Maskin says in up to 75 percent of cases, the tears are affected by blockages in the meibomian or oil-producing glands of the eyelids. Fluid backs up, leading to inflammation and other symptoms. (Restasis works by reducing inflammation.)
For the most severe cases, Maskin uses a procedure he developed about five years ago called intraductal meibomian gland probing. It involves opening each blocked gland with a special instrument he developed with a wire probe, the smallest being thinner than a human hair. "We pass the probe into what is essentially an impacted, obstructed tear gland and patients get a 75 percent reduction in symptoms immediately," he said. (A patent is pending on the instruments, which are manufactured at Rhein Medical Inc. in St. Petersburg.) In studies conducted by Maskin and published online in the peer-reviewed journal Cornea, patients reported a 90 percent reduction in symptoms nine months after treatment.
Patients have come to him from around the world for treatment (including five from Australia), but Maskin said more eye doctors are buying the instruments and learning how to do the procedure.
Updegraff agrees that those with blocked meibomian glands may need more than eyedrops. Some see their doctors regularly for a procedure that squeezes the glands to try to clear the accumulated oil. "These are patients who are truly miserable and are looking for anything to help them," he said.
As for Maskin's procedure, he said, "it makes sense and it probably won't hurt anyone, but we don't have the conclusive scientific evidence that says how well it works and how long it works.'' [Source]
Probing technique in Australia
Dr Chan suggests that if the restasis isn't helping after several months I should consider coming back as he now offers probing which he thought might help me. [Source]