This ground-breaking book contains a trove information about Meibomian glands and MGD. You will learn about the structure and function of Meibomian glands and discover how MGD develops, how it progresses, and how it can be reversed. You will learn how to decipher puzzling symptoms and Dr. Maskin’s meticulous approach to diagnosis.
One chapter is devoted to common ocular surface and systemic comorbidities. In others you will learn about conventional and newer treatments for MGD, including Dr. Maskin’s own break-through treatment, Meibomian gland probing. Here, he explains why Meibomian gland probing effectively treats MGD and provides step-by-step instructions for correctly administering the treatment.
Throughout, the co-authors dispel myths about Dry Eye and MGD while portraying the devastating effect MGD and comorbidities can have on patient lives.
Uncover the Mystery
“Our collaboration represents the intersection of a doctor’s quest to uncover the mystery surrounding a common but enigmatic eye disease, and his patient’s harrowing journey with a painful, incapacitating disease,” writes Dr. Maskin in the prologue. “We hope our joint effort will shift conventional thought about MGD, its diagnosis, and treatment toward a new paradigm based on clinical evidence that reveals the true nature of this disease, and we offer this book as a beacon of hope for patients needlessly suffering with inadequately diagnosed and treated MGD.”
For information about where you can buy Your Dry Eye Mystery Solved: Reversing Meibomian Gland Dysfunction, Restoring Hope
Since Allergan’s patent protection for Restasis ended several years ago, several companies have entered the Dry Eye market with drops that contain cyclosporine, the active ingredient in Restasis. These newer drops have different formulations than Restasis. Sometimes the concentration of cyclosporine is different and sometimes the vehicle, the liquid in which cyclosporine is suspended, is different. A generic version of the drug is also now available. For information on effectiveness, check the medication’s product information sheet. You can find the product sheet for Restasis here.
Allergan tried to delay competition for Restasis by selling its Restasis patent in 2017 to the Saint Regis Mohawk Tribe in New York. Attempts to protect the patient failed when in 2019, the U.S. Supreme Court rejected Allergan’s argument that the sovereign status of the tribe shielded the Restasis patent from U.S. Patent and Trademark Law.
Allergan loses Supreme Court fight to shield Restasis patents with Native American tribe April 15, 2109 View the full report.
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For Dry Eye patients wearing a face mask that doesn’t fit properly can be challenging. That’s because each exhalation that blows over the eyes speeds up tear film evaporation. Then the thinner layer of tear film doesn’t protect the eyes well, so the exhalation feels like a fan blowing at full strength.
It’s a vicious cycle.
If you wear glasses to protect your eyes (or for vision), not only do your eyes feel bad, but your glasses fog up. They get foggier, and your eyes get even more uncomfortable, when you walk down the frozen food aisle of a supermarket.
How to Wear a Face Mask When You Have Dry Eye
Thankfully, we found a simple solution courtesy of a video by Dr. George Yang, a double board certified New York surgeon. Dr. Yang recorded the video for medical and nursing students, but Dry Eye and MGD patients can learn from it too.
In the video, Dr. Yang shows how to get a better fit when wearing a surgical mask. We tried his simple technique with three face masks, all with the metal strip that hugs the nose: procedural masks from CVS, KN-95 (the Chinese version of the N-95), and Dr.K Mask from V-Zero in Korea. (We didn’t have an N-95).
His technique worked with each mask. The masks hugged the nose and cheeks, preventing exhalations from reaching the eyes.
Note: if you can get them, V-Zero brand Dr.K Masks get high marks for comfort.
Wear to Buy Surgical Masks
Not all face masks are made alike, and by now you may have a preferred style and vendor. There are plenty available online: Walgreens, Amazon, and other retailers like 1000bulbs.com.
One great source is Project N95. “Project N95 is a national non-profit working to protect people and their communities during the COVID-19 pandemic and beyond.” Project N95 sells only reliable, high-quality masks that meet required standards. Masks come in a variety of styles and sizes at a variety of price points.
Preventing Air Flow with 7eye Glasses
If you can’t get a good seal between your mask and your face, 7eye glasses may be a solution. 7eye Dry Eye glasses have silicone eye cups that retain moisture and protect the eyes from wind and drafts.
In a previous blog I described ways to direct focus away from the frustrating and painful symptoms of Chronic Dry Eye. This time I’m writing about my experience over the past two years practicing Tai Chi.
Tai Chi is an ancient Chinese exercise created as a fighting art that dates back over 700 years. Although still considered a martial art, today it is no longer practiced for self-defense.
Tai Chi for Dry Eye
There are many styles of Tai Chi; the most notable are Yang, Chen, Wu and Sun. These different styles all consist of a series of exercises that focus on slow movements. The movements are accompanied by deep breathing and the gathering of Qi (pronounced chee) considered the universal life force that present in all living things. Tai Chi can improve strength, flexibility, mood and overall health and reduce inflammation, chronic pain and stress levels. Considered mediation in motion, Tai Chi can also improve concentration, memory and the ability to focus, relaxing both the mind and body.
As a student of Tai Chi, and now an instructor, I have found that focusing on the slow movements of this exercise have reduced my Dry Eye induced anxiety and pain levels. Combined with daily eye care management and an excellent eye doctor, my Dry Eye symptoms, and all the anger and anxiety that goes along with this disease, have significantly decreased. I’m now living an almost normal life again.
Tai Chi might not be for everyone. (You should always check with your doctor first before starting any new exercise program.) Still, I would highly recommend it to anyone who suffers from chronic pain, depression, or anxiety. (If you’re staying at home during Covid-19, there are plenty of Tai Chi videos online.) Even if you don’t have these concerns and just want to feel better overall, you might try this ancient exercise. It helped me tremendously.
California’s Orange County Dry Eye Support Group 2020 meetings will be on May 4 and November 9, 1-3 p.m., P.T.
DUE TO THE CORONAVIRUS PANDEMIC, THE MAY 4, and November 9, 2020 MEETINGS ARE CANCELLED.
Both meetings will be held at Grace Hills Church, Fellowship Hall, 24521 Moulton Parkway, Laguna Woods CA, 92637. The schedule includes a speaker and presentation by the sponsoring organization. For meeting information and to RSVP: call Judi at (949) 933-2417 or email email@example.com.
The featured speaker in May will be Laura Periman, M.D., an ophthalmologist and the “doc with a heart.” Dr. Periman specializes in cornea and external disease. She is a frequent speaker at ophthalmology meetings on various Dry Eye topics and treatments.
Harvey Fishman, M.D., Ph.D., an ophthalmologist who practices in Palo Alto, will address the group in November. He specializes in cornea and external disease, glaucoma, macular degeneration, and same day emergency visits.
Both doctors have experience treating patients with severe Dry Eye.
Jonathan Pirnazar, M.D., an ophthalmologist at the University of California, Irvine, started the Orange County Dry Eye Support Group (OCDESG.) It was and is the only Dry Eye support group in the U.S. In the early days, 10 members would meet at a local library. Since then the group has grown to over 200 members. Today an average of 50 to 60 people attending twice-yearly meetings. The non-profit group is not affiliated with any religious or healthcare organizations.
Meetings are free and open to anyone interested in learning about Dry Eye. A $3 suggested donation covers room rental, printing, and mailing.
OCDESG aims to help Dry Eye patients feel better, to give them hope and a better quality of life. The group answers patients’ questions about how and where they can get help for their symptoms.
For more information visit ocdryeyesupportgroup.org.
Not A Dry Eye Foundation is not affiliated with the OCDESG. Notice of the meetings is provided as a service to Dry Eye patients.
Dr. John A. McAree, a board certified physician of Internal Medicine, first became aware of having eye problems at the age of 18 when he tried wearing contact lenses. He never found them comfortable and could tolerate them only for short periods of time. About 10 years later during his residency program, an astute ophthalmologist offered to administer a few tests. Dr. McAree’s Schirmer’s test result was zero in both eyes but his tear break-up time was normal. The diagnosis was Dry Eye Syndrome. He had no additional Dry Eye tests for the next 25+ years, and the only therapy suggested was giving up his contact lenses. Remarkably, his eyes remained fairly asymptomatic during that entire time.
That all changed on August 21, 2017 when Dr. McAree and some friends were boating on a small inland lake in Michigan. It was the day of the solar eclipse. Although he did not look directly at the sun, its rays reflected off the water directly into Dr. McAree’s eyes. By the next morning, his eyes were extremely painful. He assumed that he had developed solar keratitis (similar to “snow blindness”) and would recover quickly. Still in pain a week later, he sought the care of an ophthalmologist who said that except for dryness there was nothing wrong with his eyes, prescribed a one-week course of a non-steroidal anti-inflammatory drop, and suggested using a lubricating drop. Unfortunately, nothing helped.
Dr. McAree then begged the ophthalmologist for punctal plugs and a RESTASIS prescription. When these treatments didn’t help, the ophthalmologist offered to partially sew his eyes up, at which point Dr. McAree decided to find a different ophthalmologist.
The new ophthalmologist put Dr. McAree on a regimen of steroid drops and resumed RESTASIS. These measures helped a little bit but his eyes remained uncomfortable and his vision blurry. Thankfully, at least the new ophthalmologist was positive and encouraging. Having hope meant a lot.
After several months and no significant improvement in symptoms, Dr. McAree consulted a Dry Eye specialist at a local university who offered little else besides serum tears. One month later there was still no improvement. It was time to takes things into his own hands.
With some understanding of the pathophysiology of his disease, Dr. McAree diagnosed himself with Meibomian gland dysfunction (MGD). After reading reviews and about available treatments, he decided his best option would be Dr. Steven Maskin in Tampa, Florida who had developed intraductal probing of the Meibomian glands and is very well published.
Dr. Maskin thoroughly evaluated Dr. McAree and diagnosed:
possible allergies contributing to the tear deficiency
Dr. McAree first had Meibomian gland probing in August of 2018 which provided subtle but important improvements in symptoms, the most important being increased tear film stability and therefore less visual blurring.
Because of continued foreign body sensations due to conjunctivochalasis, in early 2019 Dr. McAree had amniotic membrane transplant surgery in both eyes. With surgery the comfort in both eyes improved considerably. A second Meibomian Gland probing in June of 2019 improved comfort even more.
Today Dr. McAree accepts that his eyes are not yet “normal” and will require ongoing treatment. However, he is grateful that an extremely painful and disabling condition is now much more manageable. Work requires time at a computer screen and can cause some discomfort, but he is again able to enjoy hobbies like bird watching and kayaking.
These days Dr. McAree uses RESTASIS daily, scrubs his eyelashes with tea tree oil to control demodex mites, rinses his eyes with saline to eliminate allergens, and still uses lubricating drops, but only occasionally. Plus, he is having injections to combat allergies. He is very hopeful that he will continue to experience improvement in his symptoms, and encourages anyone with debilitating Dry Eye symptoms not to give up hope.
Dr. McAree received his medical degree from Duke University School of Medicine in Durham, North Carolina and has practiced medicine for many years in Grand Haven, Michigan. He joined the Not A Dry Eye Foundation Board to emphasize the importance of accurate diagnosis of Dry Eye, MGD, and related comorbidities, and their treatment with targeted, effective therapies.
My name is Sue VandePanne, and it’s been nearly three years since I shared my story of hope. I suffered with Dry Eye, but with the right care, I overcame my struggles. I’m writing again today to say to those of you still struggling, don’t give up hope.
Over the last three years my eyes have continued to improve. It has been a slow process but today they feel better than ever. In fact, a few months ago it suddenly occurred to me that I had been going outside on windy days. A few short years ago I never would have even imagined it possible. Surprisingly, even in all that cold, Michigan, winter wind, my eyes were feeling just fine. I felt triumphant. Dry Eye was no longer running the show.
Watching Out for Fans
Even though the wind outdoors hasn’t been a problem, I’ve learned that my eyes feel better when I avoid overhead fans. For some reason air that blows from above is harder on my eyes. So now I have a mental map of all the overhead fans in my favorite restaurants and I choose very carefully exactly where I sit. Another problem solved!
I still wear wet contact lenses because enough oil from my Meibomian glands doesn’t reach my tear film, so my own tear film evaporates quickly. The wet contacts feel great. They’ve become so much a part of my daily routine that I don’t even think about them unless it’s time to order more. To maximize the amount of oil I do produce and secrete, I have my Meibomian glands probed once a year. This opens a channel for the oil to flow out and is something my doctor in Tampa, Florida will be doing once a year for the foreseeable future.
Miraculously, A Fully Functioning Individual
Miraculously, I’m now a fully functioning individual (who will never take her eyes for granted anymore). Sometimes I hear horrific stories from people who are suffering terribly and feel hopeless — a feeling that I remember well. Life with Dry Eye can seam hopeless, but I’m writing this to assure you that it doesn’t need to. Help is available. I was blessed to find a great ophthalmologist, Dr. Steven Maskin, who truly understands Dry Eye and knows how to treat it. You will find a great doctor too.
A few weeks ago I attended a social luncheon and noticed a friend had a stye on the upper left corner of her right eye. Her stye probably went unnoticed by everyone there.
But ever since my own years-long battles with Meibomian gland dysfunction and chronic Dry Eye I’ve become hyper-aware of the eyes around me. So, now I notice red eyes, inflamed eyelids, what might be anterior blepharitis, scaly skin around the eyes, dandruff in eyebrows, and yes, styes.
A few days after the luncheon I woke up with a small bump smack inside the middle of my left lower eyelid. I tried not to panic. Was it a stye, I wondered?
Breathe and Think!
“Breathe and think,” I reminded myself. I had to think!
Did I do anything out of the ordinary, like touch my eyes without washing my hands first?
Did something blow into my eyes?
A good possibility.
Should I call my ophthalmologist?
It’s Saturday morning. Oh no!
And with that thought my mind panicked and bounced even faster from thought to thought.
Maybe I should e-mail him. Is this stye a setback? Will it require another intraductal probing of the Meibomian glands in that lid? Maybe the gland is atrophied…
“Stop it,” I commanded myself. “Breathe and think!”
So I stopped, took a breath, and called a friend who happens to be a very experienced Dry Eye patient. Then I did some research on styes. This is what I learned.
A Stye in My Eye
First, a stye — sometimes spelled sty — is an infection localized to the eyelids, in glands at the base of the eyelashes or in the Meibomian glands. The infected gland swells and causes a bump. Styes can be painful, red, and tender. They’re usually caused by an overgrowth of staphylococcal bacteria and are contagious, so it’s best not to share towels or pillows with someone who has one.
How are they treated? Keeping eyelids clean is super important. First wash your hands then wash the lids with a mild cleanser. Applying warm compresses helps a lot. With those impeccably clean hands, roll up a clean wash cloth and run warm to hot water over a corner of it. Without applying pressure, hold the warm, wet corner of the wash cloth against the stye for at least five minutes. Some doctors recommend applying warm compresses from 10 to 15 minutes, three to four times a day.
Whatever you do, don’t pop a stye. Plus, avoid eye makeup for a while, at least until the stye goes away, and throw away any makeup that might be contaminated. Over-the-counter pain medications won’t speed up healing, but they might reduce the pain. And if the stye doesn’t heal within a few days, it’s best to see an eye doctor.
Ok, I was breathing again. No full-blown panic attack this time. All it took was a reminder to breath, a call to a good friend, some research, and a bit of common sense.
But in a week, if that stye isn’t gone, guess where I’ll be.
My name is Judi Beatty and I’ve had Dry Eye for nearly 20 years. Until last year my symptoms included a rough feeling at the top of my eye lids, dryness, headaches, itching, depression and persistent burning in both eyes — the worst symptom of all.
But last year I finally decided to step out of my comfort zone and reach out to a well known Dry Eye doctor out of state. So in July of 2018 my husband and I flew from our home in Orange County California to see Dr. Steven Maskin in Tampa, Florida.
Judi Beatty, Orange County California Dry Eye Support Group Coordinator
I’m one of the three volunteer coordinators of the Orange County California Dry Eye Support Group. Twice a year we invite a Dry Eye doctor to speak to our 200 members. Over the last 15 years, looking for doctors to speak to our group, I have seen more doctors than I can count and I am grateful for each one of them for taking the time to learn about Dry Eye. It can be a debilitating, depressing, life-changing disease. But last year Dr. Maskin made the biggest difference in how my eyes feel.
Talking to Patients
Before my husband and I finally decided to make the trip to see Dr. Maskin, I did my homework. (Flying to Florida from California wasn’t an easy decision to make at 74, or something I wanted to do, but I did want to get better.) I read posts written by his patients on various websites. And I spoke with many of them. They were from across the U.S. and all had severe Dry Eye.
Some patients told me they hadn’t been able to find relief and their lives had been destroyed by the disease. They became housebound. Some even said they wanted to die. But when they found Dr. Maskin, and he restored their quality-of-life, they got their lives back.
While sitting in his waiting room I noticed a map with pins that showed where Dr. Maskin’s patients had come from. The map was covered with pins because people had flown from all over the world to see him. And I thought California was far away!
On the first day of appointments, Dr. Maskin examined my eyes and performed a series of tests. While I sat at the slit lamp, he looked all over my eyes carefully, did a flourescein clearance test, and pressed on my upper and lower lids to determine the number of functioning Meibomian glands.
For the test of aqueous deficiency (dryness), after placing a numbing drop in each eye, a technician dried my eyelid margins, then put Schrimer strips in the lower pouch of each eye, being careful not to touch the corneas to prevent reflex tearing which would skew the test results. After five minutes, the technician removed the Schirmer strips. She noted the how far moisture had travelled up the strip, then repeated the test two more times, leaving the Schirmer strips in my eyes each time for five minutes.
Meibography revealed the state of my Meibomian glands –their structure (length, width, and overall shape), whether or not they could function, or if they had atrophied. The confocal microscope showed my glands at a microscopic cellular level. Dr. Maskin explained inflammation, an underlying factor in Dry Eye, often starts here.
Next came the diagnosis. It was based on the exam and the test results, and would be confirmed after probing my eyelids. This is what Dr. Maskin said I had:
Greater occipital neuralgia — that caused my headaches for five years!
It was amazing to have such a thorough diagnosis. No wonder my eyes felt so bad for so long!
Probing, Expression, and Cautery
That same day Dr. Maskin probed the Meibomian glands in my right eye. First the technician applied an ointment containing lidocaine and jojoba oil to numb the lids and minimize discomfort during the procedure. After a few minutes Dr. Maskin started probing the glands, inserting a small metal probe into each gland as I sat at the slit lamp.
He noted the sound made by the probe as it entered each gland — spongy, pop, gritty, or no sound – while the technician took notes. After probing both lids, Dr. Maskin used an expresser tool that cleared the glands with a squeezing, rolling motion, remarking that a lot of debris was coming out of the glands. Amazingly, the number of functioning Meibomian glands more than doubled immediately after probing.
I learned a lot from Dr. Maskin on day one, and on day two I returned to have my left eyelids probed and a superficial cautery of the lower left punctum. There was no real severe pain during probing. I felt mainly pressure just like the day before. Unfortunately, there wasn’t enough time to express the glands in my left eye because we had a flight to catch.
Tweaking the Judi Beatty Daily Regimen
For the next month Dr. Maskin stayed in contact with me via e-mail — sometimes daily — helping me tweak my care program. He felt that now that my glands were open I should stop using all of my facial products because of allergies or sensitivities. So I did. No more face or eye makeup, and no more moisturizers. He had me stop Bepreve drops and Retaine ointment for the same reasons, and prescribed other products until I found something that worked but didn’t cause irritation. He also had me try various eyelid cleaners and face washes, and prescribed sterile saline for flushing my eyes periodically.
My Daily Routine
Currently I use only Oasis Tears eye drops once or twice a day and autologous serum 100% in the morning and evening. I apply warm, moist compresses twice a day, use Free and Clear Shampoo on my hair, Soothe ointment at night, and Glad Wrap to keep my lids closed while I sleep. Plus I drink lots of water, which is critical. (Dr. Maskin told me to keep a daily record of how my eyes feel, notice if they are bothersome, and “ask myself what did I just do differently” that may have caused it.)
I am still searching for a safe moisturizer for my face and something that I can tolerate to clean my eyes to reduce blepharitis and styes, and possibly a concealer to hide the dark circles under my eyes. Thankfully, I am free of the burning in my eyes but still have occasional dryness which is easily remedied by Oasis eye drops (which I love). I continue to carefully monitor anything I put on my face or in my eyes, keeping a daily journal to help me determine if anything I use could be causing my symptoms to return.
The Best My Eyes Have Ever Felt
I have to say, that in 20 years, this is the best my eyes have ever felt, and I owe it to Dr. Maskin. Other doctors along the way also helped me a lot and I am grateful for their care.
Today my eyes aren’t perfect, but for the last nine months they’ve been 80% better most of the time. I still feel the roughness in the upper part of my eyes occasionally, probably due to the conjunctivochalasis Dr. Maskin found. Someday I may decide to have it fixed. And although I still have some dryness, it’s minimal and resolved with my daily regimen and drinking lots of water. Thankfully the burning is completely gone.
Dr. Maskin is a brilliant teacher, ophthalmologist, scientist, detective, and someone who really cares about helping people. He diagnosed my complex condition and addressed my symptoms. Plus he helped me figure out the many things that I needed to change in my daily routine. He taught me that for me “the less I put on my face and eyes the better my eyes feel.” I have no words to express my gratitude because I am beyond grateful and so glad that I took a chance and went to see Dr. Maskin.
Coordinator, Orange County Dry Eye Support Group