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Meibomian gland expression: maintenance or murder?

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  • Meibomian gland expression: maintenance or murder?

    Please see Sandra Brown MD's article on appropriate and inappropriate use of meibomian gland expression. I would love to get feedback on this topic. It is a big concern of mine lately.

    http://dryeyezone.com/encyclopedia/mgcare.html
    Rebecca Petris
    The Dry Eye Zone

  • #2
    Originally posted by Rebecca Petris View Post
    Please see Sandra Brown MD's article on appropriate and inappropriate use of meibomian gland expression. I would love to get feedback on this topic. It is a big concern of mine lately.

    http://dryeyezone.com/encyclopedia/mgcare.html
    I will own up to being a bit hard on my glands; this article certainly resonated with me. I have never had it explained like this before.

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    • #3
      Only problem is, 6 months from now the tide will turn, and another expert will claim the exact opposite.. What does one do??..
      Next this will be the way forward? (NOT!).. http://www.youtube.com/watch?v=V99HBOHiR3E (any volunteers??........thought not!)...

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      • #4
        Very interesting, thank you Rebecca. I think I need to find a doctor who can tell me whether mine is due to inflammation or just lack of oil. I found interesting with the lack of oil being due to either the role of androgens or lack of nerve stimulus. Hmmm...maybe that's why so many of us post-lasiks are having problems with MGD even though the doctors say it mainly affects the lacrimal gland.

        And Colin, that procedure looks especially scary, the poor patient is bleeding. That's got to cause even more inflammation and scarring.
        Last edited by Lacey1; 27-Sep-2011, 19:14.

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        • #5
          Great post!!
          I have been wondering about the wisdom of expressing the glands, especially since I have been told that my oil are clear, just not plentiful. This is probably an accurate description for many post lasik patients. If we are aqueous deficient, it would seem to make sense that we would be oil deficient too, given that the two systems are connected via feedback loops. I think for Lasik patients, we do not give our glands the natural stimulation that they may require because we are told not to rub our eyes. Maybe rather than trying to express oils, we can gently give our lower lids a rub, while keeping our flaps protected by looking up.

          I think that it makes sense to use a warm compress for 4 min. to get oils going and then leave well enough alone unless instructed otherwise, by medical professionals.

          Now we are not all the same, so a cookie cutter prescription is not going to work. . . that is how some of us got into this mess in the first place!

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          • #6
            It's good to be reminded of the importance of not overdoing it!
            Yet another post-Lasik (2005)...
            Anyone have a time machine so I can go back and undo this mess?

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            • #7
              wow! some warning. i'm gonna be even more careful than i already was.
              periodically leaving things alone for a couple of days isn't so bad after all i guess.
              i sometimes do that,but it always feels like slacking off a bit. and it makes me feel guilty of being lazy. no need for that. it just turns out to be the right thing to do....

              patrick..

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              • #8
                Originally posted by Rebecca Petris View Post
                Please see Sandra Brown MD's article on appropriate and inappropriate use of meibomian gland expression. I would love to get feedback on this topic. It is a big concern of mine lately.

                http://dryeyezone.com/encyclopedia/mgcare.html
                Well an eye doc recently told me to do warm compresses and eyelid hygiene 4x a day. I don't agree with this frequency. It seemed to be "oh, well twice a day hygiene and warm compresses don't do much, and I don't really know what else to do, so get the patient to mess with their eyes even more and then blame their failure to improve on their non-compliance!" I wasn't advised to actually express the glands, but warm compresses 4x a day I would guess has a similar result to expression. I doubt this eye doc would have ever heard of such a thing as expressing the glands, let alone have ever done it.

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                • #9
                  I think the biggest problem out there is the fact that there are far too many docs who don't bother checking a patient's meibomian glands (I assume because they are not familiar with what to look for??) - add to that that so many of us took a long while to find a doc who would try to help us, and we're left with no choice but to try to help ourselves.

                  People with high blood pressure don't need to treat themselves because every doc out there will measure and treat it if required. But dry eyes? No such luck... too many patients are left to fend for themselves after being told that their symptoms can't possibly be that bad, or that it's all in their head (ie. go see a psychologist since we can't see anything wrong with you)

                  I feel lucky to have found a good doc back in late '09... but before that? the old doc was a joke as he insisted that I was doing "GREAT!" for over 3 years as I continued to deteriorate while he did absolutely nothing other than to tell me to continue to use preserved Systane even every 15 minutes if needed.... (oh! and he finally added on Blephamide drops every 3rd bedtime) makes my blood boil when I think of it...

                  Hopefully more and more docs will learn what to look for re: MGD, so patients won't feel like they have no other option than to self-treat in the mean-time...
                  Yet another post-Lasik (2005)...
                  Anyone have a time machine so I can go back and undo this mess?

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                  • #10
                    Originally posted by SAAG View Post
                    I think the biggest problem out there is the fact that there are far too many docs who don't bother checking a patient's meibomian glands (I assume because they are not familiar with what to look for??) - add to that that so many of us took a long while to find a doc who would try to help us, and we're left with no choice but to try to help ourselves....
                    Hopefully more and more docs will learn what to look for re: MGD, so patients won't feel like they have no other option than to self-treat in the mean-time...
                    Ya hit that nail on the head. I could not agree more.
                    Rebecca Petris
                    The Dry Eye Zone

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                    • #11
                      I still don't really understand why expression/massage is important. If the heat has already liquefied the blockage, why do you need to express it? Won't it start functioning by itself as you blink throughout the day (and continue to apply the heat 1-2x a day)?

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                      • #12
                        Heat doesn't work for everyone. When I first managed to get started with `expression', the secretions come out as a solid core - which could not have been good for the health of the lids. The lids started to feel better because the inflammation eased. A couple of consultants have also expressed the glands but they never showed me how to do it properly (or effectively - in a way that didn't traumatise the lids too much)

                        I think it's knowing when enough is enough. I agree with SAAG; too many patients are left to fend for themselves and when desperate, reach for any measure that will provide relief. It's when some consultants say that it should be a part of our `routine' that it becomes confusing. Once a day - twice? Once a week?

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                        • #13
                          Hi,
                          I find this interesting as well. I am 33 months post-L word and my regular Eye Dr. for the first time said I have MGD and she put me on Azasite daily for three months then a re-evaluation to follow. I had a couple of decent days but as usual, I have had pretty bad ones as well. But she did say that Azasite is of particular benefit due to it's anti-inflammatory properties, we will see. But my main concern is with IPL, I have had 5 treatments and after each one, I have had rigorous gland expressions - very painful! I have always been told to "scrub" my lid margins with occu-soft scrubs but I find every time I do that I have a real bad day following, so my feeling is that warm compresses can help and as someone said, mild lid message such as carefully drying my lids after washing my face is best. I will not do a self expression; I feel it is murder to an already unbearable situation. And the last thing is I usually end up with ice on my eyes before bed due to all day irritation.

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                          • #14
                            I found this article to be terrific. I've had an overkill tendency -- compresses that were too hot, too hard expression, etc. I should read this article once a month just as a refresher. I'm guessing I'm not alone in that either; it too easy when you find a little relief from something to take it to the extreme.

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                            • #15
                              I'm just gonna add that if I do an expression every night, I see a big difference. If I don't do the expression, I will wake up much more uncomfortable. There is no doubt that doing one every night is very important for me. Also, while prodding and pulling on tissue may not be great, I imagine that as long as the damage isnt too severe, like you cut the gland or something, that the gland will not sustain permanent damage. I know firsthand that after an IPL treatment my eyes are horrible for a four or five days after the rigorous expression, and then they bounce back better than ever. So while I would suggest against over -indulgence in the routine, I do think it is important to keep those glands working.

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