Ignoring blocked glands if other treatments are working. Bad idea?

[JJdryeye]

I'm really hoping some knowledgeable people can take a few minutes and weigh in on this. I've really been pulling my hair out over the past year trying to figure out what my next step is in this nightmare.. The one thing I've taken away from this forum that always presents a contradiction of approaches is the idea of just treating the symptoms by means of medications, cautery or some other treatment rather than focusing more, at least initially, on the overall health and functionality of the meibomian glands.

From what I gather on here, and please correct me if I'm wrong, but glands that are blocked via. fibrous tissue or solidified oils will eventual atrophy over time, in turn adding to the probability that the person's dry eye will worsen. Yet I know of some doctors whose primary means of treating dry eye patients is to prescribe medications or try other treatments, treatments other than probing, lipiflow, lid expression.

And before I go any further, let me emphasize that I realize that probing, lipiflow, IPL, etc often do not improve some people's discomfort. I'm not suggesting they would nor am I promoting them. I'm just looking at this from a preventative point of view and trying to understand the importance of addressing this. These treatments are very expensive and even a bit controversial in the case of probing.

It seems as though the people on this forum focusing on the health of their glands are in the minority. I realize a lot of people don't have access to doctors with probes, lipiflow, IPL or just cannot afford it. But I also get a sense that many people here, and their doctors, are just not making this particular aspect of dry eye a priority. And I'm just trying to understand why.

For me personally, I have been told I have MGD and blepheritis, but I've never had anyone thoroughly examine my glands to tell me if they are blocked or not. Nor have I had anyone tell me if I have aqueous deficiency vs. evaporative dry eye. I feel getting answers to these two questions are my next step. I'm assuming if my glands aren't blocked or atrophied that probing or Lipiflow won't help?? And if I find out they are blocked, yet I find relief anyway using some medication or cautery instead, am I doing myself a disservice in the long term by not getting my glands working again??

Thanks in advanced for any guidance on this.

[LaDiva]

I've had IPL, and it didn't make much of a difference. The eye doctor told me he had good luck with people who had no tear deficiency and only MGD. He also said if one had ocular rosacea that the IPL should help. (I have all three conditions.) My other eye doctor does not recommend Lipiflow because he says the results are short-lived and it is expensive. He also does not recommend probing because he says it it too easy to damage the glands and make matters worse. He feels it is too invasive. I've noticed that after I was quadra plugged, the oil problem in my left eye got much better, but not in my right. (The right eye is dryer.) Best wishes to you.

[Nightbird]

For me personally, I have been told I have MGD and blepheritis, but I've never had anyone thoroughly examine my glands to tell me if they are blocked or not. Nor have I had anyone tell me if I have aqueous deficiency vs. evaporative dry eye. I feel getting answers to these two questions are my next step. I'm assuming if my glands aren't blocked or atrophied that probing or Lipiflow won't help?? And if I find out they are blocked, yet I find relief anyway using some medication or cautery instead, am I doing myself a disservice in the long term by not getting my glands working again??

If your glands are merely blocked Lipiflow might help. It helped me a lot. If they are atrophied to the point of being gone completely nothing will help, which brings me to the answer to your second, excellent question. I think you are doing yourself a great disservice by not paying attention to the glands, especially if you haven’t tried the treatments that may help. On top of that, what if someone comes up with an even more effective treatment in future, and your glands are gone by then?

[LaDiva]

I wanted to add that I do warm compresses three times every day, and scrubs in the morning and evening, so it isn't that I don't do anything to stay on top of my oil situation, but at this point I am not sure the other treatments would be helpful. We are all very different in how we respond to the various options.

[Rebecca Petris]

It seems as though the people on this forum focusing on the health of their glands are in the minority. I realize a lot of people don't have access to doctors with probes, lipiflow, IPL or just cannot afford it. But I also get a sense that many people here, and their doctors, are just not making this particular aspect of dry eye a priority. And I'm just trying to understand why.

That's very interesting. I would have said the opposite. But then maybe we're not talking about the same people . There's also a question of context because when this site first started almost 10 years ago, very few patients were EVER told they even have meibomian glands let alone that those might be a significant part of their problem.

I think that among those who are educated about dry eye in general and meibomian glands in particular, most of them DO sooner or later focus on meibomian gland health if for no other reason than that meibomian glands are the most treatable (albeit not necessarily successfully!) part of the collection of diseases etc that comprise dry eye. We can't fix our lacrimal glands, for the most part. We can't fix our mucins. Blink disorders and tear duct disorders often can't be improved without surgeries that bear significant risks for people with dry eye. Meibomian glands, on the other hand, are easy to reach with drugs and devices and are also quite fashionable these days

For me personally, I have been told I have MGD and blepheritis, but I've never had anyone thoroughly examine my glands to tell me if they are blocked or not. Nor have I had anyone tell me if I have aqueous deficiency vs. evaporative dry eye. I feel getting answers to these two questions are my next step.

You are absolutely right to consider more detailed diagnosis your next step. It's a vital one. But keep in mind though that the aqueous vs lipis deficiency clarification will not answer all questions... there are other elements to dry eye too.

I'm assuming if my glands aren't blocked or atrophied that probing or Lipiflow won't help?? And if I find out they are blocked, yet I find relief anyway using some medication or cautery instead, am I doing myself a disservice in the long term by not getting my glands working again??
Thanks in advanced for any guidance on this.

I think you might have that backwards in part? I don't think probing or lipiflow are going to help atrophied glands. Different doctors define atrophy different ways I guess, but you need at least partially functioning glands for any treatment to help. One of the difficulties finding out whether Lipiflow for example will help is, getting objective feedback from a doctor. I mean, any doctor who offers the service has a financial incentive to push it (much like LASIK) so more people are going to be told they are great candidates than those who really do stand a good chance of improvement with it.

But... I want to say that I am noticing a troubling trend these days: that now that these advanced MGD treatments are available is patients - well, and their doctors - jump straight to those. Why not take it slow. First find out what's going on with the MGs, from somebody who really "gets" MG disease well, and see what kind of treatment makes best sense for your situation. An awful lot of people manage to keep their MGs in good shape with simple remedies, antibiotics, warm compresses etc. Not the same as saying they keep their dry eye symptoms in equally good shape in all cases... remembering that MGs tend to get all the attention because they're reachable, but just because there's something wrong with the MGs doesn't necessarily mean that they ARE the source of the symptoms. So palliative stuff is always in order.

Anyway, bottom line, yes you're definitely on the right track. To the extent you can improve your MGs, go for it

[JJdryeye]

That's very interesting. I would have said the opposite. But then maybe we're not talking about the same people . There's also a question of context because when this site first started almost 10 years ago, very few patients were EVER told they even have meibomian glands let alone that those might be a significant part of their problem

You would definitely have a better feel for that than me. It's just something I wanted to bring up because I've been to doctors for this who don't seem that interested in the functionality of my glands and are more interested in the quick fix. And I've noticed quite a few people on here (perhaps not the majority) who are having the same experience. It seems like it could be a dangerous game to play: Paying in the long term for short term gain. I've always heard that doctors in general are trained to treat the pain rather than the cause.

I think you might have that backwards in part? I don't think probing or lipiflow are going to help atrophied glands. Different doctors define atrophy different ways I guess, but you need at least partially functioning glands for any treatment to help. One of the difficulties finding out whether Lipiflow for example will help is, getting objective feedback from a doctor. I mean, any doctor who offers the service has a financial incentive to push it (much like LASIK) so more people are going to be told they are great candidates than those who really do stand a good chance of improvement with it.

I don't know, would fibrous tissue over a gland be considered atrophied? I have no idea. I like what you said about taking it slow. I currently have plans over the next couple of months to visit several doctors to focus more on the diagnostic side of my problem. Two don't offer these expensive procedures so I'm hoping for some unbiased opinions like you said, and the other I'll see for Lipiview. I just want to get a better handle on what is going on, what I can try to rule out, and where to go from here. I've done A LOT of worrying about the potential financial requirements of getting treatment, but I realized I don't even know what my next step is, so I'm trying get a better sense of direction first, and worry later.

And on related note, I've been thinking lately Rebecca that this site seems like it's had less traffic these past 6 months or so, and somewhere in the back of my mind I'm hoping that it's because people are finally getting help via some of these newer treatments and not spending so much time on here. Is this wishful thinking on my part or have you not seen a drop in site traffic? Thanks for your post by the way.