IPL with Dr Toyos

[autumnn]

FIRST OF ALL I WANT TO THANK SAZY FOR POINTING OUT THIS DOCTOR AND HIS TREATMENT!!!!!!

Well, I finally had the appointment today with Dr. Toyos. I am exhausted and will write something more comprehensive tomorrow. But, I have to say that I definitely like the doctor. He seems very professional, intelligent, and caring. The office was the most amazing doctors office I have ever been to...beautiful...

Anyway, Dr Toyos spent 2 hours with me, exclusively (not running between patients like other doctors do) he read my long letter and I let him know my concerns about my glands due to a short run of accutane 15 yrs ago and Lasik 10 years ago. Then, he examined my eyes and skin and stated that I was an ideal patient for his treatment with fitzpatrick 1 skin, tenelgesia and rosacea signs, as well as 90 percent of my meiombian glands were blocked. I couldnt believe it-90 percent blocked? With all the treatments I was doing this was hard to believe. Dr. Toyos stated that he could often get 60-and usually 90 percent of the lower glands open and functioning and this was enough for symptom relief. He believed that treating the tiny vessels that made my glands inflammed would also help the functioning of the glands.

Dr. Toyos also went over my entire regimin and made changes- for now-no drops (and I just started the Freshkote) he stated he could see signs of a slight allergy component and he wants no pets in my bed, no sleeping mask, and for me to wash my hair before bed and keep my linens very clean. Dr. Toyos also said no compresses or steaming until he tells me otherwise- I think he sees no point in this until he gets the glands open and pumping. He also said to eat salmon 5 times a week, take flax powder, eat red grapes and drink tons of water.

As far as if this will relieve my pain- Dr Toyos said that he cant guarantee that but he said that 90 percent of my glands being blocked is making the surface of my eye very compromised, dry and irritated. The obvious answer would be that if he got these pumping again then yes, Id feel alot better.

As for the treatment, it was a bit painful. I was so glad though to feel just how close he got to the lashline, if not in the lashline itself. The warmth/burning was worth it because after when he examined my glands he muttered to himself, "great" and "excellent" while pushing on my glands. He told me my glands were responding as he hoped.

So, that was it. I am scheduled to go back in a month for another treatment. Today I paid $375.

I asked him many of your questions and the ones I missed he said to email to him. I will write more tomorrow.

I am shocked about all my blocked glands but hopeful for this treatment.....oh, and the bonus is that he said it would make the skin under my eyes look better too

Still, it is scary to give up my DE routine- even though simplifying seems tempting in and of itself....

[odydnas]

Hi autumn! Thanks for the description. I am looking forward to hearing more about your appt. i am sure I don't qualify, since I am skin type 3, probably 4. I hope you feel relief very soon! How soon are you supposed to feel a difference?

Also, do you have telangectasia on your scleral, inner eyelids, or lid margins? Is he targeting the telangectasia on your lid margins or inner eyelids? I have a TON of telangectasia on my inner eyelids...

[sazy123]

Hi autnum that is very Encouraging! Im glad you had a good experience.

Im sure you will be posting again but i had a few questions:

You say your surprised at the amount of blocked glands.... to you how obvious are your blocked glands, can you see them? and did he say that they were blocked by inflammation and vessels or were they blocked as in 'caps', lumps, toothpaste consistency.

I don't have any blocked glands or toothpaste consistency- the functioning of my glands is purely blocked by inflammation, i.e 'turned off'

Could you email him a question asking this - if a persons glands are not blocked, but just not functioning due to inflammation/vascular of inner eyelids (conjunctivitis)- would IPL help- since there wont be any ''melting'' going on?

Any noticeable improvement after the first treatment, or maybe its to early to tell?

Due to my inner eyelid conjunctivitis seemly causing it im not sure if it will help.

I am also fitzpatric skin type 1 and have some rosacea, but dont have much tangelsia (tiny bit on upper eyelid), i was hoping you would have a good experience as im hoping to come out there next month.

[calli66]

Can't hurt to try the Toyos treatment---sounds very hopeful. Get those glands OPEN---yes!

Positive thoughts sending to you,

Calli

[autumnn]

Ok- I am going to try to answer some of the questions everyone had.

From my experience the only side effects seemed to be the bit of discomfort and oddness of the procedure (which lasted about 10-15 minutes- I had had IPL before on my face so it wasnt too intimidating for me) and I know that IPL is safe for sensitive skin. As far as darker skin, Dr. Toyos said that he is working on something that in the future may be able to help darker skin. As I mentioned, he gets CLOSE to the eyelid...so much closer than I imagined he'd get. He treated the tengelesia that I have outside the lower lid (which I couldnt see to the naked eye- unlike my upper lid) and targeted the blocked glands- he mentioned it was like the ultimate hot compress to get things moving. He mentioned that after 4 treatments his patients are no longer symptomatic and return every 3 months to every year for one maintenance treatment. In terms of conditions like Sjogrens or post lasik dry eye, if blocked glands are part of the equation then his treatment could help...but, his treatment is primarily for dry induced by MGD. There is no recovery or down time. I was just fine and looked just fine right afterwards. My only precaution is that I need to protect the skin very with sunglasses and sunscreen. As I mentioned, he changed my whole DE routine- so no- you dont necessarily continue your previous treatments after this treatment. I asked him about atrophied glands and he said that word was a misnomer- but didnt go into detail about wht his theory on that is. He said that mine were just blocked. Please note that I have had some doctors say my glands are blocked and other say they werent. I have even had close to normal TBUT scores at times. To me, to the "naked eye" they didnt seem capped and I thought the oil was thin. I was convinced that they were not producing enough oil and that was the only problem. Sazy- he may surprise you when you see him- things may be far different than what you have heard/think. You may be just like me- totally blocked with tengelesia (remember, I cant see mine). For me, to hear that 90 percent were not open was SCARY- but reassuring at the same time- it was something to work on! I wish I could get another treatment TODAY! In terms of which patients are better suited for this as compared to others all I know is that he said I was a very good candidate because of my fair skin, signs of rosacea and tengelesia and blocked glands. He said the tengelesia and the blocked glands are a vicious inflammation cycle....those are what he is targeting with this therapy.

The questions I wished I asked him were why I got MGD in the first place (though he said infants can have MGD as well as 80 year olds) and if I had caps or toothpaste like issues and if the treatment can unclog the glands and get them to pump enough healthy oil that will remain healthy on their own. I will email him today about this. I will also ask him about what others asked- MG's not producing due to inflammation/vascularization of the inner eyelid and if IPL will help.

I dont know if it is too soon to see results but I feel pretty good today. My right eye (the good one) was way more moist yesterday after the treatment. The darn left wasnt but today doesnt feel so bad.....I am home today though and taking it easy so that helps...I dont want to make any conclusions too early. He did say that patients notice some improvement after the 1st treatment. I still feel odd about abandoning my DE routine and I miss my dog in bed and eye mask terribly. But, I will follow exactly what he says.

Last thing.....Dr Toyos read my note very carefully and saw that I had plugs flushed out in the past. He wanted to check himself to see if they were gone. He spent quite a bit of time attempting to irrigate them out and his conclusion is that they are more than likely still in there. I was amazed at the total attention he paid to my eyes- plugs arent normally his concern. He said with MGD he doesnt like plugs and that we will have to work around this. He said that when we get my MGD's stable the plugs shouldnt affect anything.

Lastly.....like I said, he spent 2 hours with me. When I was checking out he was told that his other patient had left because she couldnt wait any longer. I was so amazed that he put everything on hold to tackle my "tough case".

Odnyess- He targeted the tengelesia on the outer eyelids- I didnt even think it was there- you cant see it with the naked eye...

AND, AGAIN, THANKS TO SAZY FOR RESEARCHING AND FINDING OUT ABOUT THIS DOCTORS TREATMENT.

[kimby2007]

Sounds good so far. I suffer from MGD due to Sjogrens. According to Dr. Foulks who presented at the sJS conference they go hand in and. Good to know there are novel treatments out there. Good luck, I will be following this thread closely.

[bernmee]

This is really exciting!!

In terms of your diet I would do a little research into "farmed" versus "wild" salmon, I don't think its a good idea to eat farmed salmon 5 times a week.

Also with the flax, to buy your own and grind it in a coffee grinder is the best way of getting it fresh. It you can't do this make sure you buy some that has been stored properly. Too much heat and you lose the goodness, I grind a weeks supply and store it in the freezer to throw in my smoothies.

Let us know how you are gettting on as the days go by. This is really exciting!!

Bernadette

[jenny2008]

I am curious. What is tengelesia? thanks

[stephgurl1986]

Wow, Autumn, this sounds great. I'm so excited for you. Please keep us up to date - maybe this is a solution for a lot of people out there?!
(Maybe even for me, but if I'm a candidate I think I would have to do "something" (like an internship, au pair etc.) in the States as you have to return every month - that wouldn't be possible if you live in Europe)
Does he do this somewhere else as well? Probably NYC? That is only a 8 hours flight away...

[sanna]

stephgurl,

Hi, I have read some threads You´ve been writing and what is your biggest problem dry eye or red eyes? I hate my eyes because they now are red, a little dry but not a big problem. I am looking for away to remove the veins maybe laser, maybe surgery do not know. I do not want to make it worse.
I have heard that mybe you could use laser to remove veins but I do not know if thats a good idè. I have heard that there is a Doctor in Belgium that could do this I am going to sen him an email i think.

[irish eyes]

I am curious. What is tengelesia? thanks

Taken from http://www.eyeworld.org/article.php?sid=2698

We suspect IPL treatment improved meibomian gland production due to either meibomian gland stimulation or effectively decreasing telangiectasia.

Taken from http://en.wikipedia.org/wiki/Telangiectasia

Telangiectasias are small dilated blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter

[sazy123]

Autumn your welcome! im glad i could bring this to the DEZs attention, and really hope you and others experience relief as a result!

In terms of whats blocking my glands, they are certainly blocked by inflammation/vascularization. And for the most part anyway not blocked by toothpaste of caps or lumps- other words nothing as such is visible. The fact that you said your blocked glands are not visible either is encouraging for me. I know that the inflammation of inner eyelids or glands is blocking the production of oil because my glands function very well when im sick (and thus the inflammation of eyelids goes right down!). But also like you i have not had improvement from compresses and much of anything else (which i based this on no actual blockage- nothing to solidify). Compresses do not tackle inflammation. I do seem to be a weird case of MGD because they function when im ill so im not sure how i will fair. But the whole thing revolves around inflammation and vascularization disrupting the production of oil, my only fear is that it might be originating from the wrong side of the eyelid for this treatment to help (inner eyelids, rather than in the glands or the outer) but we shall see.

Also it is somewhat encouraging that he said you had tangelisa in the lower eyelid that you couldnt see, maybe i have some- i know that i have some purple colour under eyelashes, and a tiny bit of obvious tanglesia on top eyelid.


Stehgirl- I have also considered the 'au pair' route in the summer months, but not sure if that would work with my eyes being bad.

[autumnn]

Hi Sazy- Yes, thanks again. D
As for me, I had no idea that the blockage or vascularization was as bad as it is. Also, I didnt know the tengelesia (sp?) contributes to inflammation and further blockage but apparantly it does. Anyhow, I hope that tackling it will be what it takes to get rid of this darn problem for us! I still cant figure out why for now he wants me to abandon compresses though....all I can think is that maybe he thinks they are useless until the glands are open? I believe that he may be the answer for you, especially based on what you described you have in your last post. Also, it is promising that he is working on a method to eventually treat the upper lids- that is where I have the most tengelesia and there are supposedly more glands there as well.
I
Sazy are you coming out here to try this? I wish I had an extra bedroom to offer but it is just me and my boyfriend and 3 dogs in a 1 bedroom condo
I would however love to meet up with you and even go with you to your first appointment.

[calli66]

Autumn,

One part that I question---about the Toyos regimen-- "He also said to eat salmon 5 times a week."

Advisory:
"FDA's Recommendation on Fish and Salmon

In March 2004, FDA and EPA revised its advisories on mercury in fish for pregnant women and young children. Generally they are advised to eat no more than 2 meals of low-mercury fish per week - one can of salmon or half a salmon steak is considered one meal."
(this advisory applies to women who might become pregnant, also)

This is from a website here.

Just a thought.

Calli

[autumnn]

Thanks Calli- I wonder if this applies to wild salmon?

[Philipp_from_Germany]

Sometimes I just cannot believe how on earth is it possible that this treatment - which has been around since 2002 -is only available by one doctor in one western country...

In consideration of the vast number of people suffering from malfunctioning MGs ophthalmologists from all over the well-off western societies should be happy to adopt this procedure.We have eye docs with modern practices and dozens of dry eye patients at every steet corner in Germany and a corresponding number of dermatologists who use IPL-machines (just not in the eye area..) routinely.

So, now you have to change your life plans entirely and do an internship/ au-pair or whatever in the US in order to get help??? C`mon people this can´t be true. We are living in the 21st century here....

We should try to make this procedure public in our areas as insistingly as possible. Spread the word people!

@autumnn: maybe you could bring this matter up again at your next appointment with him. He must have fellow colleagues who are interested in this and have already recieved some training from him. A huge number of people could benefit!!!

[calli66]

Thanks Calli- I wonder if this applies to wild salmon?

I think it does...farmed salmon has it's problems, too, but I forget what.

Salmon's not the worst, of course (list of worse ones on the website link in my previous post). Some of the mercury content depends on where the wild salmon is caught---if the waters are contaminated. This can happen far from the source (say a coal power plant), due to prevailing winds and ocean currents.

Still...the word out there in the health community is that if you're a woman of child-bearing age, you shouldn't over-do certain seafood because of the mercury.

C

[sazy123]

Sometimes I just cannot believe how on earth is it possible that this treatment - which has been around since 2002 -is only available by one doctor in one western country...

In consideration of the vast number of people suffering from malfunctioning MGs ophthalmologists from all over the well-off western societies should be happy to adopt this procedure.We have eye docs with modern practices and dozens of dry eye patients at every steet corner in Germany and a corresponding number of dermatologists who use IPL-machines (just not in the eye area..) routinely.

So, now you have to change your life plans entirely and do an internship/ au-pair or whatever in the US in order to get help??? C`mon people this can´t be true. We are living in the 21st century here....

We should try to make this procedure public in our areas as insistingly as possible. Spread the word people!

@autumnn: maybe you could bring this matter up again at your next appointment with him. He must have fellow colleagues who are interested in this and have already recieved some training from him. A huge number of people could benefit!!!

I think its a case that the procedure has been under investigation since that time, dr toyos would of had to apply for funding which he did as stated by the article, then undertake trials. As i dont think ophthalmologists would take this up without the evidence to back it up.

He did say in an email to me that he was in the process of rolling out training for the procedure to ophthalmologists.

[sazy123]

Hi Sazy- Yes, thanks again. Dr. Toyos' idea is something new and it does make sense. As for me, I had no idea that the blockage or vascularization was as bad as it is. Also, I didnt know the tengelesia (sp?) contributes to inflammation and further blockage but apparantly it does. Anyhow, I hope that tackling it will be what it takes to get rid of this darn problem for us! I still cant figure out why for now he wants me to abandon compresses though....all I can think is that maybe he thinks they are useless until the glands are open? I believe that he may be the answer for you, especially based on what you described you have in your last post. Also, it is promising that he is working on a method to eventually treat the upper lids- that is where I have the most tengelesia and there are supposedly more glands there as well.
I sent Dr. Toyos a few questions in an email. If I hear back from him I will post.
Sazy are you coming out here to try this? I wish I had an extra bedroom to offer but it is just me and my boyfriend and 3 dogs in a 1 bedroom condo
I would however love to meet up with you and even go with you to your first appointment.

Thats very kind of you to offer autumn how far from the clinic do you live? do you know of any cheap accommodation near by?
It would be nice to meet, neevr met anyone with bad dry eye!

[irish eyes]

Sazy

Talking of meeting up with people with dry eye...

A work colleague recently said me that she suffered with dry eye like I do. I assumed she meant proper `DRY EYE' so I chattered on about the general frustration of it all. She said she was surprised that I had "....bothered the doctor with such a minor thing...".

It emerged that her idea of `dry eye' was that the NHS had misgivings about whether a person should wear contact lenses or not. It's nearly as bad as being advised `...to put water in your eyes.......and wouldn't it work the same?

That is why I so rarely want to bring up the topic with people who are not in the know.

[autumnn]

Hi Sazy- I live about an hour away from the clinic- maybe we could even schedule our treatments on the same dates. The clinic is in a very fancy part of Beverly Hills so I am not sure where cheap accommodations would be- there are some AMAZING hotels within walking distance (ah, the luxuries of being rich)- at least afterwards we can sit at a fancy street cafe and enjoy lunch and taking in the sights.....So, for a place to live, I am sure that if you did some research there would be something in other nearby neighborhoods. Perhaps you could rent a room for a few months from a family or someone needing roomates? You can look on Craigs list as there are often people renting places for the summer- just be as careful as possible because there are some weirdos out there! You could rent anywhere within an hour south of the clinic to anywhere in LA. I can help you to get there- especially because it is only once a month! We will try to schedule you on Mondays, that is when I am off work. Would you come out for four months- have you emailed him about scheduling the treatments closer together? Anyhow, this time of year is beautiful in Southern California- it might be a nice break for you.....maybe you could even pick up some part time work (au pair?), who knows- lounging on the beach or exploring LA might be a better option. If this treatment is the answer I know it will all be worth it for you. I hope that shortly I will have more news to report of the effectiveness- I can say that my right eye feels great (it really does)- the left is still burning but I cautiously say that the burning seems lessened (and I say this VERY CAUTIOUSLY because I dont want to get myself or anyone excited too soon). I am willing to go the full way with this method and 4-6 treatments is recommended- I will do all 6 if necessary. Maintenence will be easier for me than others just because of where I live, but, again, if it works I know that we can find ways to keep it up- sometimes maintenence is only once a year.
And, I must say- the asthetics - my under eye skin looks so much better.
Has anyone else emailed Dr. Toyos? I have not heard back from my last two emails and I'd hate to bother him more- he must be very busy. If someone emails him it would be nice to ask if we could be in touch with some of his clients who have had this treatment- I'd love to hear firsthand experiences

Phillip- I will ask him about whether this will be offered in other locations anytime soon....still, I'd prefer to be treated by the doctor who invented the method and has been doing it for 7 years.

[bernmee]

Forgot about the mercury in wild salmon. Any fish that grows large holds toxins in it's body.

I read somewher that trout, a small fish, has more Omega's than salmon...you might want to look into that.

Bernadette

[odydnas]

Irisheyes...I completely understand how you feel. My grandpa called me the other day telling me how he has been diagnosed with DE too and we now share the same affliction.. He "didn't even know he had it" and now he's supposed to use artificial eye drops 3x a day, and why "don't I give that a try".....sigh....

Autumn, I'm so glad to hear your skin looks better! Has your eyes felt better yet? I don't know if its too early to ask since I'm not sure when you're supposed to feel relief. Also I was wondering, did he treat the telangenctasis on the eyelid margin...or in your inner eyelids? I have a TON of them when I pull down my lower eyelid to see....not really any on my eyelid margins. I'm trying to understand where you all mean, when you talk about telangctasis. Thanks! Keep us updated!

I will probably email Dr. Toyos after I hear your results. I live in Northern Ca, so it's not a big deal traveling down there for me. The problem is, my skin type is a 3 or 4. I will ask Dr. Toyos when he thinks he will get figure how to treat people with darker skin.

[autumnn]

Odydnas- He treated the outer eyelid margin not inside the lids but I assume that the light reaches deep into the tissue and probably into the inner eyelid. I am not sure when I am supposed to see results- I would imagine that it would take a few treatments? I am kind of on uncharted water here so I am not sure. I hope that soon he can treat skin that is darker.

[Stanza]

autumn

brilliant stuff, I do hope it helps you.

like phillip also interested if he has any collegues in other parts of the world that may start using this. sounds great.

S

[sazy123]

Thanks autumn! Is there anywhere cheap near where you live? as in that case it would be easy to go together.

Im not sure yet but i think the best thing for me to do is to come out for a couple of days for the first appointment then come home, as i have uni at the moment... then ill be free from uni over the summer, but i have a job (but its with my mum) so i think it would be possible to come for a month with the next two treatments three weeks apart..... by the third treatment i should know if its going to help... so if it does i will stay or come back, then im back at uni in September (if im still there by then) so i may have to just come back for a few days if i need 5/6 treatments, which im happy to do if it does help. In terms of doing an au pair, im not sure how i will cope with my eyes...

I know though after the second treatment if there's no difference i will probably become demotivated, and i think you need motivation to travel that far when your eyes are bad! Did he say that you should notice a difference after the second treatment if its going to help? or that you may not notice anything till the third?

I don't think hes very reliable with emails, he got back to me the first time but didn't respond to my follow up email, he must be really busy and get tons of emails. Best thing to do is ask him as much as possible when you see him.

The other thing is i also have plugs which do not help, does he irrigate them out or does he leave them in for the treatment?

[sazy123]

Odydnas- Dr. Toyos treated the outer eyelid margin not inside the lids but I assume that the light reaches deep into the tissue and probably into the inner eyelid. I am not sure when I am supposed to see results- I would imagine that it would take a few treatments? I am kind of on uncharted water here so I am not sure. I hope that soon he can treat skin that is darker.

Regarding the inner eyelids i am hoping that it does penetrate deep so it reaches them as well, the fact you have to where a metal eye guards suggests it does/can. I know with my inner eyelids i have dilated blood vessels, not sure about tangelsia.

[EllMitcho]

Hey all,

Just to say this thread is amazing! I have been away from my computer for a while and this is just great to come back to! The procedure sounds promising (let's not get carried away I suppose but it DOES seem to make sense theoretically) - but most of all the time and effort to post such detailed accounts of the visit is just great!

Thanks - I will be watching this with interest

EllMitcho

[autumnn]

Hi Sazy- Just a thought- have you considered going to the Tennessee clinic- it is not as far away from you....Also, I am about 45 minutes from Beverly Hills (South) and there are tons of different areas in between- some nice some not so nice. It would take some effort to really look and try to find something that will do for while you are here- wait! maybe you could take a class at USC or UCLA and live in their dorms for cheap? In the meantime I will keep my ears perked for anyone needing a roomate. Maybe someone on this forum lives nearby and can lend you a room. Anyone???
As far as how long it takes to see improvements....well, I read somewhere that the tengelesia a month after the initial treatment is significantly decreased and the glands start becoming less inflammed. Maybe improvements start after that? Sometimes I feel like it is already helping me a little bit but I still have some burning in the left eye- I am cautious to say it is less- but it might really be- might right eye is good enough to forget about most of the day.
I called today and moved my appointment up so that it is three weeks (May 14th!) from the last appointment. My apologies- he is not doing Mon and Tues- he is doing Thurs and Fri. I thought I needed to wait four weeks or more but the receptionist said three was OK. Sazy did you hear this as well- the ability to do them 3 weeks apart? I dont want to do anything to screw this up.
BTW, I am jonesing for my steam and compresses- I still cant understand why I am supposed to abandon them until he says otherwise

[autumnn]

I wonder how many of us have glands as severely blocked as mine are. Most of my eye docs either said they were somehwat blocked or not producing enough oil. One doctor offered to mannually express my glands which would have included numbing the lids, clamping them with something and manually forcing the oil out/unblocking the glands. He was going to do this on both the upper and lower lids. I said "no" at the time because most docs were saying my glands looked okay. Now I wonder if I should have taken his offer more seriously and maybe even have my upper lids expressed at some point and time since Dr. Toyos does just the lowers.
Has anyone had procedures done to their lids that have opened the glands?
Anyway, this MGD is sure complicated.