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I met with that other ophthalmologist in the same office…

I met with that other...
I met with that other ophthalmologist in the same office today, and she went into considerable detail about my present condition and what changes she recommended in all the steps I have been doing. Here's are the five main changes she made:1) Stop using Xiidra (for now), and use Prednisolone 1% drops 4 time a day 1st week, thereafter reduce by one each successive week.
2) Stop using OcuSoft wipes and use AveNova wipes once a day
3) Take 2000 mg Omega-3 supplement a day, not more
4) Use Resolve Optive (with or without Mega-3) once a hour
5) Discontinue using Muro 128 for nightime use, use only 4)Images were taken of my meibomian glands, and she pointed out that many (most) of them were "distended" (?), meaning they were most likely clogged. To me, the difference between "normal", and my meibomian gland is that my glands look fat, which is probably what she is talking about. Production of tears is low and tear quality is poor. And now my eyes are dry, slightly red, and inflamed, but corneas are still okay. She recommends clearing out of the meibomian glands, but not at the present time, only after she see results from the Prednisoline treatment and from using AveNova wipes. She did discuss the necessity of careful daily lid scrubs, but unfortunately I'm still somewhat in the dark about just how to do that. Once the condition of my eyes have improved, then she recommends using LipiFlow to help clear out the meibomian glands. All in all, she feels that aggressive treatment and regular visits should bring symptoms back to the way things were before, even though I would have to keep with regular visits with her for careful management in the future.There was no mention of allergies. She feels that my present eye condition was precipitated by the extremely dry conditions in the Los Angeles region starting around August, and then most likely exacerbated by my recent experience with back surgery and all the medication that went with it.Overall, it sounds like the focus she has right now about my present condition is to get it ready for clearing out my meibomian glands, but now is not the best time to do it. After the clearing out, then she'll talk about long term treatment.Here's my question now: Do you think she is on the right track?
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Customer reply replied 4 months ago
5) Discontinue using Muro 128 for nightime use, use only Refresh PM Ointment
Answered in 3 hours by:
1/12/2018
Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 12,079
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Hi. I'm Dr. Rick and I have two decades of ophthalmology and retina surgery experience. I'm online and happy to answer your question today.

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As a retina doc who graduated medical school over 40 years ago I personally believe lipiflow "treatments" do not work any better then baby shampoo lid scrubs. Maybe I'm just out of touch with the use of modern (and very expensive) toys.....

the drops, tablets and scrubs are fine.

The steroids will help but their effect goes away when you stop the drop -- and the steroid drops are too dangerous to use long term.

This is how I tell my patients to do lid scrubs:

The best treatment for this condition is daily lid scrubs combined with warm compresses. I like to use baby shampoo for lid scrubs. In the shower, place the shampoo on your index fingers, close your eyes, raise your eyebrows (to stretch the skin on your eyelids) and scrub back and forth along your eyelashes for 3 to 5 minutes. The hot water in the shower helps to soften the plugged oils in the glands while the mechanical scrubbing with your soapy fingers removes the oils.

Baby shampoo lid scrubs will also help to stimulate tear production,

Make sense to you?

I am happy to be able to help you today. If you would be so kind, please help me get credit for my efforts in answering your questions and press the excellent feedback button for this encounter. And, don’t forget, I work for tips. I would also be happy to continue to answer any more questions you have until we have resolved your concern.

Dr. Rick MD FACS

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Customer reply replied 4 months ago
While waiting to see if I should be scheduled for Lipiflow, I can try to follow your instructions on how to scrub the lids myself. This sounds like a tricky business, so I'll need to proceed carefully and with practice. It can't hurt to start doing something about my meibomian glands. Then after a month or so, if it looks like it doesn't do the job all the way, then Lipiflow will be considered. What's your opinion of using AveNova scrubs?I think the point of the steroids right now is to prepare the eyes for the Lipiflow treatment. I'll ask the doctor, I'm expected to check with her again in 2 weeks.I do have a 2nd question, which has to do with estimated prognosis for my condition. I was shown a LipiScan of my meibomian glands. It looks a lot closer to "normal" than "not normal", in that there aren't any dropouts or truncations. All of the glands seem to be there, no gaps, but they do look thick. If I follow with lid scrubs and treatments to help clear them out, is it possible that my eyes can return to the condition they were just months ago? I know I will always have a Dry Eye problem, now that I am finally aware of it, but, still, is it possible that such severe Dry Eye could have developed so suddenly and irreversibly? That doesn't seem like "normal aging".

I think they are no better then a two dollar bottle of baby shampoo, hot water and your fingers.

I do believe that your meibomian glands can return to normal.

Hopefully you will not need to spend all that money on the lipidflow therapy....

Dry eyes are common, especially in folks over 40.

Just part of the Joys of Gittin' older ;)

Make sense to you?

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick MD FACS

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 12,079
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Customer reply replied 4 months ago
It's making more sense the more you talk. It's all about taking good care of meibomian glands, and I admit I've totally neglected them since I didn't know anything about them. Until now.

yup :-)

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