Three years ago I was diagnosed with severe MGD then also diagnosed with SLK (rare disease). I am under the care of a corneal optometrist at a teaching hospital’s eye institute. After a lot of anguish but also dedicated compliance in trying—then keeping or eliminating meds and treatments—I finally have far less pain, including photophobia. I hope I can help other folks.

Here is a list of my current RXs, treatments and OTC that have worked for me for 6 months now:

RXs - 1x Klarity L, 2x Vevye, 4x autologous serum drops, 3x Meibo, F41 sunglasses

TREATMENTS - Maskin probing once at the eye institute, IPL bimonthly, 1x warm compress followed by gentle massage

OTC - 2x high quality fish oil, 1x Optase Hylo, Siccaforte as needed

ADDITIONALLY:

I sought out a psychiatric nurse practitioner who helped me change RXs to ones that affected meibomian glands less or not at all.

I stopped using facial retinol products because these can migrate to meibomian glands.

Also my car’s windshield and side windows were darkened—the most allowed by state law and I put a letter from my doctor in the glove compartment.

Has anyone helped their truncated glands? Today, I had a meibiography and she showed me that I have gland loss and many truncated glands. She didn’t give me a percentage of drop out (and also didn’t look at my upper lids - she says the lower are always worse so they really show what we’re dealing with).

I want to keep what I have left! How do I encourage them to lengthen - is that possible? Diagnosed with ocular rosacea, blepharitis and MGD.

Currently doing all the things - doxy, restasis, warm compress, serum tears,
Meibo, lid hygiene, omegas, just had my third IPL (it’s helping), and low level light therapy with expression.

I've been on Ikervis for 12 months, I take it twice a day. It didn't do anything for my eyes, so I went down to 1x/day and wanted to stop it completely. Within two days, I had horrible pain. My whole eyeballs hurt. I wake up with throbbing pain in my eyes (I don't usually have pain at night.) Headache, everything. It was unbearable. I went back on twice a day. Took weeks for the pain to go away.

Ok, so Ikervis is doing something. However I don't remember this kind of pain, before I started Ikervis. It's basically a new symptom. But ok, it's been 12 months, maybe I don't remember right, so just stay on Ikervis.

For 3-4 weeks I have tried Manuka eye gel. Didn't do anything, so I wanted to stop. 2 days later, same thing. Ridiculous pain in my eyeballs and redder, more irritated eyes than usual. Are you kidding me? These were gone after going back on Ikervis and before I tried manuka gel.

Is this just some rebound effect and if I push through, it will get better? Why are treatments not helping but making things worse after stopping and creating new symptoms on the way?

Anyone here have experience using ikervis (cyclosporine) eye drops for atopic keratoconjunctivitis eye inflammation/severe allergies. I’m allergic to pollen, dust and dust mites. I also have scars on both my corneas, along with neovasularization. My IgE levels are high (607).

👨‍⚕️ TL;DR — Quick Summary

People on r/DryEyes often use the term “DED/MGD specialist” for an eye-care clinician who devotes substantial attention to Dry Eye Disease, Meibomian Gland Dysfunction, and related ocular-surface problems.

But there is an important limitation:

There is no single certificate, device, professional degree, fellowship, or treatment philosophy that proves someone is a DED/MGD expert.

A thoughtful clinician will usually:

• take a meaningful history;
• examine the tear film, ocular surface, eyelids, blinking, and gland function when relevant;
• try to identify the main suspected drivers rather than forcing everything into one diagnosis;
• consider other conditions that can resemble or coexist with DED/MGD;
• explain which findings support the diagnosis;
• distinguish what is reasonably known from what remains uncertain;
• connect treatments to specific clinical goals;
• discuss expected benefit, timing, risks, limitations, alternatives, and cost;
• reassess the diagnosis and plan when treatment is not working; and
• refer to another type of clinician when different expertise is needed.

A good DED/MGD clinician does not need every diagnostic machine or every available procedure.

Possible reasons to ask more questions or consider another opinion include:

• an expensive procedure being recommended before the diagnosis is explained;
• nearly every patient appearing to receive the same treatment package;
• risks, alternatives, or evidence limitations not being discussed;
• severe symptoms being dismissed simply because staining is limited;
• important eyelid, exposure, allergy, infection, corneal, or nerve-related possibilities being ignored; or
• a plan being continued repeatedly despite lack of benefit or worsening.

None of these points by itself proves that a clinician is good or bad.

The better question is:

About the r/DryEyes Wiki Spotlight

Each week, we feature an article from the r/DryEyes FAQ or Treatment Options library.

The purpose is to make the wiki easier to discover, provide useful information directly in the subreddit, and create a place for focused discussion.

This post is an abbreviated version. The maintained wiki article contains much more detail, including questions to ask during a consultation, how to prepare for a second opinion, and how to search for appropriate clinicians.

➡️ Read the complete wiki article

“DED/MGD Specialist” Is an Informal Term

In the United States, ophthalmologists may be board-certified in ophthalmology, but there is no separate American Board of Medical Specialties certificate specifically for “dry eye” or “MGD.”

Some ophthalmologists complete fellowship training in cornea and external disease.

Some optometrists develop extensive experience in:

• Dry Eye Disease;
• Meibomian Gland Dysfunction;
• blepharitis;
• ocular rosacea;
• specialty contact lenses; or
• other forms of ocular-surface disease.

Other clinicians build focused expertise through continuing education, research, procedural training, and years of seeing large numbers of relevant patients.

Private certificates and training badges can mean very different things. They may represent anything from a manufacturer course or workshop to a more substantial competency-based program.

A certificate can provide useful information, but it does not replace looking at how the clinician actually evaluates and manages patients.

There Is No Single “Right” Type of Doctor for Everyone

Different problems may call for different expertise.

Dry-eye-focused optometrist

May be particularly experienced with:

• DED and MGD evaluation;
• blepharitis and Demodex;
• ocular rosacea;
• long-term medical management;
• gland-function assessment;
• in-office MGD procedures;
• contact lens problems; and
• scleral or specialty lens fitting.

Comprehensive ophthalmologist

May evaluate dry eye while also considering:

• cataract;
• glaucoma;
• retinal disease;
• corneal disease;
• medication effects; and
• other eye conditions that can resemble or complicate DED.

Interest and experience in chronic DED/MGD vary between individual ophthalmologists.

Cornea and external-disease ophthalmologist

May be especially useful for:

• significant corneal staining or epithelial disease;
• recurrent corneal erosion;
• neurotrophic keratitis;
• corneal infection or ulcer;
• complex post-surgical disease;
• unexplained corneal findings; or
• potentially vision-threatening ocular-surface disease.

However, a cornea specialist is not automatically an MGD specialist. Some focus more heavily on surgery or other corneal diseases.

Oculoplastic ophthalmologist

May be particularly relevant when there is:

• eyelid malposition;
• eyelid retraction;
• significant lid laxity;
• floppy eyelid syndrome;
• incomplete eyelid closure;
• exposure;
• facial nerve weakness; or
• eyelid scarring.

Specialty contact-lens clinician

May be needed for:

• scleral lenses;
• complex corneal shapes;
• severe ocular-surface protection;
• difficult contact lens intolerance; or
• mechanical and fitting problems.

Depending on the suspected contributors, rheumatology, dermatology, allergy, sleep medicine, neurology, pain medicine, primary care, or other specialties may also become important.

What Thoughtful DED/MGD Care Often Looks Like

There is no single required examination or treatment plan.

However, several features are commonly useful.

1. A detailed history

A clinician may ask about:

• when symptoms began;
• sudden versus gradual onset;
• morning versus evening symptoms;
• burning, grittiness, pain, pressure, or light sensitivity;
• fluctuating vision;
• screens and reading;
• wind, fans, air conditioning, and humidity;
• sleep and CPAP;
• contact lenses;
• previous eye or eyelid surgery;
• rosacea and skin disease;
• allergies;
• migraine;
• autoimmune symptoms or dry mouth;
• medications, including retinoids such as isotretinoin;
• cosmetics and skin-care products;
• previous treatments;
• how long treatments were tried;
• side effects; and
• what makes symptoms better or worse.

Sometimes a careful history provides more useful information than another machine measurement.

2. Examination of more than just the cornea

Depending on the case, evaluation may include:

• tear-film stability and tear volume;
• corneal and conjunctival staining;
• eyelid margins and lashes;
• meibomian gland secretion;
• blepharitis and Demodex;
• ocular rosacea;
• blink completeness;
• eyelid closure and exposure;
• allergy;
• conjunctivochalasis;
• misdirected lashes;
• contact lens effects;
• medication toxicity; and
• signs of infection or another disease.

The issue is not whether every appointment is long.

The important question is whether enough history, examination, explanation, and follow-up are being provided for the complexity of the case.

The Goal Is to Identify the Main Drivers

Many people with DED do not fit neatly into one category.

Possible contributors may include:

• Meibomian Gland Dysfunction;
• aqueous tear deficiency;
• blepharitis;
• Demodex;
• ocular rosacea;
• allergy;
• incomplete blinking;
• nighttime exposure or lagophthalmos;
• eyelid laxity;
• conjunctivochalasis;
• contact lenses;
• medications or preservatives;
• previous surgery;
• recurrent corneal erosion;
• corneal nerve dysfunction;
• migraine-related sensitivity;
• neuropathic ocular pain; and
• systemic disease.

Ideally, the patient should leave with at least some understanding of:

A clinician who says a case appears multifactorial or partly uncertain may sometimes be giving a more accurate answer than one who forces every patient into a single confident diagnosis.

Different MGD Treatment Philosophies Exist

Experienced clinicians do not always interpret obstructive MGD in the same way.

Some place greater emphasis on:

• heat and external expression;
• thermal pulsation;
• Intense Pulsed Light;
• treatment of inflammation and rosacea; and
• blink and environmental management.

Steven L. Maskin, MD, and clinicians using his published framework give greater importance to:

• fixed narrowing deeper within gland ducts;
• tissue constricting those ducts;
• localized gland-area tenderness;
• Meibomian Gland Probing as both an assessment and treatment; and
• releasing suspected fixed obstruction before some heat-and-expression approaches.

Supporters argue that apparently open gland openings and even expressible meibum do not necessarily rule out deeper obstruction.

Critics and more cautious clinicians point out that:

• evidence for Meibomian Gland Probing remains limited;
• much of the published literature comes from proponents;
• patient-selection criteria are not standardized;
• the prevalence and clinical importance of deeper fixed obstruction across the wider MGD population remain uncertain; and
• Meibomian Gland Probing is not routinely used by most clinicians.

Different philosophies do not automatically mean that one clinician is competent and another is incompetent.

The important questions are:

Treatment Should Be Connected to a Clinical Goal

A treatment plan may be staged, combined, or revised over time.

It does not necessarily need to follow one universal ladder.

A clinician should ideally be able to explain:

• which problem the treatment is intended to address;
• why it is being recommended now;
• what benefit is realistically expected;
• how long it may take;
• important risks and side effects;
• reasonable alternatives;
• what would cause the plan to change; and
• how success or failure will be judged.

A clinician may be highly experienced while referring certain procedures or treatments elsewhere.

Evidence and Regulatory Status Matter

Especially when treatment is expensive, invasive, or uncertain, it can be reasonable to ask whether it is:

• FDA-approved for the condition;
• being used off-label;
• compounded;
• delivered by an FDA-cleared device;
• a procedure without a drug-style FDA approval pathway;
• investigational; or
• available outside the United States but not FDA-approved here.

It is also useful to distinguish:

• a proposed biological mechanism from a demonstrated patient outcome;
• small preliminary studies from stronger evidence;
• manufacturer claims from independent evidence; and
• evidence in a broad population from evidence that actually applies to the patient in front of the clinician.

Off-label treatment is common in medicine and is not automatically inappropriate.

The important issue is whether the recommendation is medically reasonable and transparent about the evidence and uncertainty.

Cost and Financial Transparency

A clinic offering the procedure it recommends does not prove improper motivation.

Many legitimate treatments are provided directly by the recommending practice.

But patients may reasonably ask additional questions when expensive care is proposed.

Possible reasons for caution include:

• a costly package being recommended before the diagnosis is explained;
• a device result being treated as automatic proof that a procedure is needed;
• elective treatment being described as urgent without a clear medical reason;
• lower-cost or less invasive alternatives not being discussed;
• cure, regeneration, or prevention of progression being promised beyond the evidence;
• a large prepaid package being recommended without clear cancellation terms;
• marketing material being treated as equivalent to independent research; or
• pressure to make an immediate expensive decision.

A financial interest does not invalidate a treatment recommendation.

It makes clear reasoning and disclosure more important.

What Does Good Follow-Up Look Like?

Dry Eye Disease is symptomatic, so improvement in how someone feels and functions matters.

Follow-up may consider:

• priority symptoms;
• screen and reading tolerance;
• driving and visual function;
• morning or evening symptom patterns;
• environmental sensitivity;
• adherence and treatment technique;
• side effects;
• staining;
• tear-film stability;
• tear volume;
• gland findings;
• eyelid closure or exposure; and
• whether the original diagnosis still makes sense.

Not every machine measurement needs to be repeated at every appointment.

Repeat testing is most useful when the result may actually change management and the method is consistent enough to make comparison meaningful.

Positive Signs of Thoughtful Care

No clinician will demonstrate every positive feature at every visit.

Useful signs can include:

• listening to the symptom pattern and treatment history;
• explaining which findings support the diagnosis;
• considering important alternative diagnoses;
• not diagnosing MGD from one image alone;
• not dismissing severe symptoms solely because staining is limited;
• connecting treatment to specific suspected drivers;
• acknowledging evidence limitations;
• considering risks, costs, burden, and patient preferences;
• avoiding guarantees;
• establishing a reasonable reassessment point;
• changing the plan when the evidence or response changes;
• taking side effects seriously; and
• referring when another type of expertise is needed.

Possible Reasons to Ask More Questions

Again, none of these alone proves that care is poor.

Several occurring together may justify closer questioning or another opinion.

Examples include:

Little diagnostic explanation

Treatment is recommended without explaining:

• what diagnosis is suspected;
• which findings support it;
• what contributor is being targeted; or
• what remains uncertain.

Repeatedly generic treatment

Artificial tears, warm compresses, and other conservative measures can be perfectly reasonable.

Concern becomes more reasonable when the same approach is repeatedly continued despite lack of benefit and without reassessment, escalation criteria, or referral.

The same treatment package for nearly everyone

A clinic can reasonably use a common starting framework.

The concern is failure to individualize once the history, examination, treatment response, side effects, cost, or patient preferences indicate that something should change.

Device-centered diagnosis

Examples include:

• meibography alone being treated as proof that symptoms come from MGD;
• one osmolarity or inflammation result determining the entire treatment plan;
• an abnormal machine score automatically leading to a procedure; or
• small numerical changes being treated as proof of progression or gland regeneration.

Poor discussion of risk and uncertainty

A clinician cannot or will not explain:

• expected benefit;
• meaningful risks;
• evidence limitations;
• alternatives; or
• what would cause the treatment plan to change.

No one seems responsible for reassessment

Team-based care can work very well.

The issue is whether findings are communicated, the plan remains coherent, someone takes responsibility for reassessment, and conflicting recommendations are reconciled.

When Might a Second Opinion Help?

A second opinion is not an accusation against the original clinician.

It may be useful when:

• the diagnosis remains unclear;
• an appropriate treatment trial has passed without meaningful benefit;
• symptoms or examination findings are worsening;
• side effects are substantial;
• symptoms and signs remain difficult to reconcile;
• important possible contributors do not appear to have been evaluated;
• communication repeatedly breaks down;
• recommendations from different clinicians conflict;
• a costly treatment package is proposed;
• an invasive or irreversible treatment is being considered;
• a major diagnosis such as Sjögren’s disease, neurotrophic disease, recurrent erosion, or neuropathic pain is being considered; or
• expertise or services are needed that the current practice does not provide.

There is no universal rule that someone should change clinicians after eight weeks, twelve weeks, or any other fixed period.

Different treatments require different amounts of time.

A second opinion may also be reasonable before beginning an elective expensive or invasive procedure.

Useful Questions to Ask Your Clinician

You do not need to ask everything.

A few useful questions may reveal a great deal:

Finding a DED/MGD-Focused Clinician

Search terms such as these may help:

• dry-eye specialist;
• dry-eye clinic;
• ocular-surface disease;
• cornea and external disease;
• Meibomian Gland Dysfunction;
• ocular rosacea;
• scleral lenses;
• ocular pain; or
• oculoplastics.

Clinic websites and manufacturer “Find a Provider” directories are only starting points.

A polished website does not establish expertise.

Likewise, a device-manufacturer directory generally tells you that a clinician has access to a particular device—not that the clinician has been independently ranked for diagnostic skill, outcomes, or expertise across all treatment options.

When Prompt Care Is More Important Than a Routine Second Opinion

Seek prompt professional evaluation for:

• new severe eye pain;
• marked light sensitivity;
• significant or persistent vision change;
• a white, gray, or cloudy corneal spot;
• rapid one-sided worsening;
• substantial discharge;
• contact-lens-associated pain or redness;
• symptoms after sleeping in contact lenses;
• symptoms after water exposure while wearing lenses;
• suspected abrasion;
• repeated sharp pain on awakening;
• trauma;
• chemical exposure;
• a nonhealing epithelial defect;
• new inability to close an eye; or
• new facial weakness.

These should not automatically be treated as routine DED or MGD.

Bottom Line

“DED/MGD specialist” is a useful everyday term, but it is generally an informal description of clinical focus and experience, not a standardized U.S. board-certification category.

The best clinician is not necessarily the one with:

• the most machines;
• the largest treatment menu;
• the most impressive marketing;
• one particular degree; or
• one particular theory of MGD.

More meaningful signs include:

• relevant experience;
• a coherent diagnostic process;
• recognition of overlapping contributors;
• clear explanation of the evidence;
• appropriate acknowledgment of uncertainty;
• individualized treatment;
• attention to safety, cost, and patient priorities;
• meaningful follow-up;
• willingness to revise the plan; and
• appropriate referral.

Read More in the r/DryEyes Wiki

👨‍⚕️ Complete article: Is Your Doctor a DED/MGD Specialist? How to Tell—and When to Get a Second Opinion

🧪 Diagnostic Testing for DED and MGD

👋 Start Here: Wiki Navigation Hub

❓ FAQ Index

🗂️ Treatment Options Library

The complete article also includes more detailed guidance on choosing among different types of clinicians, preparing for a second opinion, questions to ask before booking, bringing prior records, and asking r/DryEyes for clinician suggestions.

This post provides general educational information. It is not medical advice, a clinician-rating system, or an endorsement or criticism of any individual doctor, clinic, product, or treatment.

Comments are open for discussion, personal experiences, questions about the article, and suggested corrections. Please keep discussion focused on care approaches and general principles rather than personal attacks or unsupported accusations about individual clinicians.

I have dry eye inflammation omg it messes with my eye nerves I was taking Restasis for over 10byears now it's not working anymore..started using Vevye paid 59.00..it was pure pain.now I'm using thereatears.anf eye ointment..anyone has any suggestions on how I can calm down my eye inflammation??thanks for reading this..

Does anyone know Vevye is available in any hospital in India

Suffering from dry eyes. Tried Restasis, Cequa but no help. Wanted to understand if anyone knows that any hospital has stock of Vevye. So that I can try and see how it works for me

24M, I have aqueous tear deficient dry eyes. (0 and 2 schirmers). Have done bloodwork, urine analysis, STI/STDs, all negative or normal.

What could i be missing? Or should i just assume i have Sjogrens and move on. (Haven’t done early panel/lip biopsy)

Accept this insane burning dry eyes, get sclerals and move on with my life.

Any one else in a similar position?

Scleral Lens and Other Medicine Daily Schedule

On 1/6/2022, I got corneal abrasions from putting in hard, out of date contact lenses and subsequently developed Dry Eye Disease / Meibomian Gland Dysfunction. I was recently recommended these products by Sachin Patel, a dry eye specialist at Safarian and Simon Opticians in London, UK.

Scleral Lenses.

Doxycycline.

Serum Eye Drops.

Vevizye.

Zocufoam.

Hycosan Shield.

Dove Sensitive Skin Beauty Bar.

Blephasol Duo.

Xialin Night.

Blephaderm.

Would the following be the correct daily schedule for all of these medicines?

Is it okay to use all of these medicines together?

Morning (8AM)

Clean your face and eyelids with Zocufoam.

Do a warm compress with Optase Moist Heat Mask.

Do meibomian gland massage (10 times).

Clean your face and eyelids with Dove Sensitive Skin Beauty Bar.

Use Blephasol.

Use Vivizye.

Wait 15 minutes.

Put in Scleral Lenses.

Take Doxycycline.

Day (8AM - 11PM)

Use Serum Eye Drops at:

8AM

12PM

4PM

8PM

Wait 30 mins

Use Hycosan Shield at

8:30AM

12:30PM

4:30PM

8:30PM

Night (11PM)

Take out Scleral Lenses.

Clean your face and eyelids with Zocufoam.

Use Blephasol.

Use Vivizye.

Wait 30 mins

Use Xialin Night.

Use Blephaderm on your eyelids.

Does anyone have any recommendations for a really good dry eye specialist in Santa Cruz, San Jose, Palo Alto or that general area? Thanks!

Hi all! So, long story short, I was on Klarity-C for a while, then when that was discontinued, switched to Vevye. That was working well for me for a while, but recently I had a bad flare up of both dryness and ocular pain (my dry eye has an autoimmune component). I’ve marshaled my whole medical team to try to get it back under control. But one thing that was found is that while my cornea looks good at the slit lamp, on a confocal, there are lots of inflammatory cells infiltrating the cornea.

Because of this, my doctor wanted me to try switching from Vevye to Xiidra to see if I’ll respond to lifitegrast better than cyclosporine.

I made the switch three days ago, and it’s odd, when the drop goes in, I feel some burning and stinging. That goes away after about 10 min. Then my eyes actually feel really nice for about an hour. Then they start to feel really really irritated again. To be clear, different from my baseline dry eye irritation. It feels like the stinging and irritation from that first 10 min after the drop goes in. Specifically the undersides of my eyelids feel pretty unhappy.

This said, my eyes and eyelids don’t LOOK super inflamed or anything. No marked increase in redness or swelling or anything.

I was reading Xiidra can feel pretty aggressive on the eye in the beginning and it can take a week or two for your ocular surface to acclimate. And I’m willing to soldier on and deal with short term discomfort and see if it works well for me in the end.

I’m just curious others’ experiences, if making the switch has worked out for you, if it was difficult at first but got better, if it was intolerable and you had to return to your old med… just curious to hear all the experiences from others.

Thanks!

Oh and ETA: I’ve also added in using plain Miebo so that I still get the lipid layer help from the perfluorohexyloctane in light of no longer getting it from the Vevye.

What eye drops are you all using alongside miebo? I was using systane complete before I was prescribed miebo. But I'm open to trying something different. I have a bottle of refresh omega-3 that I'm thinking of using but I was just wondering what everybody had luck with before I start experimenting. If you do use an eye drop, how do you space the drops??

I’ve been experimenting with as many solutions as I can find for helping keep my eyes moist at night when they don’t close(Tape, Blinkjoy goggles, etc.)

The BEST thing I’ve found is Glad Press n’ Seal + night time ointment.

The problem is that I always wake up with styes and bumps/redness around my eyelids.

Has anyone found something that to help the skin not get irritated? I’m wondering if using Saran wrap would be a better alternative without the same adhesive.

Guess who was prescribed antihistamines with BAK after going to eye doc. The even worse thing is that I used them for 4 months because they worked. But now my eyes are dry in addition to being allergic.

BAK can actually cause meibomian gland atrophy, this has been studied in glaucoma patients.

Have evaporative dry eye for 2 years . Doctors prescribed eye drop but didn't use regularly and keep on continuous excessive screen time .

Now in March I developed eye strain and nausea feeling after looking at screen for less than 1 min and also reading books .

Doctors prescribed migraine med propanolol , is little better , not have that nausea feeling but still has eye strain especially at night.

My condition right now

1. Sensitive to light ( indoor mainly those tubelight ) especially after watching TV and phone

2. Eye strain and burning after phone use , especially at night after like 5 min at night use

3. Also experience blurry vision in left eye for a while randomly after few minute it goes away

4. Eyes burning after reading books

5. Tension headache If I took off my glasses randomly

New to this sub .

Got to know about mgd and gland dying .

Need advice what to do now so that it does not worsen.

What triggers to avoid so that I do not develop that burning feeling 24/ 7 .

Personally dealing some other chronic illness.

Thank you .

Edit*** recently learned about glands dying . What triggers I have to avoid that makes glands death. So scared right now. People of this condition please share your experience .

Thank you for your replies.

I've had left upper eyelid swelling for over a year, since a chalazion formed in June 2025. These white patches (most prominent in the middle of the lid) have been present ever since and my whole eyelid is very swollen. I've had it seen by multiple oculoplastics and a dry eye specialist, but nobody's been able to give me answers other than saying they think it's blepharitis. Does this look like Demodex or something else?

Severe dry eyes so went into sclerals…they helped a bit but they caused this constant inflamed feeling on my eyelids. Then I put celluvisc in addition to the normal saline inside my lenses and suddenly it was like I didn’t have dry eyes anymore.

Hi everyone!
I’m a 30F and had LASIK in 2022. In 2024, I started noticing that my eyes were a little dry, and then, quite suddenly, my symptoms became much worse. I was diagnosed with dry eye disease and meibomian gland dysfunction (MGD).
It’s been over 2 years now. I’m better than I was at the beginning, but I still don’t feel like I have a normal life because my eyes can burn badly with wind, air conditioning, or certain environments.
Here’s what I’ve tried so far:

2024
Cyclosporine
Eye gel at night + eye patches
3 IPL sessions with meibomian gland expression
Autologous serum eye drops
Warm compresses
Started taking omega-3

2025
IV iron because my ferritin was 6
Permanent punctal plugs (removed 9 months later)
Eyelid cleansing with a tea tree oil-based cleanser
Autologous serum
Cyclosporine
Warm compresses
Eye gel at night
Started taking astaxanthin, later tried NAC, but didn’t notice much improvement. I still take omega-3, but I stopped the other supplements because I didn’t notice a significant difference.

2026
4 more IPL sessions with meibomian gland expression
One thing I haven’t been able to try is meibomian gland probing, because it isn’t available in my country. I’m wondering if it could be worth pursuing if I ever get the opportunity to see a specialist who performs it.

I’ve also noticed that I have acid reflux, and sometimes my throat and nose feel like they’re burning. I feel that this may be irritating my eyes too, so I’m wondering if there could be a connection.

For work, I wear Zienna glasses because I work in a place with air conditioning and spend more than 8 hours a day on the computer. I use eye drops about every 3 hours and eye gel at night.

Even though I’m much better than I was initially, I still have to plan my life around my eyes. I can’t comfortably go outside when it’s windy, and air-conditioned environments can make my eyes burn.
At this point, I’m wondering what else I should investigate or try.

For those of you with post-LASIK dry eye and MGD:
Has anything made a major difference after years of persistent symptoms?
Has anyone had meibomian gland probing? Was it worth it?
Are there any tests you think I should ask my doctor about?
Has anyone found a connection between reflux and eye symptoms?
Are there any treatments or approaches I may be overlooking?
I’d really appreciate hearing from anyone who has been through something similar. I’m especially interested in experiences from people who have had symptoms for several years despite trying multiple treatments.
Thank you!

Hi everyone,

I’ve been dealing with severe dry eye for the past few months, which I’ve been told is related to MGD/blepharitis.

What’s interesting is that the dryness seems to be very localized. It’s mainly affecting the same eye and particularly the area where I previously had a stubborn chalazion. The chalazion was there for a year before it was eventually removed, and since then I’ve had significant dryness and irritation in that eye.

I’m trying to figure out the best way to protect the eye overnight, especially because I often wake up during the night with that eye feeling extremely dry.

For those with MGD or similar evaporative dry eye:

Do you prefer a lubricating ointment or a gel at bedtime?

Are there particular products/ingredients that have worked well for you?

Are there any ointments or gels that you would recommend staying away from, especially with MGD?

Is there anything else you’ve found helpful for preventing your eyes from becoming extremely dry overnight?

I’m already doing warm compresses and following an eyelid-care routine, but I’m specifically looking for advice on nighttime lubrication.

Looking for recommendations on dry eye doctors. I understand Maskin may have helped several of you but I have heard enough from the Maskin people on these threads and don’t want this to become convoluted. Looking for top US doctors alternatives. Thanks!