Don't get probed

[LaDiva]

Thanks for the info. NotADryEye!

[browneyesblu]

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

Camel spit may work better than some of the things I've been prescribed.

[LaDiva]

Double amen.

[NotADryEye]

browneyesblu,
Dr. ****** did the surgery.
There was a tiny amount of swelling after the first surgery on the left eye. It was not a problem. He began removing stitches after 2 weeks. All the stitches were out within three weeks. The eyes were done 1 month apart. I had a lot of tissue removed and replaced. Today, there is absolutely no evidence of anything being done. And the pain and discomfort from the chalasis is completely gone, 100% gone.

Dr. ****** was available via cell phone at the drop of a hat. I had problems because I kept developing sensitivities to the steriods and antiobiotic drops I needed to use after the surgery. Every time there was a problem, Dr. ****** had an answer, a technique that allowed me to remain on the drops during the critical weeks post surgery. I would tell him what I was going through. He would ask a lot of questions, always something unexpected, and then tell me what to do. It always worked. Always!

I have never had a doctor take such good care of me. And he was incredibly kind and nurturing, as he continues to be to this day.

Chalasis causes friction on the meibomian glands which can lead to scarring, atrophy, blockage, etc. If the chalasis is symptomatic, like it was for me, it can be nothing short of hell. If yours is symptomatic, then surgery may be helpful.

If you would like to call me to discuss further, feel free to send me a private messsage.

Hang in there. There are many of us who have been through it and are on the other side of the mountain. Sometimes the mountain is very large and takes a long time to climb.

[browneyesblu]

Many thanks for the info, NotADryEye! It's a real relief to hear this surgery can be done successfully.

[Rebecca Petris]

Rebecca,

I believe that treatment is successful 95% of the time.

95% of what? The people without comorbidities? With well controlled comorbidities? Other? Any studies to demonstrate this?

And... touchier topic... what does success consist in? To a doctor, success is reasonably healthy MGs and good oil content in the tear film. To a patient, success is feeling better. Wish they always went hand in hand.

I'm not really trying to nitpick. I have a hangup with claims like that though. I find literally every dry eye treatment interesting and potentially hopeful for SOME people... especially all the newest MGD treatments... but I am always skeptical of claims of very high success rates unless it's a pretty narrow selection of target patients. With dry eye... co-morbidities are the norm, at least for people with severe symtpoms. I'm not a doctor so I see this only from the lay perspective, but I talk to people with dry eye all day long. There's virtually always more than one thing going on, if you really dig into the history. One will have had LASIK 5 years ago and has ocular rosacea and has been told their lids don't close really well, never had symptoms then suddenly they're menopausal and whammo, massive dry eye symptoms. Another will have short lids after a blepharoplasty, then got diagnosed with dry eye and blepharitis. Another's got muscular dystrophy, or bell's palsy, and so on, and so forth. I am not sure I've ever come across someone who "just" has dry eye. - And the challenge with the comorbidities specially when symptoms are worse than clinical signs is at some point you make a judgment call about what's really causing the pain/discomfort (which at the end of the day is usually the only thing the patient cares about fixing) - which sometimes is no better than guesswork. Or you fix what you can and hope for the best.

[martin93]

Hi all
I'm sheduled for probing next week 10th of June, in Germany- proff.Geerling
I have severe MGD for 5 years ,my eye lids are red from inside,and Burn
I've been looking 2 years what can be the reason for my MGD,
-accutane or skin deseases
-Hormonal inbalance
-rosacea
-allergy
-blepharitis
-bacterial infection
-thyroid desease
I don't have any of the them
My doctor only says My meibomian glands don't produce enough oil at all,and the oil is thick

I have tried all stuff under the Sun without any effect
-Restasis
-warm compresses 2xday - 2 months+ massage
-plugs
-NAC, omega 3-fish oil
-doxy -2 months
-lid hygiene
-corticosteroids,allergy drops,Systane balance,and all kinds of artificial tears
-castor oil
and many many others ...

I have to be a student now,but I can't tolerate wind,sun,air conditioners and it's impossible for me to travel
So I decided to try MG Probing
Wish me luck and I'll post what happened after the probing

[NotADryEye]

Rebecca,
To clarify, 95% of the time probing clears the obstruction and improves, significantly, miebum flow, on some 20,000 glands probed. If you would like, we could look for the exact numbers, quantify all of this very specifically. However, I suspect that any numbers will only increase your level of frustration. To be sure, the numbers are meaningless if the outcome provides no relief to the sufferer. I, for one, have been in studies where I was being bullied into giving my "feeling better percentage" response. But that is the past. I am much more optimistic now that I am being cared for by someone who cares about how I feel, and not what number I may add to in a study.

You are absolutely right about your description of this disease. Thankfully so far we have not had fibromyalgia thrown at us. Or maybe we have? My worst personal example is a diagnosis of "occular neuropathy." What the heck is that really? And how is it possible that no one diagnosed chalasis until I saw Dr. ******? This general lack of knowledge among so many specialists about the disease(s), their diagnoses and treatment is ever so frustrating and something that maybe, collectively, we can all one day change.

Whether we like it or not, the comorbidities are real. We can rail against them. But that will not make them go away. Calling any of these things Dry Eye is one of the things that is so fundamentally wrong. Think about heart disease or cancer. What the heck is cancer anyway? How does a doctor treat something like cancer? You have to ask, which part of the body, what kind of cancer, what stage is the disease, and on and on. Hematologic cancer is treated differently from breast cancers. These are not the same. So calling what we have Dry Eye is just as useful as calling something cancer. Is it the mg's, the conjunctiva, bacteria, lacrimal glands, autoimmune, skin, lashes, whatever. Each of these little minute body parts is its own little world, but they are proximal and contribute significantly to this thing called Dry Eye. Where do you even begin?

And like you, I don't have to go far to talk to someone with Dry Eye every day. I can just look in the mirror, or sit still and take a deep breath. She's with me wherever I go, whispering into my ear. She used to say, "Help me. Please, please, please, please, help me." Now I hear her saying, "Look how far you've come. You're almost there.”

[NotADryEye]

Martin93,
Probing is designed to clear obstruction. This will allow meibum to flow. I'm not sure what thick meibum is a sign of, but keep in mind also that the the mg's are a very good barometer for overall health. If you get a cold, they become inflamed and obstructed. If you go on a crash diet they stop functioning. If there is an autoimmune problem the glands inflame. And so forth.

I had found it nearly impossible to get diagnosed properly and then treated accordingly. I don't know why. It just seems to be that way. Does it start with medical schools? I don't know. I find it baffling.

And so we end up trying everything under the sun. I finally found Dr. ******. Now I am well on my way to achieving a comfortable state in my eyes - miles away from where I was two years ago, still working at it, and getting closer every day. Hang in there. But don't neglect things like warm compresses just because you're getting probed. Especially if there is burning you may still want to continue with the warm compresses, Omega 3, doxy (low low dose daily).

Has anyone tested you for demodex mites?

[NotADryEye]

Rebecca, Here are the numbers:


There are 2 studies published in peer reviewed literature on the success of MG Probing. Dr. ******'s in 2010 and Dr. Wladis in 2012. Both showed over 95%, and up to 100%, of patients had success in reducing symptoms. That is, every patient improved.


Subsequent studies presented at AAO, ARVO and ASCRS showed up to 80 to 90 % of symptoms were relieved. For patients with severe and multiple co-morbidities, there was up to an average of 60% relief in symptoms. The key was managing co-morbid disease: In these challenging cases, patients would present with recurrent and varying comorbidities, so adjustments would have to be made continually to keep patients comfortable. When under control, patients could get up to over 80% relief, but would subsequently present with another comorbidity.

Below are abstracts of the two published articles, both from pubmed.gov.


Cornea. 2010 Oct;29(10):1145-52. doi: 10.1097/ICO.0b013e3181d836f3.
Intraductal meibomian gland probing relieves symptoms of obstructive meibomian gland dysfunction.

AUTHOR: ****** SL.

SOURCE: The Dry Eye and Cornea Treatment Center, Tampa, FL 33609, USA. dr******@dr******.com

ABSTRACT

PURPOSE:
To perform a retrospective evaluation of a new treatment for obstructive meibomian gland dysfunction (O-MGD) using invasive orifice penetration and intraductal probing.

SETTING:
Office-based ophthalmology private practice.

METHODS:
Medical charts of 25 consecutive patients with O-MGD (based on presence of lid margin or tarsal hyperemia, lid margin telangiectasia, thickening or irregularity, and meiboman gland orifice metaplasia) plus lid tenderness or symptoms of lid margin congestion were reviewed to evaluate the effect of probing on tenderness and congestion.

RESULTS:
Twenty-four of 25 patients (96%) had immediate postprobing relief, whereas all 25 patients (100%) had relief of symptoms by 4 weeks after procedure. Twenty patients (80%) only required 1 reatment and had an average of 11.5-month follow-up. Five patients (20%) had retreatment at an average of 4.6 months. All patients had symptom relief at time of last follow-up. Of 56 symptomatic and treated lids, 42 (75%) were upper lids. Patients frequently reported improvement in newly recognized but previously subclinical symptoms.

CONCLUSIONS:
Invasive orifice penetration and intraductal probing seems to provide lasting rapid symptom relief for patients with O-MGD. Probing findings in this study frequently included (1) mild resistance upon orifice penetration, (2) proximal duct gritty tactile and aural sensation suggestive of keratinized cellular debris, and (3) focal variable resistance deeper within the duct, which may be relieved with the probe, suggestive of fibrovascular tissue. Taken together, these findings may offer probing characteristics that may allow for a grading system for duct obstruction. The postprobing improvement of symptoms not previously appreciated supports the notion that meibomian gland disease exists subclinically.

Available at:
http://www.ncbi.nlm.nih.gov/pubmed/20622668




Ophthal Plast Reconstr Surg. 2012 Nov-Dec;28(6):416-8. doi: 10.1097/IOP.0b013e3182627ebc.
Intraductal meibomian gland probing in the management of ocular rosacea.

AUTHOR: Wladis EJ.

SOURCE: Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Slingerlands, New York 12159, USA. tedwladis@gmail.com

ABSTRACT

PURPOSE:
Rosacea is a significant cause of ocular surface disease, and our current therapeutic armamentarium is often ineffective. Intraductal meibomian gland probing is a novel technique to address dry eye syndrome, although its use has not been described in the management of ocular surface disease from rosacea.

METHODS:
Patients with ocular rosacea, meibomian gland dysfunction, and surface disease, which was refractory to conventional management, underwent intraductal meibomian gland probing. Each patient completed the Ocular Surface Disease Index (OSDI) questionnaire before the procedure and at the 1- and 6-month postoperative visits.

RESULTS:
Forty eyelids of 10 patients (5 men, 5 women; mean age = 42.1 years) underwent intraductal meibomian gland probing. All patients reported subjective improvement in their symptoms of discomfort, tearing, and blurred vision. The mean preoperative, 1-month, and 6-month OSDI scores were 78.11 (standard deviation [SD] = 5.33), 37.54 (SD = 7.25), and 43.00 (SD = 5.49), respectively. The differences between the preoperative and one- and six-month scores were statistically significant (p < 0.05). Nine of the ten patients in this study were able to discontinue their doxycycline use after surgery, and 10 out of 10 patients reported decreased frequency of artificial tear use. No complications were identified in the 6-month follow-up period.

CONCLUSIONS:
Intraductal meibomian gland probing is a safe, effective technique to address the ocular surface disease, tearing, and discomfort associated with ocular rosacea, and this intervention results in a dramatic improvement in these symptoms. This study provides the first documentation of these findings and represents the first quantitative demonstration of the use of intraductal meibomian gland probing in the peer-reviewed literature.
PMID: 22836802 [PubMed - indexed for MEDLINE]

Available at:
http://www.ncbi.nlm.nih.gov/pubmed/?...adis+meibomian

[martin93]

http://www.ophthalmologymanagement.c...ticleid=105865

[Phillips55]

God I'm scheduled to be Mg probed by Dr Tauber in July. Lasik was a permanent disaster for me and now I'm learning this could be too! Dry eye is one never ending nightmare. I have had 35 plus appointments since I had lasik in 2011 with several different doctors across multiple States. I will do anything I have to heal but I have been wholly unimpressed with the doctors ive seen. Lasik has corrupted the field of opmtamology and made it the ethical black hole of the medical industry.

[jax8it]

Yep you are so right....

[soaps]

God I'm scheduled to be Mg probed by Dr Tauber in July. Lasik was a permanent disaster for me and now I'm learning this could be too! Dry eye is one never ending nightmare. I have had 35 plus appointments since I had lasik in 2011 with several different doctors across multiple States. I will do anything I have to heal but I have been wholly unimpressed with the doctors ive seen. Lasik has corrupted the field of opmtamology and made it the ethical black hole of the medical industry.

Yep and the worst thing is wen u try warn others they ro ll their eyes and dont listen. so sad but no way of stoppin
it ive realised.

[NotADryEye]

Martin, Thank you for posting the article. It is a must-read for anyone with Dry Eye. I've reposted it below.

I learned at least one new medical term, "enucleate the globe."

By mid 2011 I was thinking about how to take out my eye balls, what instruments to use, would it hurt more or less afterwards. The first time I saw Dr. ****** I asked him to do it. He responded, ever so kindly, "No, no, we won't be doing that today."


http://www.ophthalmologymanagement.c...ticleid=105865