Don't get probed

[DCRdryeye]

It's been about 5 weeks since my probing. Only noticing a modest improvement. I wouldn't have it done again with this level of result. I guess it works for some and not for others.

[NotADryEye]

It's been about 5 weeks since my probing. Only noticing a modest improvement. I wouldn't have it done again with this level of result. I guess it works for some and not for others.

If you're aqueous deficient you need to address the lack of aqueous tears. If you have evaporative dry eye then the issue is with your Meibomian glands. What "works" depends not just on what is done but also on what condition you have. And many of us (most of us?) have more than one condition, thin all those co-morbidities, iatrogenic or other wise.

DCRdryeye, you might only feel a modest improvement after probing but the way I see it, a modest improvement just means that there is something else that still needs to be treated. The fact that you feel improvement means that probing helped with the evaporative/mg problem. If you hadn't addressed that then you would still be chasing that last amount of improvement to feel completely better even if you had resolved everything else.

And yes, it may be expensive, (who wouldn't rather pay less for anything and how many completely useless treatments, drops, devices, etc., have we all spent money on) but here in the US probing is covered by Medicare and so well worth the cost when you consider how important it is to have your meibomian glands functioning with open channels that allow the meibum to flow.

[zoso967]

Had MGD Probing Done

Hi,

I have aqueous deficient dry eye due to lasik. My understanding is that this lead to MGD.
I did the LipiView test which showed a very low lipid secretion score (tests how much lipids come out with each blink) but opted not to do LipiFlow at the time.

I had my MGD glands probed by my lasik surgeon in NYC. He used a 2mm probe. The procedure including prep and clean-up took about 30 minutes.

During the procedure I could hear/feel the "popping" sound Dr ****** describes in just about every gland my Dr probed. Sometimes 2 pops.
I could feel a mild sting with each probe but I would not describe it as painful. It was much less scary and painful than I imagined.

My Dr told me some of the glands orifices were not visible nor could he open them. Apparently trying to open these just caused the probe to bend.
He told me that there is a stiffer probe which may be able to open more glands and we are going to try that when he gets it.
He also prescribed Tobradex 2x day for 2 weeks but on the outside of the lid not on the inside like Tobradex is normally applied.

I easily handled treating all four lids in one session and although I brought a driver I was almost immediately fine to drive.
Next time should be even easier as I was blinded by the light the Dr was using. He will cover my cornea with a special lens designed to keep the light out.

Its been 2 days and though my eyes still get dry I haven't used tears more than 2 or 3 times since the procedure.
I used to use them all day long. Though I have to say the Tobradex is a bit irritating so I may just be making more tears due to that irritation.

I am curious to see if there's a significant difference in the LipiView scores now but I'm not sure I will get the chance to get tested again.

I am happiest with this treatment than any other I have tried and there have been a lot.
Other than artificial tears, punctal plugs and Azasite this seems to be one of the few things that work for me.

Hope this helps someone ...

[jadavispcfl]

Glad you're better!

Hi,

I have aqueous deficient dry eye due to lasik. My understanding is that this lead to MGD.
I did the LipiView test which showed a very low lipid secretion score (tests how much lipids come out with each blink) but opted not to do LipiFlow at the time.

I had my MGD glands probed by my lasik surgeon in NYC. He used a 2mm probe. The procedure including prep and clean-up took about 30 minutes.

During the procedure I could hear/feel the "popping" sound Dr ****** describes in just about every gland my Dr probed. Sometimes 2 pops.
I could feel a mild sting with each probe but I would not describe it as painful. It was much less scary and painful than I imagined.

My Dr told me some of the glands orifices were not visible nor could he open them. Apparently trying to open these just caused the probe to bend.
He told me that there is a stiffer probe which may be able to open more glands and we are going to try that when he gets it.
He also prescribed Tobradex 2x day for 2 weeks but on the outside of the lid not on the inside like Tobradex is normally applied.

I easily handled treating all four lids in one session and although I brought a driver I was almost immediately fine to drive.
Next time should be even easier as I was blinded by the light the Dr was using. He will cover my cornea with a special lens designed to keep the light out.

Its been 2 days and though my eyes still get dry I haven't used tears more than 2 or 3 times since the procedure.
I used to use them all day long. Though I have to say the Tobradex is a bit irritating so I may just be making more tears due to that irritation.

I am curious to see if there's a significant difference in the LipiView scores now but I'm not sure I will get the chance to get tested again.

I am happiest with this treatment than any other I have tried and there have been a lot.
Other than artificial tears, punctal plugs and Azasite this seems to be one of the few things that work for me.

Hope this helps someone ...

I am so glad that you are better!

[jadavispcfl]

I agree that you may have co-morbid diseases. I had to have surgery in both eyes for conjunctival chalasis. Probing opened up my glands, but that was only part of the problem.

[NotADryEye]

I had my MGD glands probed by my lasik surgeon in NYC. He used a 2mm probe. The procedure including prep and clean-up took about 30 minutes.
During the procedure I could hear/feel the "popping" sound Dr ****** describes in just about every gland my Dr probed. Sometimes 2 pops.

The "popping" sound indicates that there is fibrous tissue obstructing the gland. When there are two pops this is usually more than one band of fibrous tissue. Sometimes the sound and sensation is described as "gritty". In your case, most of your glands must have been obstructed. By probing he established and confirmed a channel for the meibum to flow.

Great that you are feeling better. Please keep us posted on how things go when your doctor gets the stiffer probe.

[DCRdryeye]

Still no improvement from probing despite all the popping and opening of obstructed glands. Sure, more meibum was flowing after the procedure, but my eyes are dryer than ever now. One top ECP used to do MG probing here, and has since stopped. His reason is that he CONSTANTLY didn't notice the results from it, nor did his patients. I didn't believe him and found one of the only ECP's in Australia who does probing, I learnt the hard way.

I don't recommend probing either. It's going to take years to effectively treat dry eye.

[jadavispcfl]

Have your been tested and gotten a diagnosis for your specific dry eye problem? Here are some of the tests: Schirmer Test, Flourescein Test, rose Bengal staining, Tear clearance test, MRI for Graves' disease or a lacrimal gland tumor, blood tests for Sjogren's, lupus, diabetes, or others, test for demodex mites, and more. Probing is a tool to solve the complicated web of eye problems. It does, as you say, get the medium flowing so the oils will protect the tears from evaporation. If there is something else going on though, that must also be addressed.

[NotADryEye]

DCRdryeye, If I recall correctly your unresolved issue has to do with retaining moisture due to the DCR surgery. Your current tear ducts are so large that your tears flow out more quickly than your lacrimal glands can keep up. Is that correct? That would mean you have an unresolved drainage issue. Probing isn't designed to solve this specific problem. I'm not sure what is. But what probing did was establish channels for the meibum to flow out of your meibomian glands. It is designed to help with evaporative tear deficiency, or an insufficient layer of meibum covering the tear film. Evaporation and drainage are not the same thing.

Also the ECP that did not see results may not have had a good grasp, and it takes an expert grasp, on all of the other co-morbidities that can mask the effects of probing because so many of these co-morbidities feel symptomatically like the others. You may have seen an earlier post where I listed 4 completely different conditions that felt exactly the same in the exact same spot on my left eye.

1. a blocked meibomian gland
2. an injury to the eye where I poked myself with my thumbnail
3. a muscle spasm in the eye lid
4. an eye lash growing at the lid margin

Also, there are countless other symptoms, conditions and diseases that I have had to address and resolve, one after another including a systemic thyroid condition. These have included conjunctival chalasis, tear saponification, intolerance of any drops including all preservative free drops, demodex mites and a growing intolerance to Cliradex and Tee Tree Oil, lashes that collide and that prevent me from blinking completely, keeping my eyes opened when I sleep, a previous corneal abrasion, aqueous tear deficiency, sensitivity to tears with delayed tear clearance after punctual cautery, bacterial infections with Staphylococcus epidermidis and Corynbacterium jeikeium, and the previously mentioned thumb nail injury, eyelash and muscle spasms. And this is not even a complete list.

Probing has been just one treatment, but one essential treatment, on my road to managing Dry Eye which is a multifactorial disease that includes many related but very different conditions. Perhaps in time, when you finally find some lasting relief, you might come to this same conclusion.

[DCRdryeye]

NotADryEye, when I had my probing done, the ECP also stitched up my large punctums and reduced their size (almost closed them completely). I am not a lay person and have been studying dry eye for 7 yrs. I've had most of the tests java recommended too except for the Lacrimal gland tumour.
Probing is NOT an essential part of dry eye care at all. 85% of dry eye sufferers actually don't produce enough oil. So probing doesn't do anything for them at all. May-be it's for 15% of the dry eye population. In fact, it's a waste of money and time and I would not recommend it to anyone. Why? I've spoken to countless people whom it hasn't worked for at all. They've checked for 'co-morbidities' and that's probably produced better results than probing which they also believe PROBING is a complete waste of money and time.

Furthermore, probing can permanently scar the delicate tissue around the Meibomian Glands. We are already in trouble with dry eyes, we certainly don't want to make it worse.

Before I hear you mention Flaxseed oil. I take a LOT of it, including Fish oil everyday.

[jadavispcfl]

DCRdryeye,

It sounds like you are very frustrated because you have spent so much time, money, and effort with little to show for it. I wonder, however, whew here are you getting your statistics from? You say 85 percent of dry eye sufferers don't produce enough oil. I have never heard that before. You say countless people have tried probing and it hasn't worked for them. You are negating the people on this thread's experiences that had good results. Why? You say that probing causes scarring on the tissue around the glands. My doctor has never poked through the tissue around the glands. He is poking through the orifice of the glands to get inside. Let's be honest here. Why are you so against probing?

[NotADryEye]

DCRdryeye, I am curious about the statistics you cite as well.

Also, I disagree with the conclusion you draw from the statement that "85 percent of dry eye sufferers do not produce enough oil." The corollary to this is that someone without dry eye produces enough oil. Therefore, if the dry eye sufferer has evaporative deficiency and does not produce enough oil, and if the production of oil is important to tear film (as evidenced by the non-dry eye population) its stability and the patient's comfort, then the conclusion one draws is that the dry eye sufferer's lack of oil production should be reversed. As probing creates a channel for meibum expression, thereby encouraging access to the meibum that is produced while also encouraging the production of meibum, than the logical conclusion one draws is that probing should be performed on 85% of the dry eye population that does not produce enough oil.

Also, perhaps you need to have your tear ducts closed more to further reduce aqueous outflow. Almost closed may not be enough.

And finally, have you had a comprehensive thyroid panel or your homone levels tested? These can also be important factors.

[DCRdryeye]

I'm in a hurry today so just passing through really. I got the 85% figure from pubmed, can't find it now but will when I get a moment free. This December I am having a partial cautery done to my enlarged punctums to bring them back to normal size (since I am against permanent closure). Then in 3 months once the tissue is completely healed I'll have plugs put in. Plugs can also be a nuisance with feeling them on the ocular surface and obtaining the correct fit. It's not an easy ride.

Yes, as a Naturopath I've had a FULL thyroid check done including rT3, T3, T4, antibodies, etc and organized it myself. I'm clear. You'll probably agree with me that TSH is not a very accurate test for Thyroid problems and many people are misdiagnosed. And yes I've had a comprehensive hormonal panel performed via both saliva and blood serum. The abnormal results were low intracellular Testosterone, low DHEA and High Estrone. - I use bioidentical Testosterone (mixed with Chrysin to bring the estrone down) and DHEA troches along with herbs and nutrients to obtain a balanced hormonal profile. All in normal ranges now.

Other abnormal markers found were low Magnesium, high Homocysteine and very high serum Copper - all being treated now.

I'm sorry to discredit PROBING, but I've been on this forum for several years and have spoken to HUNDREDS of people with direct experience having had probing. Unfortunately, they just don't seem to be obtaining the results it claims. Going against their experiences, I had it done myself since I had an ounce of belief in it and saw the logic in clearing obstructed MG's. Logic would tell us that clearing obstructions would clear the lumen for meibum flow. Yet, for some mysterious reason it didn't happen for me, as well as many others whom I've spoken too. I therefore concur with the many patients with negative results from PROBING, that it does not work.

Perhaps the acini are also fibrosed and cannot synthesize or squeeze out the meibum. I am using anti-fibrotic herbs to deal with this situation. We need to look further into the causes and discover what else could be added with PROBING to make it last and acheive 100% results with all patients. Something is missing, we must look out of the box and find it. I'm not against probing and believe it's a marvellous idea, I just didn't get the results from it, and having checked for co-morbidities...that didn't work either. Probing should work in theory, and does for a certain group of people. But many simply waste their money on it, further drives them broke and also gives the practitioner a bad reputation.

[NotADryEye]

DCR, the partial cautery/punctum sounds like a good idea given your aqueous deficiency. Can you repeat here why you had epiphora? That is why you had DCR surgery, is that right? But what caused the epiphora?

Thyroid - completely agreed. When my T3 is low, and TPO is raised, when I wake my eyes feel drier. I recently started Cytomel, at my ophthalmologist's urging, not my primary who tested me, and now my DO/naturapath has prescribed Cytomel. Much better, much wetter, now.

Magnesium - that was a big one for me as well. About the time I started taking magnesium my eyes began to feel better.

We seem to disagree about probing. I stand behind my personal experience and its efficacy. I would like to see the statistics from pub med. Also it is difficult to believe your claim that you have spoken to "hundreds of people." How many people could have had probing all around the world if you now only have one physician in Australia who performs the procedure and there are a handful of doctors who do it in the US and there is one in the UK? Did you speak to the Russian doctors and ask them about their study, also on pubmed? Perhaps it would be best if we could first quantify the total population of those probed (incidents), before making claims that hundreds have had bad experiences, or that all of had great experiences, so that we could come to some meaningful conclusions rather than relying on what sounds like hyperbole. As a healthcare provider yourself, I imagine that you would agree that this is an important distinction.

And also, it is important to point out that the people who post or come to Dry Eye Zone are not all of the dry eye patients in the world. We are just a small subset. Statistically speaking, we are not that significant. As individuals we are, but not statistically speaking.

Nevertheless, I do understand that your acini may not be functioning. This may be one of your co-morbidities. The root cause of which is ???? Even with opened channels post-probing, you are not producing meibum in an adequate quantity. And for this yes, we need more research and more treatment. All of which seems to be grossly inadequate at this time in our lives. On this point, I believe we are in complete agreement.

I would like to hear how you feel after the partial cautery. Mine are partially closed and I seem to be doing pretty well. Still addressing co-morbidities as I suspect many of us will be for the foreseeable future.

[NotADryEye]

DCRdryeye, Have you had the partial cautery done yet? How are you doing now?