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Thread: Probing and Ocular Reconstructive Surgery help for Dry Eyes

  1. #1
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    Probing and Ocular Reconstructive Surgery help for Dry Eyes

    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, especially after traveling somewhere. A doctor’s diagnosis was dry eye syndrome. Dry eye, he explained, sometimes affects menopausal women, like me. He prescribed lubricant eye drops, periodic Lotemax (a steroid), Restasis (induces more tears), Omega-3 supplements, and punctal plugs. I was also taking an over the counter eye whitener, about once a day. This therapy gave me little success. Eventually my eyelids became swollen. Lotemax temporarily help calmed these flare-ups.
    Three years of struggling with this regimen shook my self-confidence. I couldn’t remember what normal eyes felt like. My eyes began to affect every situation, personal and professional. I couldn’t imagine what my life would be like as an older woman.
    A computer search led me to Dr. Steven Maskin in Tampa, Florida. He reviewed my records and made the following diagnosis:
    • Tear deficiency in left eye
    • Obstructive Meibomian gland dysfunction (MGD)
    • Large vein mass in both eyes, nasal area
    • Superior limbal keratoconjunctivitus (SLK), both eyes
    Obstructive MGD occurs when the meibomian glands become plugged. The oil (meibum) cannot flow, reducing the required amount for adequate tear film balance. SLK 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 large vein mass in each eye is probably due to my overuse of eye whiteners.
    He explained my problems and my personal plan. The left eye tear deficiency was treated by cauterization. He prefers this technique 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 (www.drmaskin.com). Finally, ocular surface reconstructive surgery was performed on both eyes to remove the SLKs and enlarged vein masses.
    Probing is currently the only procedure to completely clear the obstruction in the meibomian glands. Each gland is mechanically penetrated with a tiny stainless steel probe. The matter from the glands is then expressed, if possible. Next, a steroid is inserted into each gland through an intraductal microtube.
    Surgery on each eye was performed, with a three week delay between surgeries. Dr. Maskin first removed the SLK, and then removed the large vein mass from the conjunctiva. He grafted amniotic membrane tissue from a donated elective caesarian section for the resurfacing.
    My eyes are now comfortable, and my self-confidence has returned. Dr. Maskin’s approach of first clearing the obstruction in the glands, and then correcting the underlying conditions, such as resurfacing, has been life changing for me.

  2. #2
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    Wow, this is great news. I am so glad to hear that your eyes are back to normal. My Dr, Dr. Michael Gagnon is talking about the same 2 procedures that you had. I have all of the problems you have except for large vein mass. However, anyother Dr has said that I might not heal well with the SLK surgery even with the grafted amniotic membrane as my eyes are so dry. How long ago did you have all of this done? Do you continue to use any drops or medications?
    Last edited by Trac; 12-Aug-2011 at 20:21.

  3. #3
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    Trac,
    I had the probing done on June 20th, left eye done on June 27th, and the right eye done on July 20th. I am down to one eyedrop- Pataday 2x/day, and I wash out my eyes 2x/day with non-preservative sodium chloride vials. I'm almost recovered from my last surgery. It has truly been life changing for me.

    By the way, I spoke to my doctor about your case- and one thing he mentioned is that some other doctors perform the probing but do not address the other underlying causes that are associated with dry eye. Probing (he invented it) works to clear the obstructed meibomian glands. But the SLK also needs addressing. Just something to think about.

  4. #4
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    Thank you so much. I am glad to hear that you are on the road to recovery. I will address these with my doctor.

  5. #5
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    Did Maskin also cauterize your puncta before probing?

  6. #6
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    yes, he did. I had already had two sets of plugs, and they didn't do much for me. My eyes were extremely bad by the time I saw him.

  7. #7
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    Does cauterizing really help that much more than plugs if you tolerate the plugs well? My doctor wants to cauterize all 4 ducts and I don't want to do it, I think it is too drastic. But, I did not want to get the plugs either and I put it off until I was blinded by so many filaments. I lost about one plug a month in the beginning, but for the last several months I have not lost any. My doctor says that cauterizing will ensure that nothing gets out of the eye and he says it is reversible if I ever need to open them again.

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    jadavispcfl- During the probing procedure..did Dr. Maskin also do the steroid injections in the MG's?

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    Quote Originally Posted by jadavispcfl View Post
    yes, he did. I had already had two sets of plugs, and they didn't do much for me. My eyes were extremely bad by the time I saw him.
    Well, I'm just curious if cautery is disguising the fact that there is negligible benefit from probing.

    In other words, there is no way to separate out the effects of probing if cautery is done prior. This should be mentioned in any research on probing... if cauterization is always done prior probing, then you cannot state that probing helps at all.

    Right now, I don't know of anyone who wasn't cauterized prior to probing by Maskin. Strange?

  10. #10
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    Probing

    I think you're confused about the reasons for cauterization and probing. I had my tear ducts cauterized 7 years ago for insufficient tear flow. While I had immediate relief, over the years my eyes became increasingly dry due to dysfunction of the the meibomian glands. The cauterization while helpful did not address the MGD so up until now, I was left only with lid scrubs and heat packs.
    Before the probing, my lids were itchy, burning and I had many styes. Since probing, my lids feel great; no more itching, burning, crusty lids.
    Thank, God for the invention of this technique by Dr. Maskin. Up until now, doctors could only offer eye drops.

  11. #11
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    Quote Originally Posted by linmis View Post
    Up until now, doctors could only offer eye drops.
    Regarding MGD treatments, I have to say this is not really accurate. Eye drops are sometimes used (mostly off label like Azasite) for MGD but treatments for MGD range from oral EFAs to oral antibiotics to lid scrubs and warm compresses to IPL and now Lipiflow recently approved by the FDA. Other than Azasite the only use of eye drops in MGD is palliative - lubrication when the tear film's breaking up too fast.
    Rebecca Petris
    The Dry Eye Zone

  12. #12
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    I'd like to clear up what happened to me. First, I had tried every eyedrop imaginable (Azasite did nothing but burn) before I saw Dr. Maskin, suffering for three years. Lotemax helped temporarily. I had two sets of plugs (lower) put in too. When I saw Dr. Maskin, the second set of plugs were gone, and I was a total mess (large eyelids and red eyes). Since I was out of town, he spent the afternoon testing me, cauterized one eye, and then performing the probing.

  13. #13
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    I am 16 years into DE and I've tried it "all" too. What I am saying is that it is impossible to identify what caused improvement if two (or more) procedures are done at the same time. If there is a change in condition, there is no way to pinpoint which worked.

    For example, in my case, my lower puncta were already cauterized when I saw Maskin. He cauterized my uppers and performed probing. Any improvement that I may have cannot be attributed to cauterization or probing... they confound each other. Their effects cannot be separated.

  14. #14
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    Did u have a doctor check your MGs after the procedures.Surely any improvement in them could only be attributed to probing.I was considering seeing Dr maskin for probing but having heard some mixed reviews on him and the benefits of the procedure,i think ill pass for the moment

    Quote Originally Posted by spmcc View Post
    I am 16 years into DE and I've tried it "all" too. What I am saying is that it is impossible to identify what caused improvement if two (or more) procedures are done at the same time. If there is a change in condition, there is no way to pinpoint which worked.

    For example, in my case, my lower puncta were already cauterized when I saw Maskin. He cauterized my uppers and performed probing. Any improvement that I may have cannot be attributed to cauterization or probing... they confound each other. Their effects cannot be separated.

  15. #15
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    For Lfarls,

    Yes, Dr. Maskin injected a steroid into my eyelids after he cleared the obstructions with the probing and excreted any matter that was blocking my eyes. At approximately 50 pokes/eye, probing consists of 300 pokes.

    In answer to spmcc, I only had my left eye lower punctal cauterized before the probing. So, my improvement in my right eye was only due to the probing. My left eye was worse than the right eye.

    One thing that I MUST STRESS, is that probing is ONLY part of the answer. Your doctor MUST look for other factors that may have CAUSED the closing of the MGs. In my case, he had to do reconstructive surgery for SLKs too.

    There is a new professional article that is worth reading: "Dry Eye Relief" by Steven Maskin, MD. It is found at www.ophthalmologymanagement.com, July 2011. It explains five different findings in the glands that he looks for. Some of the glands have atrophied, and some are partially atrophied. Some are blocked with fibrosis half way up the gland. He has to punch through the fibrosis to get the gland to open up. He also explains a 13 step process that he goes through for dry eyes.

  16. #16
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    Correction for www.ophthalomologymanagement.com, July 2011

    I need to clarify the reference to the above magazine. In order to get to the dry eye article, you need to go to the SUPPLEMENTS page. In fact, there is a whole special supplement just for dry eyes. It it called, Special Report

    What You Need to Know to Survive the Onslaught of Dry Eye Sufferers.

    There a lot of good information in that supplement.

  17. #17
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    I got great results from the Maskin probe. I haven't used eye drops in 3 days. My lids are not itching, burning or crusty. I'm spreading the word to all those suffering with MGD.

  18. #18
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    I've had some difficulty since the Maskin probe. I had a severe blocked gland which caused my eye and the whole side of my face to swell. After 3 weeks on doxycycine, it improved but several weeks later, I had a reoccurrence in a different gland...more doxy. I am 4 months post probe and my eyes have not improved. I am wondering if others have had the success you've had

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