Meibomian Gland Probing by Dr. Maskin- WOW.
After being in severe pain for several months for a progressively worsening case of MGD I went to Florida to see Dr. Maskin for a workup and probing. I felt like I finally saw and expert. Dr. Maskin was EXTREMELY thorough and checked me for things that no one had ever examined before. Here's what he found:
Bacterial infections in both eyes- no one ever performed a basic culture of my eyes before this- and yeah- bacteria growing in your eyes certainly contributes to chronic inflammation. . .
Delayed functional tear clearance NOT a profound aqueous tear deficiency- there is a difference between these two and they are managed differently. I had always been told I had an aqueous deficiency (but no one ever checked my FTC). I have some aqueous deficiency obviously, but not nearly as bad as my Drs. here thought.
Conjunctivochalasis (meaning that the conjunctiva that covers my eyeball is wrinkled- due to chronic inflammation- which plays a role in trapping allergens, bacteria, irritants etc. which worsen the inflammation in dry eye)
Severe Meibomian gland dysfunction- On my left upper lid I had only 5/32 functional glands and 3/32 on the right upper. My lowers were slightly better at 10/20 on the left and 9/20 on the right.
Dr. Maskin removed my punctal plugs and cauterized my lower ducts all the way shut and my uppers about 80% shut- this improved my FCT and also got rid of the excess tearing/blotting I was having all the time. He also thinks that plugs can contribute to bacterial infections in eyes. Unfortunately, within 48 hours at least one of these have opened up in both eyes- I'm a little annoyed at this- now I have to wait until this Friday for a guy at my local practice to repeat the procedure with my eyes feeling like someone has a blowdryer on them. But- it is still better than how I was feeling- uncomfortable, but not the debilitating pain of before.
Dr. Maskin then did the probing, followed by an expression of each gland.
So the day I had the procedures done I felt like I had been in a prize fight (obviously), and wasn't very optimistic about feeling much better the next day. But I woke up in the morning- and it was literally a miracle. For the first time in 3 months I didn't have to rush to put on goggles and tolerate a morning of almost unbearable pain. I went to breakfast with my dad glasses free. I was absolutely shocked at what a profound difference the procedure made and how fast it made it. Some people need the procedure repeated (about 40% of people- and the usual time between is around 14 months)- but if I have to do this on a regular basis NO PROBLEM.
Finally- Dr. Maskin wants me to get surgery in July to correct my conjunctivochalasis. This should decrease the trapping of tears, irritants, etc. in the wrinkles on my eyeball and lead to a more normal functioning lacrimal system. I will most likely do it, but it is a big deal and I'm still trying to decide for sure. . .there are always the complications of surgery to consider of course.
So that's it. I feel like I'm on the road to a much more normal life.
I'm pretty much attributing my improvement to the probing- since I had upper and lower plugs in both eyes before I really don't think cautery would make the difference I experienced.
Honestly, if you have MGD, you REALLY should give this procedure a try. I'm so glad I did.
Thanks for the update.
Does insurance cover this procedure?
My main issue with this is scarring of the glands.I spoke personally with Dr Latkany about this and he said its too risky.
Did Dr Maskin give u any guarantees about the procedure permanently destoying the glands?
Id gladly fly to him 2-3 times a year if it improved things 50%
Yes, insurance covers the procedure (at least in my case). There is a CPT code for it. In the interest of full disclosure, I must say that about 2 months later, my MGD has worsened significantly again. Whether this is due to allergies, potential autoimmune disease (being worked up again for that now) or whatever, I'm almost back to where I was pre-probing. I know for some people this procedure has lasting effects, but for me, they were only two months.
I see Dr. Maskin for AMT surgery in a few days, and he believes that conjuctivochalasis can further irritate MGs due to them rubbing on the wrinkled surface of the eyelid. I also have an aqueous deficiency (stt of about 2) and he has published on clinical improvements in ATD following this surgery. I'm also going to get a reprobe during all my back and forths from Tampa over this next month for the surgeries. I can only hope and pray that the combination of the two will be longer lasting for me. I can't make trips to Tampa every two months! Once a year yes, maybe twice a year, but not this frequently. If only there was someone who did it locally. . .
Good luck with your surgery.
Ya,i think the reason they clog back up is due to inflammation which is the reason the glands clog up in the first place.
Maybe,Dr Maskin would know some docs close to u who perform it?
Originally Posted by MLE
Do chalazion cysts occur due to blocked meibomian glands due to build up of fluid? Is that another reason to keep the meibomian glands flowing with hot compresses? (I hate hot compresses!)
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