Has anyone worsen with Meibomian Gland Probing?
I recently saw one of Dr. Maskin’s patients who said he initially felt relief with probing (no expression was done) but then the 2nd and 3rd time he was probed, he felt worsening of pain. His meibography does not show worsening but maybe there is some microscopic worsening of his glands. The fact that Dr. Masking does not express the oil after probing could be related as well, he wondered. I do not know, but the patient is sure he felt worse after the 2nd & 3rd probing.
Today for the first time, I had a patient (in her early 40th’s who had been on Accutane for 2 cycles and has ocular and facial rosacea) say that she feels she has been getting styes more frequently after a 2nd & 3rd probing. After her first probing she felt pain relief and no styes for 8 months, which was wonderful and was a long time for her. She was hesitant to say she felt worse after probing and expression but she says that she notices deeper styes after her 2nd & 3rd probing. She has a history of multiple styes before the probing, but they seemed to be closer to the orifice of the gland. She wondered if the probing “pushed down” the scar so the styes now develop deeper and more suddenly.
Her meibography in her left eye, the eye with the most issues, does not look worse. It may even look a bit better, though there is a difference in how far down the eyelid was everted between images.
There is a controversy about whether meibomian gland probing makes a patient worse. I have not seen any patients worsen on meibography after probing even accounting for aging, but maybe some of our probing/expression patients have worsen and have not return to us to tell us. The gentleman above is the first patient I have met who said probing seemed to make him worse. He has no history of Accutane use or autoimmune disease. It is possible the probing did increase cellular damage which we cannot see.
Doctors who do not do probing often sound the alarm to patients that probing makes patients worse, but there are no published data to show this to be the case. These doctors may have a financial stake in a competing treatment, such as Lipiflow or IPL (Intense Pulse Light). Similarly, I have heard from patients that surgeons who do probing say Lipiflow compresses and damages the meibomian glands too much and causes more scar tissue: an accusation again which has no published data to support such a claim. Also, surgeons who do not do IPL say Lipiflow or Probing make patients worse.
It is very frustrating as there are still no randomized, controlled studies to prove one treatment is superior to the other.
If you feel you have worsen from meibomian gland probing, Lipiflow, and/or IPL, or even warm compresses (I have a friend who swears warm compresses make her eyes have more pain), please let us know.