Significant Improvement -- Sharing My Treatment Protocol

[deep_dry_eye]

Background, I've had severe MGD where I was bedridden for more than a year. I now have significant improvement in my case. I wish to share here my treatment protocol, and hope others can have success. I've visited 10+ different optometrists/opthamologists doctors, some even Harvard educated, most of them were useless -- I can not emphasize the importance of finding a true dry eye expert.

This is my current treatment regimen:

• IPL, monthly. My IPL protocol follows Dr Laura Periman, who does the upper and lowers. I do notice a small improvement from Toyo's protocol who only does the lowers. I also firmly believe for my case that continuous IPL helps me, rather than some patients who only need 4-6 sessions. Of course, every patient is different.
• Xiidra, I am on Xiidra twice a day.
• Restasis, I am on Restasis twice a day.
• Omega 3, I am on high quality DHA+EPA Omega 3s. Nordic Naturals is a good brand.
• GLA, I am on HydroEye (4 pills a day).
• Blinking exercises, I cannot stress the importance of this, I literally do thousands everyday of conscience full blinks. Use computer? Watch netflix? Literally, consciously blink after 3 seconds.

I do not think 1 treatment has helped me, but a combination of *all* the treatments together has helped me.

The results over a 6-9 month period:

• I went from having persistent SLK, to minimal traces.
• I am back to work full time, using the computer 10+ hrs a day.
• My life is by no meals normal, but I am functional -- I no longer have that terrible light sensitivity and constant foreign body sensation.
• My glands have good output, and latest meibography continue to show structural improvement. While I don't claim tissue growth, when I look at the scans, I can definitely see healthier glands, less inflammation, and the terminals look healthier.

Things that I've tried that I think helps, but don't do anymore:

• Multiple rounds of LipiFlow, I still think at least 1 round of LipiFlow can be helpful.
• I used to do 10+ times of warm compress a day, however, I've stopped now as I believe it brings on my inflammation.
• Serum tears never worked for me.
• Azithromycin (oral or topical) is still one of the best drugs ever, even better than steriods. I recommend every1 to give this drug at least a shot first, its really good at flushing out the glands. However, I've stopped since its incompatible with IPL and Azyter (topical Azithromycin) is not available in my country.
• Doxy is effective, but less so as Azithromycin. I've stopped since its incompatible with IPL.
• Steroids, steroids are very effective, but there are dangers and risks to steroids. I try and avoid steroids as much as possible.

Feel free to ask any questions, good luck all!

[MGD1701]

Great to hear, congratulations, thanks for sharing. If possible, keen to know/learn:

What do you mean Az Azithromycin & doxy are its incompatible with IPL?

IPL: Periman's and Toyos's are not the same brand? I thought they are the same??

What are your likely gland loss %, your TBUT and staining before and now?

Do you have water issue too?

Inflammation: what kind do you have? bacteria, demodex? IPL works for both, right?

Lid hygiene: do you do it? what products?

BlephEx: you also do it monthly, prior to IPL, as you mentioned before, right?

Thank you.

[deep_dry_eye]

Great to hear, congratulations, thanks for sharing. If possible, keen to know/learn:

What do you mean Az Azithromycin & doxy are its incompatible with IPL?

Doxy and to a lesser extent, Azithromycin are phototoxic. i.e., they react to sunlight. Most drs will not perform IPL if you are on either of these drugs.

IPL: Periman's and Toyos's are not the same brand? I thought they are the same??

No, unlike LipiFlow, every IPL protocol from every doctor is different. It's more of an art rather than science. i.e., the dr will look at your skin type, and then determine intensity of the pulsations. Just like it is important to find a dry eye expert, it's important to find an IPL expert.

What are your likely gland loss %, your TBUT and staining before and now?

I have moderate gland loss. My TBUT at its slowest was 3s, with pretty bad staining. Last checkup, TBUT was 10s with no staining. However, TBUT and staining has high variance, so don't put too much weight on it.

Do you have water issue too?

I do not have aqueous problems if thats what you are referring to.

Inflammation: what kind do you have? bacteria, demodex? IPL works for both, right?

Inflammation is such a loose term, IPL has the theorized effect of reducing inflammation. The exact mechanism is unknown. The exact cause is unknown.

Lid hygiene: do you do it? what products?

I tried it before, but my lid margins are clean so I stopped. I used to use Claridex and OcuSOFT.

BlephEx: you also do it monthly, prior to IPL, as you mentioned before, right?

Thank you.

My previous IPL dr gave me free BlephEx every visit. But like I said, my lid margins are clean, so I did not benefit. I also personally think BlephEx is useless, at least for me.

[MGD1701]

Thanks for quick answers.

LipiFlow - Did you try LipiFlow, if so, did it help you? How do you compare it with IPL?

IPL
Did your doctor express glands after IPL session?

TBUT I have read, non-invasive is reliable.

Thank you again.

[deep_dry_eye]

Thanks for quick answers.

LipiFlow - Did you try LipiFlow, if so, did it help you? How do you compare it with IPL?

Yes -- something like 4 times. I would say it helped a bit, but I do believe IPL is more effective. I would definitely give at least 1 LipiFlow round to clear any obstructions inside the glands.

IPL
Did your doctor express glands after IPL session?

First dr did not , 2nd dr did.

TBUT I have read, non-invasive is reliable.

It has high variance in the sense that there is high variance of the disease. i.e., different times of days, there's good days and bad days.

[Topher3]

In regards to eye redness have you seen a reduction as the test break up time has increased? And I’m so happy for you it’s working out! I could only dream of that.

also how long were you suffering in total before this aggressive approach was taken?

[deep_dry_eye]

In regards to eye redness have you seen a reduction as the test break up time has increased? And I’m so happy for you it’s working out! I could only dream of that.

also how long were you suffering in total before this aggressive approach was taken?

Yes -- as my eyes improved , my redness has slowly improved as well.

I suffered for more than 1 yr before I had proper treatment. I probably had another yr of average treatment before this more aggressive approach.

[Topher3]

Are you talking in regards to a red haze or have you actually seen a reduction in the veins as your body is now able to produce the nutrients from the lipids to nourish the eye?

[Alix]

Thank you for sharing really pleased for you!

[MGD1701]

Thank you again.

Great to know IPL ''without'' expression still worked for you.
Did you feel difference/relief ''right after'' IPL session without expression?

[Milo007]

Thanks for sharing your success story deep_dry_eye

The best part is you are back to work full time with 10+ hours a day in front of a computer from being bed ridden for a year!

This is truly inspiring.

[deep_dry_eye]

Thank you again.

Great to know IPL ''without'' expression still worked for you.
Did you feel difference/relief ''right after'' IPL session without expression?

I find immediate relief after manual expression but not from the IPLs (without expression).

In my initial sessions of IPL, I felt no difference. In my latter sessions, I felt small improvements -- i.e., the stickiness of my blinks. Even without expression, my later rounds I felt small difference. My 2nd IPL dr says he does expression for diagnostic purposes (i.e., to determine the energy setting of next round of IPL), but there might be a therapeutic component to it as well.

[deep_dry_eye]

Are you talking in regards to a red haze or have you actually seen a reduction in the veins as your body is now able to produce the nutrients from the lipids to nourish the eye?

Small reduction in red veins on eyes.

[MGD1701]

Your 2nd IPL doctor is impressive, he cares for results - by expressing glands for diagnostic purposes - smart approach.

[Guest]

Great news! Very happy for you! Where do you purchase the HydroEyes as it’s not available in Canada? Thanks!