Dr. Korb - compromised lid seal found in majority of symptomatic dry eye patients who did not respond to regular treatments

[Guest]

Absolutely. Doing whatever we can to lower overall ocular inflammation can help the glands do better.

[Milo007]

I'm strongly considering it... it costs 65 CAD, so not too bad. I'd like the objective data it can provide me, particularly in regards to the length of my glands, so I can monitor over time if what I'm doing is slowing/stopping decline, or even causing them to lengthen again (there are some reports, for example, that with treatments such as probing and Lipiflow that the glands have grown LONGER, whereas previously this was thought to be impossible... makes me wonder if it's possible for someone with mild truncation and glands that overall are capable of functioning decently to cause truncated glands to lengthen over time with simple treatments such as Blephasteam goggles and insane amounts of blinking exercises... )

I got my lipiview done for 16.75 CAD :-D

Well a thing worth mentioning is that there are basically two kinds of blink exercises - light blink exercises and hard blink exercises. Light blink exercises don't squeeze your eyelids strongly rather they are done to ensure that your eyelids mutually touch each other (with a gentle force of one eyelid margin over the other) everywhere and this primarily trains your eyelid muscles to perform a complete blink. On the other hand hard blink exercises involve squeezing your eyelids as hard as you can and the purpose is to generate enough pressure (greater than 3 psi) over the meibomian glands using the riolan and orbicularis muscles of your eyelids to push the lipids forward through the central duct of the meibomian glands. So hard blink exercises are basically done to milk the glands.

If you are doing blink exercises too often then make sure you do light blink exercises during the waking hours. If you do hard blink exercises too often it would actually drain the lipids out of your glands in a short time and if you already have sluggishly functioning glands they won't be able to replenish the lipids in quick time. So the result would be after sometime (following hard blink exercises) your glands would be having a shortage of lipids and your LLT will drop starting the cascade of inflammation.

Dr. Korb's study shows once the meibomian glands (healthy ones) are fully emptied of their contents it takes 2.2 hours on an average to partially recover the maximum amount of lipids that the glands can hold. Also since all the glands don't synthesize lipids together (they work in shifts) MGD sufferers are less likely to benefit from hard blink exercises too often particularly during the waking hours.

My advice : Do light blink exercises every 30 minutes.
Do the hard blink exercises before bedtime to empty the glands. A night's sleep will give enough time for the glands to recover fully their reservoirs.

To be honest, I'm intrigued by the results of multiple Lipiflow treatments... I do believe it does a superior job of heating the glands than even Blephasteam can do. However, it's very costly... additionally, in my case, my eyes are so incredibly sensitive that I worry about having something like that on my eyes for the procedure causing MORE inflammation afterwards due to over-irritation of my sensitive nerves in the region.

If I were to try Lipiflow, due to my over-sensitive nerve issues, I'd only do it if my eyes were fairly calm already AND if I'd be able to use steroid drops for a day or two after the procedure to cancel out any inflammation caused by having the device on my eye.

My doctor recommended me 10 days of loteprednol etabonate use to counter inflammation of the ocular surface following an array of tests and procedures that included schirmer's, TBUT, a saline wash of my eyes and IPL.

So your concern of canceling the inflammation following lipiflow is quite justified. If you don't control the inflammation aggressively post lipiflow it will reblock your glands making the procedure ineffective.

The cost is a downside of lipiflow.

Have you tried IPL?

[Milo007]

SAAG

These are my latest lipiview reports.

What do you reckon of my glands?

My doctor says everything "seems" alright but my LLT is still below 100 nm.

[Guest]

Other, more invasive stuff would require careful consideration and thought).

[Milo007]

re: blink exercises

Right now, I'm doing them much the way Dr. Korb (I think it was him) demonstrated in a video presentation I watched: I gently close my eyes... take a moment to ensure the lids are fully closed (not squeezing them, only concentrating on the feel of the lids making contact across the their entire width)... then I gently squeeze 4 times (and I concentrate when I do this, paying attention to ensure I am squeezing across the entire width of my eyelids)... then I open my eyes. Regarding the degree of gentle squeeze... if I put my index finger on the skin beside the outside corner of each eye (over the orbital bone), I can barely feel the skin moving when I do the squeezes... so it's very gentle.

I am on it! This is a nice protocol specially the four consecutive "gentle" squeezes. It feels much easier on my eye muscles than a hard squeeze. If I squeeze even slightly hard my right upper eyelid develops blepharospasms. I will continue with this protocol.

It shows that the majority of your blinks are only partials... so if I were you, I'd continue doing blinking exercises in an effort to improve that ratio since my understanding is that more complete blinks = better.

Two of my doctors told me the same thing. The only thing they found that was wrong with my eyes is partial blinks. But even then I believe inflammation and the formation of the cappings have a large role to play.

Regarding your LLT numbers, this article discusses that a bit: https://www.reviewofophthalmology.co...by-the-numbers

Signs and symptoms don't always match though... so personally, if I had those Lipiview results, but still had symptoms, I'd be thinking it can't hurt to continue to do whatever I can to improve my MG function (within reason... for example, warm compresses or Blephasteam... other, more invasive stuff would require careful consideration and thought) and also work on blinking exercises to get more complete blinks.

That's an informative article. Thanks for sharing it!

You are so right! We should score our progress based on improvements in symptoms not statistical data. The SPEED score seems more relevant than test results in this regard.

I think I will resume warm compresses with a tolerable temperature this time. Last time I got it horribly wrong and it caused more inflammation instead.

[Guest]

SAAG Milo007 Do you know if there are any sideeffects to taping eyes? Thank you for sharing the info.

I was getting corneal edema and subsequently had blurry vision every morning I woke up. My glare got worse. It felt like I was causing this rubbing by taking my eyes so tight. I knew it wasn’t good but the alternative was worse. So yeah, if you can apply the tape gently enough as to avoid pressure on the cornea, but tightly enough to keep the lid closed, you’re good. Easier said than done sadly.

[Meibum Ian]

Two of my doctors told me the same thing. The only thing they found that was wrong with my eyes is partial blinks. But even then I believe inflammation and the formation of the cappings have a large role to play.

Interesting. Do you think the cappings themselves are preventing correct blinks?

[Milo007]

Interesting. Do you think the cappings themselves are preventing correct blinks?

No but the cappings are blocking lipid flow directly. When I puncture the cappings using a needle I can see lipids exploding out and my symptoms are alleviated almost immediately.

Unfortunately the cappings reform in hours. Also volume of lipid secretions vary day by day sometimes hour by hour possibly due to varying degrees of inflammation.

[Dryinvancity]

hehe Meibomian gland nerds unite! :-D

I've found it useful to do this and think everyone who deals with MGD should monitor their own glands because it really helps you learn what's working, and what's not. You start to notice trends over time that are very useful when deciding how to handle your eyes.

And for anyone else reading this, please note that I'm not suggesting this as a substitute for your doctor monitoring them... only as an additional thing to do so you have additional data points to consider when thinking about the impact of various treatments/lifestyle changes on your MG's.



Absolutely. Doing whatever we can to lower overall ocular inflammation can help the glands do better.



I'm strongly considering it... it costs 65 CAD, so not too bad. I'd like the objective data it can provide me, particularly in regards to the length of my glands, so I can monitor over time if what I'm doing is slowing/stopping decline, or even causing them to lengthen again (there are some reports, for example, that with treatments such as probing and Lipiflow that the glands have grown LONGER, whereas previously this was thought to be impossible... makes me wonder if it's possible for someone with mild truncation and glands that overall are capable of functioning decently to cause truncated glands to lengthen over time with simple treatments such as Blephasteam goggles and insane amounts of blinking exercises... )



To be honest, I'm intrigued by the results of multiple Lipiflow treatments... I do believe it does a superior job of heating the glands than even Blephasteam can do. However, it's very costly... additionally, in my case, my eyes are so incredibly sensitive that I worry about having something like that on my eyes for the procedure causing MORE inflammation afterwards due to over-irritation of my sensitive nerves in the region.

If I were to try Lipiflow, due to my over-sensitive nerve issues, I'd only do it if my eyes were fairly calm already AND if I'd be able to use steroid drops for a day or two after the procedure to cancel out any inflammation caused by having the device on my eye.

May I know where in Canada lipiview is $65? I was quoted $180 I’m Vancouver. thanks

[Guest]

May I know where in Canada lipiview is $65? I was quoted $180 Im Vancouver. thanks

Yeah $65 is a good price!

[Topher3]

@milo117 you gotta be pretty happy with that lipiview scan your top glands are pretty much perfect, very little loss. You do have some tortuosity but that’s expected with the small amount of atrophy you have. Your bottom glands do appear to have more atrophy, that’s expected however as the top ones don’t atrophy as much as bottom usually. If you can get those top glands free of blockage there’s no reason you can’t feel normal again. There’s not enough damage for you to hopeless. Great news.

[Milo007]

Is 100 normal is that what they say? What is usually required to be like a base for comfort? Your symptoms that you describe are very severe and Do not in anyways correlate with the images you have shown unless 90% of glands in each eyelid is blocked? This is of course assuming you aqueous later is normal.

What is your aqueous layer? Has it been compromised since the lasik surgery you had? As most know the aqueous layer is 90% of our eye 5% mucin and 5% oily lipids. IF the 90% is compromised harshly I can see how you could be having your symptoms even with the amount of glands you have. Your glands do look good especially in your top lids so I can’t really see how partial blinking is a problem.

Is this post meant for SAAG ?

[Topher3]

Is this post meant for SAAG ?

SAAG I thought it was her lipiview results yeah sorry

[Milo007]

SAAG I thought it was her lipiview results yeah sorry

Lol... It happens. I think SAAG is going to have her lipiview results soon!

[Milo007]

@milo117 you gotta be pretty happy with that lipiview scan your top glands are pretty much perfect, very little loss. You do have some tortuosity but that’s expected with the small amount of atrophy you have. Your bottom glands do appear to have more atrophy, that’s expected however as the top ones don’t atrophy as much as bottom usually. If you can get those top glands free of blockage there’s no reason you can’t feel normal again. There’s not enough damage for you to hopeless. Great news.

It's very interesting when you say my lower glands have more atrophy. I don't exactly know how atrophied acini look like in a meibography. I always though dark areas represent part of the glands that have atrophied. I might be wrong. Do you notice structural changes in the meibomian glands of my lower eyelids that indicate atrophy/damage?

Can you mark the areas of atrophy editing my pictures?

I am always trying to infer what the hell is wrong with my glands. The orifices do get blocked by cappings everyday and the volume of secretions is sometimes copious and sometimes low. Only thing I haven't paid much attention to yet is demodex infestation of my eyelashes and possibly meibomian glands. Waiting for the tea tree oil to arrive from US to commence my demodex protocol.