Don't get probed

[NotADryEye]

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.

Steroids should not be randomly injected into the lids for mgd unless you have refractory chalazion, and then the doctor should probably use a different steroid to inject directly into the chalazion. For mgd, it’s better to inject the steroid directly into the gland ducts.

Significantly more expressible meibum after probing typically indicates that your mg’s are in a chronically obstructed state. You probably wouldn’t be a good candidate for Lipiflow until after probing. You might even consider periodic probing, e.g. annual or more frequent, to establish and maintain an unobstructed mg outflow tract, in the same way that you go to the dentist to keep your teeth clean. In this way you would use probing as a preventative measure, preventing chronic damage to the glands so you don’t end up with fibrosis and atrophy.

These 5 steps are from a handout I picked up in his office and that Dr. ****** provides to ophthalmologists who perform probing.

•Establish or Confirm with evidence of probing’s physical proof, a patent orifice and duct system for optimal meibum flow.
•Keep orifice and duct patent by treating co-morbid disease and use of lid hygiene/nutriceuticals.
•Microtube injection of intraductal pharmaceuticals to modulate growth and differentiation of dysfunctional ductal and/or acinar epithelium to super-optimize meibum quality.
•Maintain comfort and gland health with topical jojoba/pharma therapy.
•Palliate with topical therapy

Would you say that these five steps were followed by your doctor?

Sounds like you weren't diagnosed with specific co-morbidities, were you?

[DCRdryeye]

Everyone treats differently based on feedback and studies. The ophthalmologist I worked with used to inject the glands with anti-inflammatories but had clients return complaining of swelling, etc. If I request he injects me during my next probing, he'll do it. He's a very open minded doctor. He also recommended Testosterone cream (but I was already using) and very rarely will an ophthalmologist in Australia stock it, nor dare to mention it. So he is the best we can get and he spent 2.5 hours with me.

He also stitched three of my punctas with dissolvable stitches as an alternative to plugs and dura-plugs to see if it made any difference.

Furthermore, rather than charging me $6,000 for probing (like a doctor we both know), he charged me ZERO due him knowing I've been stuffed about by so many doctors. Certainly a real gem and compassionate eye doctor, what a relief from the nasty ophthalmologists I've seen in the past, eg: I document a visit to another ophthalmologist here: http://www.blockedtearductsurgeryadult.com/?p=91

[NotADryEye]

Finding a good doctor is half the battle. It's great that you've found someone that is compassionate and will work with you. Will you be going back to him?
Still, I can't help thinking there is more to it. You clearly understand that keeping the mg channels opened is important. Now there is work to do to find out what else is going on and how to address it. That's the other half of the battle.

[DCRdryeye]

Yes I'll definately go back to him for further probing, but not until after I get my two left enlarged punctums 'partially cauterized' to a size they once were or as small as we can get them. That will be performed by another doctor in another state. Yes, unfortunately we have to travel from doctor to doctor once we know what they do. Some perform treatments that others don't. Eg: The wonderful eye doctor who performed the probing was into permanent cautery which I didn't want. However, another well-known dry eye doctor in Sydney mentioned 'partial cautery' which really caught my interest. It involves light sedation and thus is treated as a day procedure.

[jadavispcfl]

Probing Helped Me

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.

Hello,

I am also A patient of Dr. ******. In June of 2011, I sought out Dr. ****** after suffering for three years. Dr. ****** probed my eyes that day after a 2 hour evaluation. He also cauterized my upper lids. He told me that I only had 3 functioning glands in my upper lids. I have to stress, as notadryeye does, that I also had CO-MORBID diseases. In my case, each eye had conjunctival chalasis. This is a loosening of the conjunctiva, brought on (I believe) by the repeated enlarging of my swollen eyelids. In other words, there wasn't enough tolerance between my eyeball and eyelid when repeated swelling occurred. The result was the conjunctiva became squeezed and stretched, creating a loosening. The result was pain and trauma to the eye when I blinked. Any change in my surroundings, such as traveling, seemed to affect my eyes and cause them so be bright red.

A week after the probing, where Dr. ****** injected a steroid in each gland, he performed surgery with a amniotic membrane transplant, to my left eye. He performed the same thing on my right eye a month later.

The results after probing were relief, but I could tell that I was not out of the woods. It was only after the surgery that I felt true and lasting relief. My results were life changing for me. I can't say enough about how much better my eyes are.

Two years have gone by, and I still am a dry-eye patient. I've had to deal with inflammation this year. I also had my eyes probed again in September, this time with NO steroid injection. I had absolutely no problems after the probing. In fact, while the actual procedure is a little tough, my eyelids felt so much lighter afterwards. It was sort of like the feeling you might have when you leave the dentist after a good teeth cleaning.

So, addressing the co-morbid diseases are so important. I would not have had the same outcome if Dr. ****** had just probed and cauterized the ducts.

[LaDiva]

I've thought about having probing done, but the quality of my oil is bad. Would it do any good to probe if the oil quality is so bad it still refuses to flow well? I take antibiotics, Omega supplements, and use hot compresses, expression, eat no dairy, no inflammatory foods, no alcohol, drink plenty of water...etc... I am not sure probing would help in my case, and have no idea what else to do to improve oil quality. I truly think if I could improve oil quality, that my eyes would be in pretty good shape.

[NotADryEye]

I've thought about having probing done, but the quality of my oil is bad. Would it do any good to probe if the oil quality is so bad it still refuses to flow well? I take antibiotics, Omega supplements, and use hot compresses, expression, eat no dairy, no inflammatory foods, no alcohol, drink plenty of water...etc... I am not sure probing would help in my case, and have no idea what else to do to improve oil quality. I truly think if I could improve oil quality, that my eyes would be in pretty good shape.

Whatever the quality of your meibum, it is important that it flows, that it is not backed up in the glands, and that the glands are not constricted. You may have some blockage or constriction as these can cause the quality of the meibum to degrade i.e. you need good fresh meibum flowing through an unobstructed channel, not old stale meibum that may have bacterial or microbial debris.

Several conditions can cause poor quality meibum including hormonal imbalances, thyroid disease, demodex mites, bacteria, anything that causes inflammation of the glands and the list goes on.

It is important to address food sensitivities. One of my barometers for meibomian gland condition and function is my skin. If the skin on my face is clear I have a better chance of having clearer meibum because the meibomian glands are a type of sebaceous gland. In the case of food sensitivities you may need to determine which specific foods you are sensitive to. In an earlier post I listed the dozens of foods that I was sensitive to. Dozens. So although we are all told to avoid dairy and the like, the foods that you need to avoid may be different. I am not saying that you should start drinking milk, but rather that there may be other foods that you need to avoid. After completely eliminating all the foods to which I was sensitive for one year I began to slowly reintroduce them. I had worked on improving my gut flora as well and together now I am doing much better with different foods. I believe that many of the sensitivities are now eliminated though I have not been retested recently.

You may also need to be tested for demodex mites. Demodex can live in the meibomian glands, cause inflamtion and degrade the quality of the meibum. Bacteria also contribute to poor quality meibum.

It is terrific that you are taking O3 supplements. You may also consider increasing the O3 you consume in your diet while at the same time reducing 06.

Also, do you have any autoimmune diseases? These can contribute to poor meibum e.g. Hashimoto's hypothyroid.

[LaDiva]

I've been tested for everything (including food and other allergens) , and have used an elimination diet to discover what not to eat. I had a bad case of acne before starting the antibiotics, and do not know what caused the acne as I have always had nice skin, but it was BAD. I've had my hormones checked. Nothing much left to do. I also take special vitamins and EFAs. Thank you for the suggestions, though. I do have ocular rosacea.

[Katewest]

LaDiva-Remind me again how long you have been dealing with dry eyes. I am getting my hormones checked tuesday

[LaDiva]

Hi Kate,
I was just thinking about this yesterday. You are a mind reader! It will be four years in May. Actually, the eye doctor has been telling me I have dry eyes for the past twenty years, but they didn't bother me until May of 2010. I thought there was something in my eye, and it hurt, so I went to the eye doctor and she said my glands were plugged and told me to use hot compresses. Needless to say, it wasn't a cure. My eyes are better than they were, but still not normal. Good luck with your hormones!

[NotADryEye]

I had a bad case of acne before starting the antibiotics, and do not know what caused the acne as I have always had nice skin, but it was BAD... Nothing much left to do.... I do have ocular rosacea.

The acne coincides with mgd/ocular rosacea, since the meibomian glands are a type of sebaceous gland. If you are having acne you are more likely to have mgd - like acne of the mg's. You may want to be tested for demodex mites. There is a type of rosacea that is caused by demodex. Some 5-8 years ago there were dermatological studies linking rosacea to demodex but the studies were inconclusive. Still some found a type of rosacea caused by demodex.

You might also consider probing since your doctor told you your glands are plugged. Warm compresses do help. But if the openings are constricted or blocked with fibrous tissue your meibum does not have a clear channel of flow. Probing re-establishes the channel.

[LaDiva]

Thank you NADE!

[jadavispcfl]

I have rosacea and some adult acne. The rosacea is common with dry eye sufferers. I just had another checkup, 6 weeks post probing. The meibum oil was flowing in my glands, and my eyes are comfortable. This is my second probing procedure. All I can say is that it really has helped me. I had NO complications post probing.

[NotADryEye]

I have rosacea and some adult acne. The rosacea is common with dry eye sufferers. I just had another checkup, 6 weeks post probing. The meibum oil was flowing in my glands, and my eyes are comfortable. This is my second probing procedure. All I can say is that it really has helped me. I had NO complications post probing.

I'm with you on this. Same excellent results. No complications. Each time.

[jadavispcfl]

Thank you NADE. It's good to hear from you!