Don't get probed

[DCRdryeye]

I admire Dr. ******'s approach with cautery and plugs. Taken from the above link:

http://www.ophthalmologymanagement.c...ticleid=105865
I prefer thermal cautery as the quickest and best way to restore increased tear volumes. Some patients prefer using cyclosporine (Restasis, Allergan).
Many colleagues successfully use plugs to punctal occlude, but I have found problems including frequent loss of plugs, local tissue trauma with nasal bulbar erosions, colonization with bacteria with intermittent seeding of the ocular surface, and fibrosis within the canaliculus. Plug proponents like its reversibility (assuming it does not scar into place), although I frequently use light cautery to create a superficial, sometimes partial, occlusion to maintain reversibility.

...Most will fully cauterize or simply re-insert plugs over and over. In Australia, Dr. C, mentioned he'd do a partial cautery on me since my puncta is so large and place a plug in what remains.

[martin93]

I admire Dr. ******'s approach with cautery and plugs. Taken from the above link:

http://www.ophthalmologymanagement.c...ticleid=105865
I prefer thermal cautery as the quickest and best way to restore increased tear volumes. Some patients prefer using cyclosporine (Restasis, Allergan).
Many colleagues successfully use plugs to punctal occlude, but I have found problems including frequent loss of plugs, local tissue trauma with nasal bulbar erosions, colonization with bacteria with intermittent seeding of the ocular surface, and fibrosis within the canaliculus. Plug proponents like its reversibility (assuming it does not scar into place), although I frequently use light cautery to create a superficial, sometimes partial, occlusion to maintain reversibility.

...Most will fully cauterize or simply re-insert plugs over and over. In Australia, Dr. C, mentioned he'd do a partial cautery on me since my puncta is so large and place a plug in what remains.

Full cautery refers only the patients who suffer from water deficiency-Lacrimal gland

It does not help to solve the problem for people with MGD ,I have tried plugs too...no success.And I have contacted with mgd patients- fully cauterized -no success either
After 2 days I have probing,and I hope it will help.

[spmcc]

FYI ****** won't probe you unless he first cauterizes you. If all your puncta are open, he insists on cauterizing two. If two are already cauterized (like I was), he insists on cauterizing the remaining two.

This is one reason why he can't report any meaningful results from probing. If he's also performed other treatments at the same time, he cannot say that probing alone has any value. He cannot separate out the effects of probing from cautery. But his research papers don't divulge that he has also performed other treatments on the patients in his studies.

[NotADryEye]

FYI ****** won't probe you unless he first cauterizes you. If all your puncta are open, he insists on cauterizing two. If two are already cauterized (like I was), he insists on cauterizing the remaining two.

This is one reason why he can't report any meaningful results from probing. If he's also performed other treatments at the same time, he cannot say that probing alone has any value. He cannot separate out the effects of probing from cautery. But his research papers don't divulge that he has also performed other treatments on the patients in his studies.

As Dr ****** writes in the Oph Management Article , "Dry Eye Relief", all patients receive a comprehensive and meticulous evaluation focused on dry eye and surface factors causing symptoms and suffering. If the patient has co-morbid aqueous tear deficiency, then they have punctal occlusion as the article says. If they do NOT have ATD, then they do NOT get punctal occlusion. His 2010 peer reviewed study and article in CORNEA clearly states in the text on page 1147 and in Table 1 on pages 1148, 1149 and 1150 that 16% of patients received punctal occlusion on the same day as MGP. As it turns out in this landmark paper, most patients did NOT receive punctal occlusion.

In the subsequent peer reviewed paper on MGP in 2012 by Wladis, he treated patients with MGD alone therefore not requiring any additional therapy. He reported 100% of patients showed significant relief.

[Cali]

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

OK. First time I laughed in a few days. Thank you.

[martin93]

Hi all
As I promised I will post what happened after my probing procedure

I got probed at 10th June.
Only probing without injecting corticosteroid in each gland.
The doctor who did it,said each gland has been deeply clogged, and I felt how the needle "pop" each gland .
After probing I felt great,although my eyes were inflamed.
The doctor said we have to do lipiflow right after the probing ,to express the opened glands. So we did Lipiflow as well.
After those both procedures I felt 100% symptoms free, but after 1 hour the anestesia effect felt, and my eyelids started to hurt terribly.
The next day the pain was bearable,but I still felt my eyes inflamed and a bit painful. On the slit lamp exam,my doctor said all glands are no more clogged,and he see them all opened.
Today is my 4th day after probing and lipiflow .I don't feel the pain from the needle,but I still feel my eyelids inflammed ,red,burning.
I have to take my steroid drops for inflammation and to do warm compresses+massage for a few months + doxycycline (1 month -100mg,2 months -50 mg) .

...
Hope to feel some improvement in next days,since my meibomian glands are no more clogged.
Advices are appreciated

[poppy]

When patients seem to be routinely given steroids after procedures like probing and lipiflow, I wonder how much of the benefit is purely from the steroids.

[DCRdryeye]

Hi Martin,

Having MGP and Lipiflow together sounds very effective. I’m sure you would be feeling very sore afterwards.
Two concerns:

1. As poppy pointed out, what will happen when you stop the steroid drops
2. The doxycycline is to keep the meibum in a fluid state, rather than solidify to prevent your glands clogging again. What will happen when you stop the Doxy?

Time will tell, and it’s just a matter of seeing how you pogress over the next few weeks and months. Please do keep us informed of your progress and I hope it really works out for you long term.

[martin93]

DCRdryeye

Thank you !

I forgot to mention that I was done Meibography . My opth said all my glands look normal and not atrophic
With doxy I hope to close that vicous circle Non working glands-Inflammation Inflammation-Non working glands
In all red articles on internet I saw lots of people said they feel much better on the next day after probing, don't know why my eyelids are so inflamed and red yet.
I will keep you informed next weeks for sure .

[NotADryEye]

When patients seem to be routinely given steroids after procedures like probing and lipiflow, I wonder how much of the benefit is purely from the steroids.

That's a good question. I've had probing 3 times, the first time with steriods injected into glands. I never used steriods routinely post probing. The first time the glands stayed opened for 7 months. During that time I had AMT surgery on both eyes, and I used steriod post surgery, for about 1 or 1.5 months, per eye. After the second probing the glands stayed opened for 8 months. It is about 6 months after the third probing. So far so good and no steriods. Also, steriods will not dissolve, or otherwise eliminate, fibrous tissue.

[NotADryEye]

In all red articles on internet I saw lots of people said they feel much better on the next day after probing, don't know why my eyelids are so inflamed and red yet.
I will keep you informed next weeks for sure .

Martin,
How long has the inflamtion/redness lasted? It may be a reaction to the preservatives in any anesthetic applied to your eyes, or it may be to much was done on the same day.

I've been probed three times and have never had any redness or inflamtion, except after the second time. I was sensitive to the anesthetic. The redness and burning lasted well into the evening, but was completely gone the next morning. The third time probing was without anesthetic and there was absolutely no reness or burning. None.

How are you feeling today? Better?

[Cali]

That's a good question. I've had probing 3 times, the first time with steriods injected into glands. I never used steriods routinely post probing. The first time the glands stayed opened for 7 months. During that time I had AMT surgery on both eyes, and I used steriod post surgery, for about 1 or 1.5 months, per eye. After the second probing the glands stayed opened for 8 months. It is about 6 months after the third probing. So far so good and no steriods. Also, steriods will not dissolve, or otherwise eliminate, fibrous tissue.

So I am not understanding how this works. So if your glands have atrophied, dropped out, have scarring or fibrous tissue, a one-time probing doesn't work to open the glands and break up the fibrous tissue. Is this a procedure that would have to be ongoing forever to keep the glands open? Does the probing cause more scarring because you are in essence surgically altering the glands to open them, then they re-heal but with scarring? Or is the goal at some point they've been probed a number of times that when they re-heal, they re-heal with a larger opening so they can function correctly? Does it work if the glands have dropped out, atrophied, are twisted, etc. or only if they are "plugged" with fibrous tissue from repeated healing/scarring?

And, the initial thread was titled "Don't get probed." Like another person posted, if your glands aren't functional to begin with (have atrophied, dropped out, are twisted or misshapen as perhaps seen in a meibography prior to probing) why would it matter if you get probed or not? They already don't work so why would giving probing a shot hurt you if the glands are already non-functioning?

Sorry, I'm just not understanding how this works.

[martin93]

So I am not understanding how this works. So if your glands have atrophied, dropped out, have scarring or fibrous tissue, a one-time probing doesn't work to open the glands and break up the fibrous tissue. Is this a procedure that would have to be ongoing forever to keep the glands open? Does the probing cause more scarring because you are in essence surgically altering the glands to open them, then they re-heal but with scarring? Or is the goal at some point they've been probed a number of times that when they re-heal, they re-heal with a larger opening so they can function correctly? Does it work if the glands have dropped out, atrophied, are twisted, etc. or only if they are "plugged" with fibrous tissue from repeated healing/scarring?

And, the initial thread was titled "Don't get probed." Like another person posted, if your glands aren't functional to begin with (have atrophied, dropped out, are twisted or misshapen as perhaps seen in a meibography prior to probing) why would it matter if you get probed or not? They already don't work so why would giving probing a shot hurt you if the glands are already non-functioning?

Sorry, I'm just not understanding how this works.

I've read tons of Probing articles and think i can answer your questions

Atrphied gland doesn't mean dead for ever,many articles claim Probing can restore atrophied glands
For the fibrous tissue case I think probing is the best way to open thegland and "pop" the fibrous tissue /as in my case
30% of all Probing patients need retreatment after some time ,it's not because of the efficacy of the procedure,but because of some co morbids which cause the glands to get clogged. Rosacea, inbalance in estrogen and testosteron ,for example.

Probing has been life saving for so many people,and if someone says it's not helpful for him, That doesn't mean it won't be helpful for 20 other people for example

Quick update"
my left eye is feeling much better,but my right is still burning and dry

[Cali]

OK, thanks Martin. I have ocular rosacea so that would continually affect my glands, forever. But probing might give me relief for certain periods of time before the ocular rosacea affects the glands again. Got it!

[martin93]

http://www.ncbi.nlm.nih.gov/pubmed/22836802