical indications that the mg were blocked by tissue? If the glands were producing meibum that couldnt escape wouldnt this result in swelling or styles? Or perhaps the mg cease production if they are blocked? Was the probing painful? Anyone know of a good doctor in australia / nz that does probing and ipl and lipiflow?
          Haden, Dr. Brendan Cronin in Brisbane does IPL and Probing (he probed my ducts over 12 months ago). He's a dry eye specialist and one of the nicest ophthalmologists you'll meet. The ophthalmologist in Bondi doesn't do Probing anymore.


          • #6
            Thanks for the replies. Ive been to 3 different opthamologists over the past 4 years, and realise now that unless they are a dry eye specialist, i am pretty much wasting my time, except for generic recommendations like 'use preservative free drops' and 'eat omega 3' etc


            • #7
              Originally posted by Haden View Post
              Thanks for the replies. Ive been to 3 different opthamologists over the past 4 years, and realise now that unless they are a dry eye specialist, i am pretty much wasting my time, except for generic recommendations like 'use preservative free drops' and 'eat omega 3' etc
              True story...


              • #8
                Hey guys,

                I read some articles about partial blinking the past few days and it got me thinking.
                Both Prof. Geerling in Duesseldorf and the doctors of Prof. Baudouin told me I only blink partially but I didn't think it contributed in more than a minor way to my dry eye and MGD. However, after researching a bit, it became clear to me that it may well be the number one problem that started the whole cycle.
                Apparently, a lot of contact lens wearers develop a partial blinking reflex for some reason. That prevents the oil in your MG's to spread across the eye surface, leading to dry eyes at the end of the day. This in turn causes friction between the eyelids and the eye itself, possibly leading to inflammation of both. Partial blinking also reduces the flow of meibum in the glands. And those two factors are known to cause MGD and plugged glands.
                And I think that is exactly what happened to me. How else is it possible that after a year of wearing no contacts at all, my eyes suddenly began to feel dry, even without them? My guess is now that I continued to blink improperly and that that led to the MGD I developed later on. And also, why else are my eyes still so dry even when all my glands are open now and visibly producing clear oil? It didn't make any sense. But now it does.

                Can you give me some thoughts on this? I only thought of this theory a few days ago and it may not seem spectacular to you, but this means a lot to me. It would be such a relief to be able to grasp the reasons for my condition.

                I've started blinking exercises right away. I try to do them every 15 minutes, but it's hard to keep up. But if I can relearn the proper blinking reflex, I might be on my way to durable recovery, especially now that my MG's are open and producing clear oil.


                • #9
                  Originally posted by Santaklauzz View Post

                  Can you give me some thoughts on this? I only thought of this theory a few days ago and it may not seem spectacular to you, but this means a lot to me. It would be such a relief to be able to grasp the reasons for my condition.
                  Its interesting that you say that. My dry eyes (MGD) developed almost immediately after I tried contact lenses for the first time. I also started a new job a few months prior where I spent a lot of time in front of a computer so I always attributed my my dry eyes to the computer. I've asked a few eye doctors if they thought the contacts had anything to do with my dry eyes but they all dismissed it. I tried different types of contacts for less than a month and then never wore them again. Ever since then my eye have been progressively getting worse. I only recently found out that I dont blink properly but I'm pretty certain thats what caused my dry eyes. I never even though that the contacts might have triggered the blinking but its certainly possible.

                  Im curious about your IPL and Lipiflow procedures because I am planning on getting them done; specifically the techniques and pre and post preparations for them. Dr Toyos and Dr Korb are some of the pioneers for each of these procedures, respectively. I am wondering if other doctors are following the same procedures.

                  On Dr. Toyos website it says: "After treatment and expression of the glands we give the patient a drop of Durezol," he continues. "Postopera-tively, we have the patient use Durezol for three days, and Xibrom once a day until they see us again, for inflammation. Then we have the patient use AzaSite at night for 10 days before the next treatment." - See more at:
                  Did you doctor express your glands and if so how? Also were you prescribed the medications mentioned above?

                  It then mentions: Dr. Toyos notes that it usually takes three to four treatments over the course of four months to get the secretions thin and working correctly. "After the gland is normalized we do maintenance treatments every six months to a year," he says. "Younger patients need fewer treatments."
                  Have you or are you planning on doing multiple procedures during a specific timeline?

                  Regarding the Lipiflow, did your doctor do MG expressions prior or post to the treatment? Also, were these soft (with a q-tip) or hard expression (painful ones) where they try to clear the blockage? Dr Korb says to wear night time sleeping goggles in addition to administering night time drops every time before you go to bed. Did you do this prior to and after the treatments?


                  • #10
                    That's interesting. When my dry eye problems began, I also used the computer for hours on end and had to study a lot too. So it probably was the combination of contacts in school and low blinking rate at the computer that altered my blinking reflex and dried out my eyes to the point of developing MGD.

                    I wouldn't recommend Lipiflow though. I paid 1200 euros for it and it was nothing more than a warm massage in my experience. What I do recommend is MG probing if your glands are plugged. That really helped in terms of clinical signs. My glands went from completely plugged to open and producting. Unfortunately that didn't translate immediately in improved symptoms.

                    IPL (or vascular laser) I don't know. That remains to be seen as I'm currently under treatment. But the big difference between Lipiflow and IPL, regardless of the completely different mechanism, is that Lipiview was engineered by deduction (if we warm the glands and massage them, they should be getting better. That is the premise) whereas IPL was discovered by empirical induction (we have real improvement here in some patients, so maybe this treatment works for dry eye). So speaking as someone with a scientific background, this sounds a lot more promising and legitimate to me. Also, I believe there were several people on this forum that had some improvement with IPL, which was also on of the reasons for me to try it.

                    I had my second vascular laser treatment a week ago and before those two, I had one IPL treatment with the E>Eye device. I'm feeling like my eyes are steadily but very slowly getting better with ups and downs. Since I'm also doing a lot of other treatments simultaneously, like doxy and restasis I don't know whether it is really the laser that does the trick. It could even be the long term effects of probing, if there ever were any. But as long as I keep getting better, I'm planning on continuing them every three weeks and I'll keep you updated.

                    Prof. Geerling and his assistants only expressed my glands very gently with a q-tip to assess their condition. It never hurt and they never used forced expression to open them, but offered a probing and lipiflow treatment instead.


                    • #11

                      Did you have the probing done prior to or after the Lipiflow? If your glands were completely blocked it would make sense why the Lipiflow would not work. The device is supposed melt all of the hardened oil and then remove it from you glands making room for the new and hopefully improved oil. If in our case, the underlying issue issue is actually our blinking defficiency, then we would also need to do blinking exercises after the treatment, or else the glands would just clog back up and the treatment would be useless.


                      • #12
                        MGD30, when I read your story I couldn't believe the similarities with my son's. He started a new job about two years ago, that required long hours in front of the computer. Less than a couple of months into his new job, he tried contacts for the first time, which irritated and dried his eyes. A few days later, he tried different types of contacts for a couple of more weeks, and eventually gave up, but his dry eye condition never improved. He saw many specialists and none attributed his new condition to the contacts, they all agreed that it was a coincidence. His MG became obstructed and he developed severe MGD. He tried Restasis, antibiotics, OTC drops/gels, steroids, supplements, etc. Only the moisture chambers/goggles made a visible improvement to his symptoms . He's had BlephEx and LOM debridement, with no results. In August he was seen by Dr. Korb who's performed extensive testing over the course of two days. Dr. Korb determined that my son's MGD was caused by his partial blinking, possibly triggered by computer overuse. He recommended that he wear moisture chambers during day and night in preparation for a lipiflow treatment as well as frequent blinking exercises. Our local ophthalmologist will do his lipiflow procedure this week( unfortunately we don't live close to Boston).


                        • #13
                          MGD30, I had Lipiflow just after the probing so it should have worked. But as I said, it is merely a sophisticated and expensive warm compress imho. The massageing was very gentle and the heat was quite modest. And it was over before I knew.

                          I agree that if you don't work to correct your partial blinking reflex, your glands could become clogged again. But in my case, I'm still taking doxy, restasis and doing gland expression twice a day with a q-tip and everything still seems to be open.
                          I can really see little puddles of oil coming out when I press on my glands.

                          The reason why my symptoms are still so bad, is, I believe, the inflammation of my eyelids. i think that prevents my glands from working at full capacity. And that's why I'm now doing IPL/vascular laser treatments.
                          I don't think my partial blinking is a big problem now in terms of drying out my eyes because I'm now doing blinking exercices througout the day and I'm trying to blink consciously when I can.
                          Before, I didn't have a clue that blinking was the problem and my eyes would not be properly lubricated all day long. That's no longer the case. So I don't think my glands could become plugged again soon.
                          But I agree of course that correcting that reflex is key to durable improvement and getting your eyes back to normal in the long run.


                          • #14
                            How to get rid of inner eyelid inflammation?

                            Quick update:
                            A bit more than a month ago, my eyes improved to the point that I could go out jogging, go to two-three classes a day, take the train, go shopping etc... with minimal discomfort for the first time in a year.
                            My eyes were only marginally worse upon waking in the morning and also in the evening they were still pretty normal.
                            The only thing I could not tolerate was wind so going outside for more than half an hour was still a big issue.
                            But to me, it was a huge improvement, and I attributed it to the vascular laser therapy I'm currently doing. (and also the restasis and doxy I use to keep my glands open and the oil clear)

                            However, after three weeks, they started getting worse again. I think I abused them because I also did an experiment to try to improve my vision by reading everything at the 'edge of blur' all day (google Tod Becker myopia improvement)
                            And I also got into this new videogame on pc... Furthermore, I think I also overdid the blinking exercises. I guess my eyelids (and glands) got way more inflamed by the friction of constant forced blinks all day...

                            So now I'm trying to be careful. I've stopped my experiment and I'm taking regular breaks from the computer

                            I've noticed that my eyelids are still very red and inflamed, even after the 4th laser session. The inflammation should be going away, but I think that the laser is not close enough to my eyes.
                            I asked them to do it as close as they could the previous session, but they can't treat directly onto the eyelids for the most part, so I'm guessing the effects are only minor.
                            Also, how is it possible to get rid of that inflammation while my eyes are still dry? My eyelids are rubbing over my dry eyes all day, so I'm stuck in a vicious circle...
                            Do you think it is possible to decrease the inflammation by using lubricating drops?
                            Did any of you guys with MGD manage to get rid of inner eyelid inflammation somehow?