How Intraductal Meibomian Gland Probing and Surgery Relieved my Dry Eye Symptoms
Renewed Eyes-Renewed Life
How Intraductal Meibomian Gland Probing and Surgery Relieved my Dry Eye Symptoms
It happened gradually. My eyes appeared extra tired and red after a long day, particularly after travelling. I first turned to help at my local drug store. Unaware of my real condition, I initially treated my eyes with over-the-counter eye whiteners. They improved my appearance by constricting the blood vessels in my eyes, but my eyes still felt tired and sore.
After my self-help failed, I turned to local eye doctors. The first doctor found penguiculae on the whites of my eyes (sclera). Penguiculae are thickened spots on the sclera, usually due to excessive sun exposure. He prescribed a steroid for two months. I had heard about dry eye syndrome and asked him about it. He advised me that I was too young to have it, and did no further testing. “Just remember to always wear sunglasses outside to keep the penguiculae from getting worse.” I left his office feeling confused and put off.
By the time I saw my second doctor, my red eyes were very red. He diagnosed that me with allergies, and prescribed a five day course of Pataday. After a few weeks, I was back with a different doctor. He explained that I had keratoconjunctivitus sicca, or dry eye syndrome. Dry eye, he explained, sometimes affects women that are menopausal, like me. He prescribed lubricant eye drops, Lotemax (a steroid used for a limited time), Restasis (a drug that sometimes promotes the body to produce more tears), and removable punctual plugs. He placed the plugs in my lower tear ducts to keep my tears pooled on my eyeball longer. I was also still using the eye whitener when I needed it, however. I began to notice that the vascular veins in my eye were becoming larger. The whitener was not helping much at all. On a good day, my eyes were still somewhat red. Periodically, however, I would have a flare-up with severely red, burning eyes.
One morning I noticed that my eyelids were swollen, and my eyes had dark circles under them. I also noticed that I could stand bright lights. Another doctor visit did not deliver any answers. I was always asked the question, “Do your eyes have gooey discharge in them in the morning?” My answer was always “no”. I was prescribed Lotemax again, followed by lubricants. The Lotemax did reduce the swelling in my eyelids for a time. I also started to use a thicker, preservative-free lubricant drop more often. By now I needed the lubricant at least every two hours. This doctor also recommended me seeing the best doctor in their group.
The next doctor I saw prescribed a combination of prednisone, lubricants, permanent duct plugs (the temporary ones fell out), and more Restasis. My eyes were red and inflamed all the time by now, and my eyelids were swollen again. He also mentioned possibly surgery for the penguiculae. The prednisone quieted my eyelids for a time, but my eyes remained red.
Frustrated, I searched the internet. I discovered that there are three layers that make up the tear film. The top layer is a thin but important oily layer. The oil comes from tiny meibomian glands found just behind the eyelashes. There are approximately 50 glands around each eye. The glands provide oil (meibum) for the top layer of the tear film, preventing its evaporation. “Could I have something wrong with my meibomian glands?” I wondered.
I asked about the meibomian glands on my next doctor visit. I was prescribed AzaSite, an eyedrop that is supposed to get into the meibomian glands and thin the meibum. I couldn’t tell if there was any improvement after a three month course of treatment. This drug also burned my eyes.
Three years had gone by. My flare-ups occurred more frequently. It was apparent that eyedrop therapy was not effective for me. My frustration with my red eyes shook my self-confidence. I couldn’t remember what normal eyes felt like. Every situation had to be played out. I got dressed in a darkened room because I couldn’t stand the bathroom lights. I no longer wore red or pink clothes. I had to get up earlier in the morning, so my eyes would be somewhat presentable for work. Travelling always caused a flare-up. I knew my eyes were getting worse. I was using lubricant drops every hour. I couldn’t imagine how my life would be as an older woman. I needed to find some answers.
Another computer search led me to Dr. Steven Maskin’s book, “Reversing Dry Eye Syndrome”. Dr. Maskin’s book offered detailed explanations for the reasons behind my dry eye symptoms, explained tests to pinpoint where the problems might occur, and offered practical suggestions for managing dry symptoms. Surgery was suggested in some cases. With more answers came more questions. One answer I got was that the eye whitener I had been taking off and on was very damaging. All it ever did was to provide temporary help to get the red out. It was the probable cause of the increased prominent vascular blood vessels so apparent by now. I decided to seek out Dr. Maskin for help.
By the time I saw him, my eyelids were severely swollen and my eyes were bright red. Lotemax could only control my swollen eyelids for a few days. Dr. Maskin first reviewed my medical records, and asked specific questions to pinpoint my symptoms. He then examined my eyes and performed a series of tests to determine the extent of damage. After testing, he diagnosed the following:
• Tear deficiency in left eye (no plugs found)
• Obstructive meibomian gland dysfunction (MGD) with Posterior Blepharitis (both eyelids)
• Superior conjunctivochalasis (CCh) in both eyes
• Surface vascular veins enlarged in both eyes
• Penguiculae in both eyes
• Rosacea on face (typically associated with MGD)
Obstructive MGD occurs when the meibomian glands become plugged. The oil (meibum) cannot flow, reducing the required amount for adequate tear film balance. Superior CCh occurs when the eyelid is tight to the eye globe, creating mechanical friction trauma. The result is a wrinkling or looseness of the conjunctiva. The looseness creates a potentially inflammatory situation in the eye. The Penguiculae are benign growths on the surface of the eye. They could eventually grow onto the cornea. They could be removed with surgery. Rosacea is a reddish skin disorder of the face. Many people who have MGD also have rosacea.
He explained my problems and how he would treat them. The left eye tear deficiency was treated by cauterization. This technique was preferred over punctual plugs, which tend to fall out and/or cause other problems. The MGD was treated with Intraductal Meibomian Gland Probing, a new procedure he invented. Finally, ocular surface (conjunctiva) reconstructive surgery was performed on both eyes to remove the superior CCh and enlarged vascular veins.
The probing is a new approach to alleviate the symptoms of obstructive MGD. First, Dr. Maskin applied pressure to my glands to see if they were functioning. In my case, he only detected two glands out of 30 were functioning on each upper eyelid, and less than 10 out of 20 were functioning on each lower eyelid. Next, each gland was mechanically penetrated with a tiny stainless steel probe. This probe alleviated the pressure built up in the glands. He then expressed the plugged matter built up in my glands. Finally, he injected a steroid into each gland through a tiny tube. The results of the probing were dramatic. Within hours, my eyelids were no longer swollen. I looked and felt better by the next day. I was so thankful to finally find relief.
Surgery for the each eye would start the next week, with a three week recovery delay between surgeries. The surgery for each eye was the same. Dr. Maskin first removed the wrinkled CCh, and then removed the enlarged vascular vein tissue along with the penguicula from the conjunctiva. Next, he used the wrinkled CCh material and grafted it onto the conjunctiva where the enlarged vascular vein tissue had been removed. Finally, he grafted amniotic membrane tissue from a donated elective caesarian section on to the space where the CCh had been.
The final result after a few weeks is indescribable. I rarely need the lubricants now. My eyes are now comfortable and are no longer noticeably red. My eyelids are longer inflamed. Probing and surgery have changed my life. The probing procedure may need repeating in a year. It is a reliable, tested procedure that should be considered by anyone suffering from obstructive MGD.
what are the cost of the procedure, and do you have a link that provide more information regarding to the procedure?
I don't think I am supposed to talk about costs on this forum. I will say that you do have to pay up front, and then Dr. Maskin's office will file for your insurance. There are videos of the procedure on Youtube. You can also go to www.drmaskin.com to get more details. He has really helped me. It is worth the money.
I spent a lot of money visiting Dr. Maskin and it was a wasted trip. He told me he could help me before I even went to see him.
Just be careful what you commit to.
will this procedure work on dry eyes from Stevenson-Johnson Syndrome.
will this procedure work on dry eyes resulted from Stevenson-Johnson Syndrome? Do you have any idea about it.
Just to note I had this procedure done last year and had no success at all from it