Dr. Latkany

[Eli]

Hi all,
I just wanted to mention that I went to see Dr. Robert Latkany today in New York City for a consultation. I thought you guys would like a report. Firstly, his office is beautiful and spacious. Dr. Latkany himself is very kind and generous with his time. He actually showed me how to do a proper lid massage with q-tips, and then even watched me do it to myself in a mirror to make sure I would do it right at home. He also expressed my meibomian glands which many of you have asked about doing. I can tell you that it is not as much as fun as going to the movies (i.e. a little uncomfortable) but it definately works. Afterwards, you blink a few times an can feel this nice slick feeling on your eyes. Ahh!! to feel normal if for only but a moment. (A little disclaimer: the ammount of meibum that flows from the gland after an expression is really not visible without significant magnification, so if you're trying this at home don't expect to see anything come out.). Anyway, if you are within reasonable traveling distance from either New York City or White Plains, I would highly reccomend that you visit Dr. Latkany. He is a very patient and knowledgable doctor who has seen a lot of dry eyes and can probably help you with yours.

[Julie1]

Hi Eli,

I'm glad that you had a good experience with Dr. Latkany.
How did he tell you to clean your eyelids? Did he show you how to express your glands or is it something that is not to be tried at home?
Did he have any other suggestions or advice?

Thanks, Julie

[Eli]

More Dr. Latkany

Hi Julie,
Actually, yes, meibomian gland expression is possible to do at home. And according to Dr. Latkany, its a very vital part of the eyelid regimen for those afflicted with MGD. I'm going to paste in a description of how to do it that I sent to another member earlier: "I went to see Dr. Latkany (yeah, the same one that does the Q&A forum) today. He expressed all of my lower glands (which does kind of hurt a little ) and told me that although they were clogged up that they were all still patent (meaning open) and therefore I would be able to improve my situation. Dr. Latkany said that it is crtitical that people with Blepharitis/MGD are trained in how to properly maintain their eyelids. He told me that practically no one that walks through his door is doing it right until he shows them how. His upcoming book is going to illustrate it, apparently, but the basic idea is this: after a warm compress, 2 or 3 minutes, you place a finger on the outside corner of your eyelids and gently pull toward your ear, tightening your lower lid. Then, take a moist q-tip and press the lower lid against your eye-the white part- (apprently you can push pretty hard) Start in one corner and work your way towards the other. You aren't dragging the q-tip, but pressing firmly in one spot, lifting it, moving over slightly, pressing etc. The trick is to press in the right spot so that it encourages the glands to expel their meibum. You aren't trying to do lid rolls. For me, he said I was doing it right when I was pressing just barely below my eyelashes. You don't want to go too high cause then the q-tip kind of slides up over the lid into your eye,(ouch) and if you go to low, the lid just sort of rolls over. When you are done, you pull your lower lid away from your eye, then take the q-tip and wipe your lid margin clean. Dr. Latkany did it to me while looking through that microscope thing, and he said he was able to get every gland to pop open and expel whatever was stuck in it. (The same thing with the q-tip as described above) You have to do this twice a day for at least a month probably to help encourage the glands to resume their normal function-if nothing else it will definately clear out all of that junk that gets stuck in there. Dr. Latkany was very enthusiastic about the potential benefits of doing this. I wish he could personally show you how to do it. he was very patient with me, showing me how to do it to myself looking in a mirror. The good thing is once you learn how to do it right, it will probably help you!
I should point out however, that my description really isn't a good substitute for him (or someone like him) actually showing you how to properly get the job done. I mention it mostly to inform readers that there are some good techniques available to help you manage your condition.

[np1981]

Yes a diagram would help.

[Judy]

Hi Eli,

Can you describe where exactly the "lid margin" is? Thanks for your detailed description!

Judy

[Eli]

Lid margin

Hi!
The lid margin in the flat surface of your eyelid where the meibomian gland ducts are located, just above (On the lower eyelid) your eyelashes. Only the inside edge contacts your eye. When you blink, or just shut your eyes, the two (upper and lower) lid margins meet. For people with normally functioning meibomian glands, that small brief pressure from a blink is enough to cause meibum to be secreted and subsequently spread across the tear film. Basically, wiping the lid margins after expressing the glands just clears away all of the goop that hopefully you got to come out. Before your wipe them, pull your lower lid away from your eye with a finger so you don't scrape your cornea with the q-tip. I get a little nervous describing this because don't want anyone to hurt themselves. Just remember, you are NOT wiping the inside of your eyelid! Just that little flat strip on your lower eyelid.
As far as the upper lids go, with your eye closed, you can apply pressure around your eylashes, but he didn't say anything about wiping the upper lid margin. It would be pretty hard to do at home without flipping the lid over.
Hope that helped.

[Julie1]

Eli,

Thanks for posting a very thorough description of how to do meibomian gland expression. I tried it tonight, and I think I could feel a smooth layer of oil on my eyes. My eyes definitely did not burn!! I will continue doing the expressions 2x/day. I'm really glad that you had a good experience with Dr. Latkany -- I am impressed that he actually showed you how to do the massage as most doctors would not have done so!

I hope you continue to feel better!

-Julie

[Judy]

Hi Eli,

Thank you so much for your detailed descriptions. I will feel very comfortable trying to express my meibomian glands. We had company this weekend or I would have started right away... You should write technical manuals!! Anyway, God Bless and have a wonderful day!

[Eli]

Good Luck

Thank you for the compliment Judy-you know it's funny-I almost took a course on technical manual writing just for fun once. I guess I don't have to!
I wish you success with your eyes and hope you find relief with all my heart.
God Bless you too!
Just be careful around your eyes with those q-tips! Poking your cornea, while probably harmless can still be pretty uncomfortable. Guess how I know that!
Best of luck
Eli

[blueeyes]

Eli,
Thanks for that detailed explanation. I have been to five eye doctors and not one ever showed me or told me to massage my lids or express the glands. I have learned from reading and now from this sight. I have started to very carefully do as you described. Please let us know after a month how this has helped you.
Terri

[buntbean]

I've been to Boston to see 3 different eye doctors and not 1 of them suggested massage, or expressions only warm compresses and doxycycline. Thank you for the information.