Don't get probed

[DCRdryeye]

Yes, the problem is the diagnoses often doesn't match the symptoms. I've seen a number of optometrists whom said my eyes look fine and my tear film is as "smooth as a babies butt". Well, why am I in so much pain? It's not just the cornea's but the entire eye area, conjunctiva, etc exposed to the environment. I wear moisture chambers 24/7.

Next week I'm seeing a top ophthalmologist whom is the only one I know in Australia to do Meibomian Gland Probing, Gland expression, and has a plethora of compounded drops. He's on the other side of the country, but the flight will be worth it. The lengths we go through - phew!!!

[NotADryEye]

I had the expression done and eyelid wiper scraper thingy done. (The opt scrapes off the build up of old cells on the eyelid margin).

Sighthound, you might reconsider probing as nothing you have had done so far would clear obstrucive tissue. It is good, nevertheless, that the inflamation is reduced.

A study recently published found that patients with Dry Eye have a lower threshhold for pain. This may be true for many of us. And you already know where you stand with this.

My heart goes out to you. But hang in there. Bit by bit, if you continue to pursue comfort you will achieve it. That is also true for so many of us.

How well are you able to tolerate the scraping? Is it painful? Uncomfortable? Or just another simple procedure.

Keep us posted.

[NotADryEye]

DCRdryeye,

You might ask the new ophthalmologist to check you for conjunctivochalasis.

Probing should help. It's madenning to me, all the way in Florida, that you have to travel so far for this treatment. But don't lose hope. It is terrific that you are taking the initiative.

Best of luck, and please keep us posted also.

[JJdryeye]

Rebecca,
To clarify, 95% of the time probing clears the obstruction and improves, significantly, miebum flow, on some 20,000 glands probed.

NotaDryEye, are there any other studies published which confirm the success rate of probing besides the two you listed? I have the feeling I'm headed in that direction, but I'd feel more comfortable about the procedure knowing the results came from a larger sample size than 35 people.

[JJdryeye]

Martin, can you give us a 3-month update please?

[Almondiyz]

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.

Both my optometrist & ophthalmologist told me that intraductal meibomian gland probing causes scar tissue to form from repeated procedures which creates a new MGD monster problem.

It seems no matter who or where someone practices in my area, all the doc's seem to be favoring the Lipiflow treatment for MGD. I certainly understand how scar tissue may form since the probing procedure is not a cure & needs to repeated just as with the Lipiflow.



I asked about probing for my MGD because I saw many YouTube videos & insurance covers the procedure. The Lipiflow idea makes sense, yet I'm still skeptical...maybe even paranoid that all the people who perform Lipiflow are out to make money since insurance doesn't cover the "experimental treatment." Has anyone had probing done for MGD & have scarring issues? Thanks

P.S. I live in the Raleigh/Durham/Chapel Hill area in North Carolina, USA. Duke University Medical Hospital & University Of North Carolina at Chapel Hill Medical Center. Both are major teaching & research hospitals. Duke & UNC both own or are linked to practically every hospital in the state, actually nationwide & even in China. I feel like an experiment for someone's research publication. Even private physicians have some ties with Duke or UNC. HELP!

[NotADryEye]

Both my optometrist & ophthalmologist told me that intraductal meibomian gland probing causes scar tissue to form from repeated procedures which creates a new MGD monster problem.

First, probing does not cause scarring. Second, many people only need to be treated once. Third, repeated probing does not cause scarring. This is simply a falacy. I have been probed numerous times. There have been absolutely no, and I mean absolutely no adverse affects from probing. On the contrary, probing gave me immediate relief as it does for so many people.

In fact, there is an objective, multicenter randomized, controlled, blinded study soon to launch that is being funded by patients who had been long suffering from MGD and dry eye. These patients underwent probing which led to comfortable eyes and restored lives.

Furthermore, these patients are upset that the transformative benefits of probing are not widely appreciated and available, which had led to their own delay in reversing their suffering. Thus they are committed to funding this study out of pure altruism.

It seems no matter who or where someone practices in my area, all the doc's seem to be favoring the Lipiflow treatment for MGD. I certainly understand how scar tissue may form since the probing procedure is not a cure & needs to repeated just as with the Lipiflow.

Duke was instramental in the development of Lipiflow. Is it any wonder that the doctors in your area promote it? How could any of them risk saying anything against it?
Next, lets explain how probing works and why it is sometimes repeated. Probing clears obstructed meibomian glands. If fibrous tissue regrows or the glands are otherwise re-obstructed, then there is no risk in reprobing. Probing can not stop fibrous tissue from regrowing until function is restored to meibomian glands and other comorbid diseases are also treated. When meibomian glands are obstructed probing clears the obstruction and thereby function is restored to the mg's. When the obstructions are cleared and other comorbid diseases are treated the fibrous tissue does not regrow, obstructions do not reoccur and probing is no longer required.

I asked about probing for my MGD because I saw many YouTube videos & insurance covers the procedure. The Lipiflow idea makes sense, yet I'm still skeptical...maybe even paranoid that all the people who perform Lipiflow are out to make money since insurance doesn't cover the "experimental treatment."

Lipiflow makes sense if the glands are not obstructed and particularly if the glands are not obstructed with fibrous tissue. Heating the glands and massaging them when the meibum has no escape route can cause it to travel further back into the gland. It is like having an enormous blemish on your skin and pushing the oils further back. Can you picture that? It would be safer to do Lipiflow after probing. But after probing Lipiflow may not be necessary.

Has anyone had probing done for MGD & have scarring issues?

I have not had any scarring issues.

P.S. I live in the Raleigh/Durham/Chapel Hill area in North Carolina, USA. Duke University Medical Hospital & University Of North Carolina at Chapel Hill Medical Center. Both are major teaching & research hospitals. Duke & UNC both own or are linked to practically every hospital in the state, actually nationwide & even in China. I feel like an experiment for someone's research publication. Even private physicians have some ties with Duke or UNC. HELP!

Yes, that is a problem when physicians put there own interests ahead of their patients. I have been to enough doctors, including several at Bascom Palmer in Miami another enormous and well respected research hospital associated with a univeristy, where I was sure I was no more than a research subject. I am so greatly relieved now to be under the care of a physician who cares about his patients. He has restored my hope and has helped me tremendously. Words can never express my gratitude.

[NotADryEye]

NotaDryEye, are there any other studies published which confirm the success rate of probing besides the two you listed? I have the feeling I'm headed in that direction, but I'd feel more comfortable about the procedure knowing the results came from a larger sample size than 35 people.

JJ, I justed posted this same info to Almondiyz in this thread: There is an objective, multicenter randomized, controlled, blinded study soon to launch that is being funded by patients who had been long suffering from MGD and dry eye. These patients underwent probing which led to comfortable eyes and restored lives.

Furthermore, these patients are upset that the transformative benefits of probing are not widely appreciated and available, which had led to their own delay in reversing their suffering. Thus they are committed to funding this study out of pure altruism.

[JJdryeye]

JJ, I justed posted this same info to Almondiyz in this thread: There is an objective, multicenter randomized, controlled, blinded study soon to launch that is being funded by patients who had been long suffering from MGD and dry eye. These patients underwent probing which led to comfortable eyes and restored lives.

Furthermore, these patients are upset that the transformative benefits of probing are not widely appreciated and available, which had led to their own delay in reversing their suffering. Thus they are committed to funding this study out of pure altruism.

That's good to know. Do you have a link or any information on where I can read about this or follow it's progress?

[NotADryEye]

That's good to know. Do you have a link or any information on where I can read about this or follow it's progress?

The information on the study is not yet publicly available. When it is, I will be sure to post here.

You asked about other studies.

This article is about a study in Austria. Only the summary is translated into English:
Interventionelle Therapie bei Dysfunktion der Meibom-Drüsen
http://link.springer.com/article/10....717-013-0178-1


Another is from a journal in Russia available on pubmed.gov:

Efficacy of physiotherapy and hygienic procedures in treatment of adults and children with chronic blepharitis and dry eye syndrome.

Article in Russian
Prozornaia LP, Brzhevskiĭ VV.

Abstract:
110 patients aged from 3 to 42 years old were examined to estimate the efficacy of chronic blepharitis treatment: 50 patients with chronic blepharitis and dry eye syndrome (DES), 28 with DES due to computer vision syndrome and 32 with isolated chronic blepharitis. All patients received eyelid massage. If the secretion was too thick and difficult to evacuate from meibomian glands then duct probing was performed. In addition a complex of hygienic procedures was performed using phytoproducts ("Geltec-Medika", Russia): blepharoshampoo, blepharolotion, blepharogel 1 and 2. Moist warm pads (with blepharolotion and calendula extraction) were applied on the eyelids in 25 patients. Massage and probing of meibomian gland ducts and hygienic procedures were showed to be effective in management of clinical signs of chronic blepharitis including coexisting DES. Moist warm pads improve efficacy of background therapy in patients with meibomian gland hypofunction and have no effect in blepharitis with excessive meibomian gland secretion. Eyelid hygiene was showed to be effective in adults and children as well including infants.

http://www.ncbi.nlm.nih.gov/pubmed/23879027


Probing is becoming state of the art care around world.

[JJdryeye]

Both my optometrist & ophthalmologist told me that intraductal meibomian gland probing causes scar tissue to form from repeated procedures which creates a new MGD monster problem.

It seems no matter who or where someone practices in my area, all the doc's seem to be favoring the Lipiflow treatment for MGD. I certainly understand how scar tissue may form since the probing procedure is not a cure & needs to repeated just as with the Lipiflow.



I asked about probing for my MGD because I saw many YouTube videos & insurance covers the procedure. The Lipiflow idea makes sense, yet I'm still skeptical...maybe even paranoid that all the people who perform Lipiflow are out to make money since insurance doesn't cover the "experimental treatment." Has anyone had probing done for MGD & have scarring issues? Thanks

P.S. I live in the Raleigh/Durham/Chapel Hill area in North Carolina, USA. Duke University Medical Hospital & University Of North Carolina at Chapel Hill Medical Center. Both are major teaching & research hospitals. Duke & UNC both own or are linked to practically every hospital in the state, actually nationwide & even in China. I feel like an experiment for someone's research publication. Even private physicians have some ties with Duke or UNC. HELP!

Both my optometrist & ophthalmologist told me that intraductal meibomian gland probing causes scar tissue to form from repeated procedures which creates a new MGD monster problem.

Almondiyz, do you have, or can these doctors you speak of provide, any type of proof that probing really does cause scar tissue? Have they been quoted in any articles, literature, videos, studies, etc?

I have to say it's quite frustrating when on one hand you have four people on this thread stating their eye care professionals warned them about permanent tissue altering risks of the procedure, and on the other hand you have people swearing up and down it's safe and effective. As much as I tend to lean toward the two small studies available on the procedure, I'm not ready to easily dismiss the comments of professionals who look at eyes for a living, especially for a procedure which has only been out for a few years. Hopefully this new study NotaDryEye mentioned will provide a larger sample size and a clearer picture for both patients and professionals.

[NotADryEye]

I have to say it's quite frustrating when on one hand you have four people on this thread stating their eye care professionals warned them about permanent tissue altering risks of the procedure, and on the other hand you have people swearing up and down it's safe and effective.

I suspect we'll find that the professionals who warn against probing have a vested interest in promoting Lipiflow. These will be:
1. optometrists who might consider probing to be invasive, even though medically it is not invasive, and to whom Lipiflow is marketed as a non-invasive procedure
2. anyone who has invested in Lipiflow whether it be the angel investor, ophthalmologist, optometrist, etc.
3. Anyone who works for Lipiflow e.g. helped to design it, engineer it, promote it, market it, sell it, etc.
4. And as we've already heard, anyone in the Duke University area. There were some Canadians involved as well, although I do not recall where they were from.


The issue is really money behind the marketing of Lipiflow versus the money behind probing. Once angel invenstors come in, it doesn't really matter to them what happens to the patients who would benefit from a competitor's procedure. The investors just want to make their money. And in this case the investors see probing as Lipiflow's direct competitor. But to us patients it shouldn't matter. Effective treatments are effective and eventually we all know the difference. However, the issue is for those of us who are in agony now and need help now.

[DCRdryeye]

Okay, 2 weeks ago, I had to fly to the other end of the country (Queensland) to get Meibomian Gland Probing done. This ophthalmologist is at the top of his game with dry eyes!! very rare to find in Australia. After some expression with the Collins MG Expressor Forceps he noticed my meibum was low in quantity and poor in quality. So he began to perform MGP. He used two anaesthetic needles on all four inner eye lids (upper and lower) and 4 Dextamethasone injections - they all REALLY hurt. Then the probing itself was comfortable. We both felt the needle pushing through fibrosed tissue in every gland. Thus I have stenosed and fibrosed MG's.

After the probing, he used the forcepts again for expression. And yes, the meibum came out in larger quantities.

However, two weeks later I have not had any relief. I consulted another 'interstate' ophthalmologist today (again, having to fly) and have seen him twice before in Sydney. He used to do Meibomian Gland Probing and has stopped. His reason is because his patients return and they are back to where they were 'before' the probing and the benefits were zero to minimal.

Perhaps once the glands are fibrosed and stenosed, they are scarred, stiff and without the flexibility, unable to pump and squeeze the meibum out. In other words they are "buggered". Lipiflow would be useless for them, just a manual squeeze instead of the glands doing it themselves - a waste of money.

Anti-inflammatories cannot do anything for fibrosed, stenosed tissue. They are like a scar, lost it's elastin and collagen and has no stretch and pliability.

My next step is to 'fly interstate again' with new information I received today of two places that do meibography and see what the state of my stuffed glands are. I'm afraid I'll leave very upset with the images

I agree with many statements above such as manually squeezing the glands will simply push the meibum further up if they are blocked. It's true, where else will it go if fibrosis is an issue? and I agree that probing does not cause scarring. The needle used is very fine and if pushed into tissue other than the glands it will stop and go no further. The needle is flexible and only follows the glands. I'm confident with probing, but doubt it works.

[NotADryEye]

DCRdryeye, Any co-morbid conditions must be carefully identified and treated. If the co-morbidities are not diagnosed and addressed, and there can be many, it may feel as if probing has done nothing even though it has opened the glands and allowed the meibum to flow which is very important in restoring comfort. If, for example, you have developed chalasis, you will still not feel very good. I found it difficult to distinguish between the sensations when everything was going on at the same time. And when one condition was addressed and subsiding, another one would suddenly feel very prominent. I call this the "tight shoes" syndrome. If your shoes are too tight you can't feel your headache.

Was the dexamethasone that was used injected directly into the glands or into the lid diffusely?

What did the doctor say about comorbidities?

What did he tell you to do daily e.g. compresses, supplements, etc.

[DCRdryeye]

The Dextramethasone was injected into the inner eyelids. Comorbidities, simply drink more water which I'm not good at and reduce dairy consumption. I don't have chalasis.
It's a difficult thing.