Diagnostic from Dr. Tseng

[GeorgeT]

Hello,
Two days ago I was seen by Dr. Tseng. There were a lot of pictures that his assistant took using the slit lamp. Dr. Tseng said that some meibomian glands are constipated but saw the oil coming out upon squeezing.
Next test was for demodex mites and came out negative.
Next she did a kinetic of lipid test over the cornea to see how the lipid layer spreads over the cornea. Results were not bad.
Last one was fluorescein test. First test showed a very low baseline, meaning very low tearing. Second one, performed after 10 min was reflex tearing and was good in both eyes because of more tears. Last one was done after another 10 min and I had two cotton swabs inserted in my nose. I was having a serious tearing.
I told him that I am taking doxy which helped me the most by suppressing the excruciating burning pain and also decreased my inflammation in eyelids.
Conclusion:
Low aqueous part but glands are producing tears, they are not shut off. Some meibomian glands are “constipated”.
I was given methylprednisolone (PF) drops for 3 weeks and then to come for a follow up. He expects more tears or more dry. More dry will need upper plugs.
Another follow up will be done for meibomian glands expression. I asked about culture of the lipid from meibomian glands and he agreed.

I was told before that my aqueous part is deficient,but no tests were done.
I don't know much about the steroid that I was given, so I thank you very much for any comments......

Best Regards,

George

[Lucy]

George, it sounds like you are a satisfied patient at this point. The assistant explained what she was doing and why. That's a rare commodity for some eye docs. (Notice I said SOME) I did get a chuckle out of the "constipated" glands, though. Seven years around dry eye information and that's the first time I ever heard the term used on meibomian glands!

Please let us know if/when you have follow up information. Lucy

[YGB]

Hi George - it sounds like you got a good workup at Tseng's office. Tseng also gave me the preservative free steroid to use if needed, but I never used it since I wanted to try a more natural approach.

From the visit, it sounds like your primary problem is aqueous with some meibomian/oil issues as well. It seems like Restasis is a good option to try if you have not tried it yet since it can have a positive effect on the lacrimal gland/water producing gland. It can also help inflammation of the eyelids.

My personal opinion is that expressing "constipated" meibomian glands is likely not the best option for treating meibomian issues. My opinion is based on my thought that warm compresses are a much more natural way of releasing the oil in the glands and can be done daily which is needed to get the glands back to working on their own. Again, this is my opinion and I'm not saying I'm totally against expressing the glands, but I would want to be sure that compresses/omega oil supplements/restasis were not working over a long period of time before turning to "expression" as an alternative treatment.

As for plugs, since you have mostly an aqueous issue, they may help you more than they helped me. Plugs did little for me in terms of comfort. My alternative to plugs was to frequently spray my eyes with "Nature's Tears" until my aqueous level improved. I still use Nature's Tears, but not nearly as often as I used to.

Moisture chamber (mc) glasses/goggles will likely help as much, if not more, than everything noted above (with the possible exception of warm compresses).

IMO, I believe the best course of treatment is mostly natural with the hope that the eyes will get back to working normally to at least some degree. Natural treatments for me include warm compresses, proper vitamin/fish oil/aloe vera juice supplements, Nature's Mist water spray, good diet, proper water intake, humidifier at night if needed based on humidity levels, mc goggles/glasses, and acupuncture for about 8-10 visits and then I repeat after a month or two.

My 2 non-natural treatments dry eye treatments are doxycycline and restasis. I plan on trying to get off doxycycline in about a month since I have been on it for about 8 months and I know it is not ideal to stay on antibiotics (even weak ones I suppose) for too long. I have no plan for getting off Restasis since I think it is helping and the risks seem minimal to date. Best. YGB

[GeorgeT]

Lucy and YGB,
Thank you so much for the input. Dr. Tseng visit satisfied me but not the outcome and the cost.
Dr. Tseng asked me to use the steroids for a week 3drops/daily, then decrease the dose for the second and third week. Now I use the steroids.
I need to have upper plugs too. This will be the next step.
I take fish oil every day/ aloe vera juice and hot compresses. I still take doxy but I will stop it ASAP. I use drops theratears 3-4 times/day and Nature Tears mist many times. After I started steroids left eye hurts more than the right and it used to be vice versa. I haven't tried Restatis yet. I still have constant pain.

Best Regards,

George

[Lucy]

George, are you using some type of dry eye goggles? Panoptx is probably the best, but others are available. You might find some at a Harley dealer, or other motorcycle shop.

So many of us have gotten a measure of relief from goggles! It just can't be discounted when you are in pain. It does not fix our problem, but gives relief while we continue with the compresses, medications, gels and hotpacks.

I have two pair of Panoptx. One is RX, with progressive bifocals and Transition lens. The other is plain sunglass type for wearing while I have my boston scleral lens on.

Lucy