Schirmer Test and glands are fine but lipid layer thin

[TARYN]

Hi Jack. It is probably better you ask a doctor that question. All I know is that I had burning, redness and inflammation. I went to several dry eye specialists and finally ended up flying to Miami (only a 2 hour flight from Washington DC) Dr Tseng said I had a loose conjunctiva and pingueculas which weren't allowing my tears to spread evenly over my ocular surface. The burning stopped immediately after the surgery. Then I had 3 weeks of healing and my eyes were clear and white. I would guess scar tissue causes all kinds of problems. I know you need a smooth ocular surface.

[jack1988]

Hi Jack. It is probably better you ask a doctor that question. All I know is that I had burning, redness and inflammation. I went to several dry eye specialists and finally ended up flying to Miami (only a 2 hour flight from Washington DC) Dr Tseng said I had a loose conjunctiva and pingueculas which weren't allowing my tears to spread evenly over my ocular surface. The burning stopped immediately after the surgery. Then I had 3 weeks of healing and my eyes were clear and white. I would guess scar tissue causes all kinds of problems. I know you need a smooth ocular surface.

did none of the other dry eye doctors notice you had loose conjunctiva?

[TARYN]

I went to the top specialist at Johns Hopkins and other respected corneal/dry eye doctors and no one else mentioned it. Dr Tseng did not think the loose conjunctiva was severe but since it was causing constant burning and redness, I decided to try the surgery. I think the procedure took less than 1/2 hour. No pain at all. It has made such a difference in my quality of life. I used to think about my eyes constantly. Hopefully you can get some answers from your doctor or maybe get in touch with Dr Tseng to see if he can recommend some doctor near you.
Last year I had the same procedure (conjunctivoplasty and amniotic membrane) to get rid of the pingueculas because they were causing redness. I had the same great result.
Good luck. Hopefully you can get this resolved. I would assume the doctor that did your strabismus surgery probably had other patients who developed scar tissue and dry eye. Is he being helpful?

[jack1988]

Been to the doctor, he said my scar is flat and have no conjunctival chalasis. The doctor did say my glands aren't blocked but the oil is slightly milky. He has told me to try Doxy, warm compress and eyelid hygiene

[TARYN]

Hi Jack, Good news everything healed well. Hopefully you will find ways to make your symptoms better. I tried compresses, probing, IPL and eyedrops. None of those things worked. Cold compresses and Patanol and cleaning my lids with Theralid did help but it only gave temporary relief from burning and redness. For me the conjunctivoplasty with amniotic membrane transplantation really helped me.
Good luck with the compresses and lid hygiene. Hopefully things will get better.

[jack1988]

Hi Jack, Good news everything healed well. Hopefully you will find ways to make your symptoms better. I tried compresses, probing, IPL and eyedrops. None of those things worked. Cold compresses and Patanol and cleaning my lids with Theralid did help but it only gave temporary relief from burning and redness. For me the conjunctivoplasty with amniotic membrane transplantation really helped me.
Good luck with the compresses and lid hygiene. Hopefully things will get better.

Cold compress?? how does that melt the oils? do they not clog up if you cold compress?

[TARYN]

Warm compresses and steaming the lids will open up the glands so that is helpful if you have blocked glands/MGD. I have allergies so Patanol followed by a cold compress is very soothing.
If you have both MGD and allergies then possibly a combination of warm compresses to open up the glands and if the warm compresses cause inflammation, then following it with a cold compress will calm things down. Everyone is so different. You just need to find something that works.

[jack1988]

Warm compresses and steaming the lids will open up the glands so that is helpful if you have blocked glands/MGD. I have allergies so Patanol followed by a cold compress is very soothing.
If you have both MGD and allergies then possibly a combination of warm compresses to open up the glands and if the warm compresses cause inflammation, then following it with a cold compress will calm things down. Everyone is so different. You just need to find something that works.

I use Cromoglycate. I guess that is similar to Patanol.

do your glands never get blocked?

[TARYN]

Warm compresses and steaming the lids will open up the glands so that is helpful if you have blocked glands/MGD. I have allergies so Patanol followed by a cold compress is very soothing.
If you have both MGD and allergies then possibly a combination of warm compresses to open up the glands and if the warm compresses cause inflammation, then following it with a cold compress will calm things down. Everyone is so different. You just need to find something that works.

[TARYN]

Sorry the previous reply posted again.
Hi Jack, My eyes are in pretty good shape now. When I first started having problems with my eyes, I was told to do warm compresses to help loosen and liquify the oils. Unfortunately that irritated both my eyelids and eyes by creating inflammation. Then I was told to use a facial steamer. That worked very well. It loosened the oils without giving me inflammation. I also found that I had an allergic component and started using Patanol followed by a cold compress. That gave me temporary relief. I still had redness and burning in my eyes. I then tried IPL which made my eyes worse. I then found out I had irregularities and pingueculas in my conjunctiva which was preventing my tears from spreading evenly over my ocular surface. The AMT surgery got rid of the redness and burning and has given me the reilef I was looking for.
And to answer your question, my glands are ok now because I use the facial steamer on a regular basis.

[jack1988]

Sorry the previous reply posted again.
Hi Jack, My eyes are in pretty good shape now. When I first started having problems with my eyes, I was told to do warm compresses to help loosen and liquify the oils. Unfortunately that irritated both my eyelids and eyes by creating inflammation. Then I was told to use a facial steamer. That worked very well. It loosened the oils without giving me inflammation. I also found that I had an allergic component and started using Patanol followed by a cold compress. That gave me temporary relief. I still had redness and burning in my eyes. I then tried IPL which made my eyes worse. I then found out I had irregularities and pingueculas in my conjunctiva which was preventing my tears from spreading evenly over my ocular surface. The AMT surgery got rid of the redness and burning and has given me the reilef I was looking for.
And to answer your question, my glands are ok now because I use the facial steamer on a regular basis.

Thanks. Can you link me to a facial steamer? Do you steam and then cold compress?

[TARYN]

Since my eyes and eyelids are good right now I am not on a strict routine, but when I wanted to keep the glands from clogging up, I would use the facial steamer in the morning for as little as 10 minutes or as much as 20 minutes. After that I would put a drop of Patanol followed by a cold compress for 15 minutes. I don't do it everyday, but it is a treat when I do it because it is like an at home facial.
I bought my facial steamer several years ago so they may have better ones now. The one I have is by Conair and the reason I like it is that it heats up to a temperature that gets the job done but doesn't burn my face or eyes. Check out Amazon and if you read the reviews make sure people aren't complaining that the product doesn't get too hot.
This is the one I have and it still works well.

[jack1988]

Since my eyes and eyelids are good right now I am not on a strict routine, but when I wanted to keep the glands from clogging up, I would use the facial steamer in the morning for as little as 10 minutes or as much as 20 minutes. After that I would put a drop of Patanol followed by a cold compress for 15 minutes. I don't do it everyday, but it is a treat when I do it because it is like an at home facial.
I bought my facial steamer several years ago so they may have better ones now. The one I have is by Conair and the reason I like it is that it heats up to a temperature that gets the job done but doesn't burn my face or eyes. Check out Amazon and if you read the reviews make sure people aren't complaining that the product doesn't get too hot.
This is the one I have and it still works well.

Probably a stupid question but why would the heat from the not also cause irritation?

[TARYN]

I felt the steam was a more gentle heat. Maybe it was more diffuse. When it was suggested to me that I use the facial steamer to open up my blocked glands, it made sense because I always felt better after a shower. Meaning If you have allergies or MGB or a stuffy nose....a shower or steam opens everything up. It works for me without the irritation of a warm compress on my skin.

[jack1988]

Schirmer is a test that has high variance, and should have very small clinical significance. A negatve Schirmer test does not imply one does not have dry eyes/MGD.

Yes, your glands can be intact, but produce little oil. You need to find the root cause of the disease, it is most likely inflammation. Good starting points is to do IPL (which can help promote secretions), Xiidra and Reatasis (which can help reduce/control inflammation).

I have IPL on the 10th June!

I hope it helps. I don't have any crusting or anything though, so don't think I have MGD/Blepharitis. I guess we will see.