going to a private clinic, what to ask for?

[quattroboy]

Are you sure tear production is your issue? Would be unusual at your age. Not unheard of if linked with an autoimmune issue.

Doxy is used to reduce inflammation associated with MGD and bletharitis but there are more effective azyter both orally and topically but again mainly for MGD.

In terms of ikervis it can help tear production but it's success rate is very low around 15 to 25 % depending on which clinical trial you study.

[orange86]

I went to Optimax last weekend (dry eye centre) and the ophmalogist tested my eyes:

Schirmer's test:
Left eye: 4
Right eye: 5

So i have aqueous deficiency.

meibomian gland exam: left and right eye glands are blocked. Left more severe.

She recommended i see the surgeon and go for the MiBo treatment however its on the 13th Jan which is too long to wait as im in pain.

She said it's quite severe dry eye for someone my age.

[quattroboy]

I would agree, however I'm similar thanks to lasik.

What broke the back of my MGD and bleth was probing followed by Lippiflow, but the glands on my top lids have reblocked due to bad oils. MGD and bleth seem to come down to inflammation, bacteria and demodex. Best treat all three. Both internally and externally. Diet and supplements are important reduce inflammation causing foods, sugar, diary and gluten. Use tea tree products to kill the demodex and Manuka honey to help with inflammation and bacteria.

Blethex can help remove the biofilm on your lids but I found it to be very temporary solution.

Hot compresses are a double edge sword because heat can add to the inflammation. But also help melt the oils.

i had no success with ikervis but I've imported xiidra from Canada, seeing how I go.

I've got punctual plugs, three currently lost one.

In terms of treating the MGD and bleth it takes time and I mean months. But again I strongly recommend Manuka honey gel on the lids three times a day and the drops twice a day.

[quattroboy]

For advice on bletharitis and MGD join https://www.facebook.com/groups/455149017841336/

[quattroboy]

My docs thoughts on bletharitis MGD treatment https://www.thebestsense.com/blephar...walker-regimen

[orange86]

Hi Folks,

I went to BBR Tear clinic in Hereford yesterday.

Assessment:
Using the Lipiview machine they could see my LLT (Lipid Layer Thickness) 54nm in left eye and 73nm in right eye. (60nm or less and 90% chance of MGD, 60nm or higher = 50% chance of MGD).
They also did a Lipiview meibography, all my glands are present bar one big gland where i had a stye drained a few years ago and that is no longer there. The consultant said some of my glands are short and stumpy and some are not straight lined. So MGD is progressing.

She also did a Tear osmolarity (tear saltiness), one eye was worse than the other which probably wasn't a surprise. The worse eye was outside of the normal limits of healthy osmolarity.

Afterwards a dye was added to my eyes and i think she observed under the slit lamp my tear film (tear break up and dry spots). She noted i had minor blepharitis in my left eye.

She confirmed what i knew before that i have combined MGD and Aqueous Deficiency.

Treatment
MSD:
I took the BlephEx, Lipiflow and E-eye (IPL) treatment straight after the assessment.
I will have 3-4 follow up sessions for the E-eye (consultant said the E-eye treatment jump starts the meibomian glands).

Aqueous Deficiency:
This is harder to treat. She wants me to initially go on Ikervis to treat the inflammation . The problem is she cant write a prescription for this drug. She will write a letter to both the local NHS clinic i went to and also the eye hospital (where i'm still waiting for an appointment!) to request they put me on ikervis. I will probably have to chase the clinic and eye hospital up ASAP to try and get this drug. I need some relief now.

I mentioned Azyter and Doxy but she said she wants to do the treatment in a order and see if my eyes respond to the ikervis first. Also punctual plugs was mentioned but inflammation needs to be controlled first.
She also mentioned i might have sjogren's syndrome.

The drive to the clinic was 3 hours each way, my eyes were tired and hurting when i got back home, especially after driving in the dark!

Does Ikervis improve the tear film quality and break up time?
As it's immune suppressing it reduces the inflammation on the lacrimal glands in order for it to regenerate and work again?

[gilles]

Hi Folks,

I went to BBR Tear clinic in Hereford yesterday.

Assessment:
Using the Lipiview machine they could see my LLT (Lipid Layer Thickness) 54nm in left eye and 73nm in right eye. (60nm or less and 90% chance of MGD, 60nm or higher = 50% chance of MGD).
They also did a Lipiview meibography, all my glands are present bar one big gland where i had a stye drained a few years ago and that is no longer there. The consultant said some of my glands are short and stumpy and some are not straight lined. So MGD is progressing.

She also did a Tear osmolarity (tear saltiness), one eye was worse than the other which probably wasn't a surprise. The worse eye was outside of the normal limits of healthy osmolarity.

Afterwards a dye was added to my eyes and i think she observed under the slit lamp my tear film (tear break up and dry spots). She noted i had minor blepharitis in my left eye.

She confirmed what i knew before that i have combined MGD and Aqueous Deficiency.

Treatment
MSD:
I took the BlephEx, Lipiflow and E-eye (IPL) treatment straight after the assessment.
I will have 3-4 follow up sessions for the E-eye (consultant said the E-eye treatment jump starts the meibomian glands).

Aqueous Deficiency:
This is harder to treat. She wants me to initially go on Ikervis to treat the inflammation . The problem is she cant write a prescription for this drug. She will write a letter to both the local NHS clinic i went to and also the eye hospital (where i'm still waiting for an appointment!) to request they put me on ikervis. I will probably have to chase the clinic and eye hospital up ASAP to try and get this drug. I need some relief now.

I mentioned Azyter and Doxy but she said she wants to do the treatment in a order and see if my eyes respond to the ikervis first. Also punctual plugs was mentioned but inflammation needs to be controlled first.
She also mentioned i might have sjogren's syndrome.

The drive to the clinic was 3 hours each way, my eyes were tired and hurting when i got back home, especially after driving in the dark!

Does Ikervis improve the tear film quality and break up time?
As it's immune suppressing it reduces the inflammation on the lacrimal glands in order for it to regenerate and work again?

Blephex (Blephasol) and warmth treatment made my inflammation a bit worse.
she mentioned you "might have sjogren's syndrome", I think it is pretty clear after a test (with these paper-looking things in your eyes with closed eyes for 1 minute) if you have enough tears or not. Atleast that's what my doctor told me.

I haven't tried IPL nor Lipiflow, so please keep us updated for progress on that matter.
I use cyclosporine eyedrops (made via a sterile labrotatory at the clinic I'm visiting), it's kind of the same as Restasis or Ikervis, just 0.05% CsA supplemented with e.g. Isoptotears (with Restatis it's castor oil, if I am not mistaking). I've been using it for over 2 months now (it works quite slow).

You are mentioning your eyes are tired and hurting when going back home and earlier you mentioned the daily (computer) screen use, that's kind of my complaints too. And certainly strong light when it's dark. I've been using some glasses now for a week and noticed the inflammation reaction I get when using a screen or when it gets dark is less apparent. I used to feel my upper eyelids getting warmer and eyes getting tired in a matter of minutes at these specific moments. So maybe your eyes (eyesight specificly) might be a factor too. Once they are tired or the eyesight is bad you tend to squeeze your eyes and they have a harder time focussing (once they try to focus, you don't blink that regularly as you need to).
Just could try to take that into account too!

[orange86]

For anyone in the UK, how long has it taken to get an appointment to see an eye doctor at the NHS hospital?
It's 3 weeks since i was referred to the eye hospital but still no appointment letter !

The tear eye clinic (BBR) have recommend i use Ikervis however im still waiting on the confirmation letter for my hospital appointment. At this rate, i'll have to go a private eye doctor to ask for meds!

[LindaDawn]

. I think you will get your appointment through in the next week or so, working on the premise that 4 weeks is enough time to have a referral allocated to a clinic. If not then I would ring your hospital or get your go to follow it up for you. Are you going to get a rheumatology appointment too to check if you have sjogren,s? Your go should be able to arrange this, although there will probably be a wait for that too.

[Alix]

I live in London, and my first appointment at NHS Moorfields was about 2 months after being referred by my GP. The NHS have very strict guidelines when it comes to prescribing Ikervis as it is really expensive. If you have Srogrens though they will give it to you.

[orange86]

I saw a consultant at a private hospital the other day hoping to get ikveris..

He examined my eyes and noticed:
- My tear break up time is approx 3 seconds. He said a normal person would have 10 seconds.
- Couldn't see breaks/ spots on my eyes to suggest damage has occurred.
- Press on my eye lids and said some oil is flowing. (LipiFlow and IPL has helped although i know that not all of the glands are easily expressing oil just yet).

He suggested that i keep to my current schedule:
- Fish oils daily
- Warm compress with expressing eye lid massage after
- Use of Thealoz Duo Gel at least 5x a day.
- Use Vita-POS during day time.

The only addition he has suggested is:
- Hylo Dual, use every 2 hours.

At this point i told him i've tried 7-8 different eye drops and they drain away and im in discomfort again after 10 minutes, why would Hylo Dual be any different?

I mentioned that the consultant who treated me with LipiFlow and IPL suggested i get on Ikervis.
He said that he wants me to continue with the above regime along with Hylo Dual and to come back in 3 weeks for a follow up appointment, potentially look at punctual plugs and maybe ikervis.

I did say that i have dry mouth, dry skin and currently under tests by the local dental institute (bloods taken and salivary glands ultrasound to be taken), potential Sjögren's syndrome. He said that would inform him of the dry eye treatment in the future. but currently doesn't automatically assume the MGD and LGD is auto immune.

He wants me back in 3 weeks, but it was close to £200 for the appointment (scandalous like LipiFlow lol) i've also received my hospital appointment which is mid Feb for my ophthalmology outpatient visit. I will take ALL my eye drops, stress my issues about being tested for Sjögren's syndrome as i have the symptoms and the pain i suffer each day.

So not the outcome i had hoped for.

[Guest]

Make sure doctors treat your inflammation which presents regardless of water or oil issues.
Perhaps good to check corneal nerve/sensentativity due to your pain?

[rm14dp]

Hello orange86. I have had dry eye MGD since 2011. Like yourself, used a number of eye drops, latest Thealoz Duo Theoloz Gel and Emustil. Treated with Doxycycline oral, Azyter drops etc etc. I was being treated and reviewed at my local hospital eye clinic , and they prescribe the drops etc on NHS prescription. It has become more severe in the last few weeks tear break up time one second. An NHS hospital near by with an eye clinic also offers an " eye casualty" immediately seen clinic. The pain was so bad I went there and I was booked into see a different NHS consultant in my usual eye clinic the following week. This consultant has taken a different approach I am now on Ikervis, NHS prescription, have been referred to a Rheumatologist, to investigate Sjogrens as I have other symptoms. Don't give up on the NHS its just a case of getting into the right eye clinic with the right eye consultant who specialises in dry eye MGD not all of them do. I was lucky this time, but its taken me a long time. if you can find a local hospital with an "eye casualty" unit or via A&E to an eye clinic that may help you. I too tried the private route but just too expensive. Hope it works out for you

[orange86]

quick update: i've been using Optimel honey eye gel for over a week. It's helping with the soreness and pain, especially at work sat at the computer all day. Redness is still present though. I might stop taking it a day before my eye hospital visit to try and put my eyes back to their base dry state

[LindaDawn]

Thank you for posting about Optimal honey gel. Does it sting at all? I am so frightened of trying anything new these days. Please let us know how yr appt goes.