Don't get probed

[sighthound]

I have seen a very good optometrist with a dry eye clinic near Toronto. I asked his opinion on MG probing and he said that he has several patients that got it done somewhere else, and it damaged their glands. He checks the glands with an instrument with a light, under the lid. He said the glands were crooked instead of the normal straight shape. I asked if he had seen patients that had the probing done by you-know-who in florida. (I don't want to use the name). He said "Yes". And he said that their eyes felt better for a few months, and then went very dry. He does not recommend probing at all.

[irish eyes]

That is my consultant's view also. (UK)

[browneyesblu]

I was also told the same thing, by a prominent opthalmologist in NY. However, since then it occurred to me, how did he know the damage was caused by the surgery? Or could the glands have been damaged by the disease process prior to surgery? I would be very grateful if anyone could shed some light on this.

[NotADryEye]

Sighthound, I find the statements made by your optometrist irresponsible and indicative of his level of ignorance and understanding of intraductal Meibomian gland probing. There are clearly patients, like myself, who have benefited tremendously from the procedure with no adverse effects.

Clearly, your optometrist in Toronto has not seen me post probing. If he had seen me, his opinion, and it is only an opinion, would be very different.

The reason the patients felt better for only a few months is that there were other co-morbid diseases that were not treated. If these comorbidities are left untreated not only will the patient not feel better long term, but the glands will become re-plugged.

If you have a broken arm and an infection in the vicinity of the break, will you feel better if only the infection is treated? No, of course not. Which comorbidities did the optometrist in Toronto diagnose and treat? Were the treatments effective?

To answer browneyesblu, no, the glands were not damaged by probing. And yes, people do have gland drop-out, atrophy, unusual shapes, all visible via meibography. I do. Probing has helped to restore function to my glands as have the other treatments prescribed by Dr. ****** for numerous comorbidities.

[LaDiva]

NotaDryEye, I have been seriously thinking about probing, but am concerned that the quality of my oil will cause the glands to remain blocked. Can you please expound on the other treatments used to treat the co-morbid diseases that accompany mgd? Thank you.

[Rebecca Petris]

The reason the patients felt better for only a few months is that there were other co-morbid diseases that were not treated. If these comorbidities are left untreated not only will the patient not feel better long term, but the glands will become re-plugged.

'Scuse me just a minute If the only possible explanation for lack of prolonged relief is untreated co-morbidities, that means the treatment is 100% successful. I know of no dry eye treatment, be it drug, device, surgery, home brew or camel spit for which such a success rate can be supported.

[LaDiva]

I have not yet tried camel spit, but it something else to add to the treatment list! LOL!

[sighthound]

I am just relating what I was told. The opt trained with dr Korb, so he is knowledgeable. He said that the probes are larger in diameter than the glands, and therefore can cause scarring. This scarring can lead to the gland not working. He said that it may help if the fibrous tissue is very close to the opening of the gland, but even so, he will not perform the procedure because of the risk of damaging the gland. Remember, that this is new, so nobody knows of the long-term safety of it. I will ask him if he has seen the same patient before and after probing. I see him again in 3 weeks. He did say that some of the glands he checked that had been probed were dramatically misshapen. That is why I asked him if some of the people he saw had got it done in florida. Remember, the person in florida is making money selling those probes. It seems a little odd that a dr can just order a video of the procedure, order the probes, and then do it. I would think a delicate procedure like that should be taught hands-on.
He said that he has patients felt better at first after probing, and then it was like the taps had been turned off a few months later.
I also saw a good opt at Herzig, who did lipiflow. He was wary of probing too. And the big-name NYC dr also advised me against it. The common theme was the risk of scarring.
Also, my opt has seen some people with a lot of mites helped quite a bit using Cliradex wipes. So maybe that will help some of you.

[jax8it]

I would put camel spit in my eyes if it worked.lol

[MartyM1985]

I would put camel spit in my eyes if it worked.lol

Hey, if you know a guy... holler.

[LaDiva]

Amen jax8it!!!

[NotADryEye]

NotaDryEye, I have been seriously thinking about probing, but am concerned that the quality of my oil will cause the glands to remain blocked. Can you please expound on the other treatments used to treat the co-morbid diseases that accompany mgd? Thank you.

LaDiva,
Much depends on the specific co-morbidity and your ability to tolerate treatment. For me, for instance, anything with a preservative is not an option. Also, I can only discuss my own co-morbidities and the treatments that I have had. But let me give you an idea.

Conjuctivochalasis - posterior and anterior conjunctivoplasty, both eyes, with amniotic membrane transplants. This is surgery. First one eye, then the other about one month later. Before the surgery the pain was excrutiating and I felt like I had tissues shoved into my eyes. I kept my eyes closed much of the time. Keeping them closed kept the pain from coming on and increasing. Now, post surgery, the tissue sensation and pain is completely gone. Completely.

Demodex mites - I have been treated with a 25% solution of tea tree oil, lip balm containing TTO, Cliradex and most recently a 10% solution of TTO. The 25% solution (from Dr. Tseng) was very difficult to tolerate. I applied it once or twice a day (once as the treatment progressed). Ultimately I had to stop. The lip balm was at first difficult to take - I imagine mites and bacteria dying and trying to escape and getting into my eyes. But after a time that subsided. Cliradex was next. I can only tolerate it once a day, although instrutions say to use it twice a day. I have run out of Cliradex and am now using a 10% solution of TTO. It is not as strong as Cliradex but stronger than the lip balm. I have used it for just one day and watering in my eyes increased over the first few hours. But already I can see that redness in the eys is diminishing and it is easier to write this post. In other words, my eyes are more comfortable.

Bacteria - so much depends on the specific bacteria that is cultured. In my case there was s. epedermidis and corynbacterium jeikeium. These responded to an antiobiotic, preservative free, that I applied to my eye lashes at night. The bacteria is gone.

Aqueous deficiency - my lower ducts are cauterized. My upper ducts were closed and are now mostly opened, but still partially closed.

Hashimoto's thyroiditis - I am hypothyroid and am taking, as are many people, Synthroid. The autoimune disease alters the fatty acid that the mg's secrete. Getting good levels of T3, T4 and TSH are important. But equally important is reducing TPO. This can be done with a gluten-free diet and taking Moducare. I am not taking moducare because it is contraindicated in patients who have had organ or corneal transplants. Since there are no studies on someone with Amniotic membrane transplants in the eyes it is not something that I am going to risk.

Thick meibum - warm compresses 2x per day, for two minutes only, using an eye mask with microbeads that I heat in the microwave. I have two masks. I am thinking about getting the rice baggies offered here.

All of these treatments, except 25% TTO, lower ducts cauterized and thyroid hormone, were prescribed/administered by Dr. ******. He weighed in on the Moducare question, although ultimately it was my decision. Over the year and a half that I have been seeing him, there were many, many, truly countless issues I encountered along the way. Each of these was addressed in turn. (For example, I began a course of chelation after I was tested for high led. Chelation casued all sorts of problems in my eyes and exacerbated blepharitis, poor meibum secretion, etc.)

If you would like to talk via phone, feel free to send me a private e-mail.

[NotADryEye]

'Scuse me just a minute If the only possible explanation for lack of prolonged relief is untreated co-morbidities, that means the treatment is 100% successful. I know of no dry eye treatment, be it drug, device, surgery, home brew or camel spit for which such a success rate can be supported.

Rebecca,

I believe that treatment is successful 95% of the time. Sometimes, for example, there is complete gland drop out and even then opening the glands helps to restore function to the damaged tissue.

It is important to point out that, confocal microscopy showed a reduction of congestion and reduced inflammation after probing. This leads to prevention of fibrosis and increased comfort.

Nevertheless, it is essential to treat the co-morbid diseases. I, for example, am still dealing with a stubborn demodex population.

[NotADryEye]

I am just relating what I was told. The opt trained with dr Korb, so he is knowledgeable. He said that the probes are larger in diameter than the glands, and therefore can cause scarring. This scarring can lead to the gland not working. He said that it may help if the fibrous tissue is very close to the opening of the gland, but even so, he will not perform the procedure because of the risk of damaging the gland. Remember, that this is new, so nobody knows of the long-term safety of it. I will ask him if he has seen the same patient before and after probing. I see him again in 3 weeks. He did say that some of the glands he checked that had been probed were dramatically misshapen. That is why I asked him if some of the people he saw had got it done in florida. Remember, the person in florida is making money selling those probes. It seems a little odd that a dr can just order a video of the procedure, order the probes, and then do it. I would think a delicate procedure like that should be taught hands-on.
He said that he has patients felt better at first after probing, and then it was like the taps had been turned off a few months later.
I also saw a good opt at Herzig, who did lipiflow. He was wary of probing too. And the big-name NYC dr also advised me against it. The common theme was the risk of scarring.
Also, my opt has seen some people with a lot of mites helped quite a bit using Cliradex wipes. So maybe that will help some of you.

Sighthound,
First, I am not surprised that an optometrist, who is not trained or licensed to perform any type of invasive procedure would hesitate to recommend probing. Probing is not considered medically invasive, but to an optometrist it would seem relatively invasive. To an ophthalmologist who is a surgeon probing will be relatively un-invasive. Perhaps this is why so many optometrists are adopting Lipiflow since they are not trained in, nor allowed to practice, invasive medicine.

The probes come in several sizes. They are not larger than the gland. They may be larger than the opening if there is fibrous tissue blocking the opening.

My glands are not scarred. I have been probed. Some of my glands are dramatically misshapen and were so before probing, not after. Even dramatically misshapen glands can be probed and the fibrous tissue can be pierced. This will not damage the gland. It will instead help to restore function to the gland. Note that confocal microscopy showed REDUCTION of congestion and reduced inflammation after probing. After each probing, I experienced an enormous increase in comfort. As co-morbidities were treated, there was more time betweeen probings and severely painful issues, like symptomatic conjuctivochalasis, are not returning.

Let’s discuss the price point next. A Lipiflow system costs what, maybe $200,000? Once purchased, an ophthalmologist or optometrist will have to perform quite a few procedures to recoup that investment. I can’t imagine that this $200,000 investment in Lipiflow compares in any way to the price of hand-held probes.

Re: Cliradex, Thank you! I have been using it for some time. I used to see Dr. Tseng in Miami (he manufactures Cliradex) and he treated me with a 25% Tea Tree Oil solution. I ended up with TTO toxicity. However I find Cliradex to be relatively tolerable, but only once a day. Because Cliradex is currently on backorder, I am using a 10% TTO solution.

Keep us posted re: your next visit with the optometrist. I would be particularly interested to hear how he treated those probed patients, what co-morbidities he diagnosed, what treatments he prescribed and their efficacy.

[browneyesblu]

Conjuctivochalasis - posterior and anterior conjunctivoplasty, both eyes, with amniotic membrane transplants. This is surgery. First one eye, then the other about one month later. Before the surgery the pain was excrutiating and I felt like I had tissues shoved into my eyes. I kept my eyes closed much of the time. Keeping them closed kept the pain from coming on and increasing. Now, post surgery, the tissue sensation and pain is completely gone. Completely.

Hi NotADryEye,

Thanks for answering my first question. Did Dr. ****** also do the conjunctivoplasty? Did you have many problems post-op? I'm asking because I believe I have some degree of conjunctival chalasis. It's only symptomatic some of the time and then only in one eye and usually mild, but I understand it can interfere with success of other dry eye treatments long-term. I asked one surgeon about this, he said he doesn't do it anymore because there is so much swelling afterwards, so I'm also scared about having it done. I'm really in a quandry about this so any advice you could give would be greatly appreciated.