Painful blocked glands, toxic meibum & probing

[Meibum Ian]

I’ve been wanting to post this for a while, but it’s hard to effectively describe what’s going on and my thoughts about it.

Would love to hear from anyone experiencing anything similar, alternative theories or suggested treatments.

Clinical signs

• Meibography is good, indicating no significant dropout or problems.
• Lipiview lipid layer thickness: Now 100 in both eyes
• TBUT 8 seconds (1 second a year ago).
• At most recent exam, no problems with oil or glands detected (expression with cotton bud, but not of every gland).

What I experience

• Blinking pain. At worst it feels like tiny razor blades or stones are sewn into my eyelids. At best, just like something is between my eyelids and stopping them make proper contact with each other.
• Tacky’ sensation when eyelids separate
• A feeling of fullness and pressure in upper eyelids. Sometimes as though they are going to explode. I get this very strongly if I sleep without taping eyelids.
• Tenderness in some spots when touching eyelid during massage. As though the contents of the glands can’t be pushed through the gland openings. The location of the tender points / glands is pretty much symmetrical between both eyes and has been the same for a year. Upper lids only, mostly in nasal corners.
• Occasionally, the blocked glands can be expressed. I see semi solid meibum expressed. Translucent stringy, or mozzarella-like.
• Sometimes the expressed meibum is extremely painful, to the point where I have screamed and felt like I would pass out when it gets into my eye. My eye would also turn red when this happened. In the past, meibum expressed would have a brown / dirty appearance. I suspect release of this ‘toxic meibum’ sets off inflammation again.
• It feels like the blocked glands interfere with the entire blink. When they do occasionally open up, my whole eye feels hugely better. I’ve read about how the upper eyelid pulls moisture up from the lower lid and wonder if this action becomes broken by the blocked / swollen gland. It just seems like moisture spreads much better over the eye.

So I have a problem with trying to reconcile clinical signs with my symptoms, at least in this regard. It’s frustrating to be told that I have no problems with the glands, and to not really be listened to. I am sick of feeling alone in trying to diagnose my own problems and get the treatment I need.

But to my mind this indicates that I can now systematically produce good oils and my problems are localised to a few glands. The huge relief (ecstasy really) I occasionally feel when the blockage occasionally clears indicates to me that this is now about 80% of my problem.

I am booked for a gland expression with possible probing. I think this means only glands unable to express anything will be probed. I suspect something will come out of even my bad glands, so not sure how useful this will be. I’m also wondering if I need PRP or similar injected into the glands to stop them producing the ‘toxic’ meibum

I think I would actually feel significantly better if these glands were somehow just removed, if that is even possible. Obviously it would be better to have them unblocked and expressing good oil somehow but maybe this would work as a last resort?

[MGD1701]

Not clear about your issues - blocked glands and inflammation? clear or toxic oil?
but you wrote ''no problem with oil and glands - recent exam.''??

how can you 'feel' blockages especially your lipid layer is 100.
can not image, ''the blocked glands interfere with the entire blink'' - do you feel dry then?

How about something more objective, so something can be ruled out.
osmolarity
inflammation level, MMP-9, foamy team film, demodex?
staining results for fluorescein & lissamine green
lids position/sealed, blinking patterns? - have these been checked??

BlephEx, debridement (to remove dead cells etc) have you done this? this could link to blinking too??
I would try this first if inflammation presents, prior to probing as probing is invasive.

[SirDryEye]

Hey, I also have pretty good functionally glands (clinically), but in when it comes to symptoms, I suffer with a lot of the stuff u mentioned above, like painful blinks. I have to wear moisture goggles every chance I get! I guess there’s nothing we can do

[Guest]

Ok, I know we have different issue, as far as we both know. Yet what you describe is very similar to myself. I’m probably just not as bad as you.

- in my left eye, I get that scratchy feeling that something on my eyelid scratching my cornea. When I do a compress and release the glands, that goes away pretty much instantly.

- I have a tacky sensation on the lid margins but I also have it behind the upper lids. It can feel like the upper lid is stuck to the upper portion of the globe. Not the margin, the entire lid. At times, thankfully mostly gone now, it can feel almost like the upper lid has suction to the eye and its lightly pulling epithelium off.

- expressing my glands at its worst also created more pain. Agreed the toxic meibum is getting released into the tear film

- I have a pressure in the upper lids as well. Almost feels swollen there. Right at the very start of my glands, near my forehead in the center or possibly temporal sides. If I express too hard there, I get this insane pressure. Like my eyes will explode exactly like you said. Not expressing as hard helps that. But I also know if you don’t get after it, you won’t clear the gland.

Are you currently on doxy? Have you had your lid flipped to check for papillary conjunctivitis? It sounds like the conjunctiva is the issue.

Im also not understanding how you can have a llt of 100 and still have blocked glands. The fact that they function is a good sign. But something is causing those glands to become blocked. The question is what.

Are there times when the pain is worse? Have you been keeping a journal?

Does it feel like when you blink, there’s presssure keeping you from completely clamping down those lids?

Im sorry you’re still getting this insane lid pain. So curious what the back of your lids look like. Did the doctor find concretions or anything when he flipped the lid?

[Topher3]

This is definitely a puzzler. You have a lipid layer thickness 100 but only a 8 second TBUT, and you are having solid meibum expressed, how is that possible. Your test results have to be inaccurate it just doesn’t add up. Do you possibly have allergies causing pappilae underneath the eyelid that’s causing your discomfort when blinking?

What is your Aquaous layer thickness? Have you done a schirmer test to see the thickness of your water layer? This layer usually refers to painful blinking. Some people have got practically 0 lipid layer thickness however dont experienced pain with blinking due to a good Aquaous layer.

tenderness on the lids usually relate to styes or chalazions. Usually there is a feedback loop once the gland is blocked it sends a signal for the gland to down regulate stopping chalazions but also causes atrophy of the gland. So be careful with that.

What is your diet like ? Please be honest do you eat a lot of takeaway?

[MGD1701]

Lipid layer thickness by LipiView
I got 100 (shown on the report) before LipiFlow for one eye which is of course incorrect.
I do not apply (oil-based) drops 1 day or at least 4 hours prior to the consultation.

CCH conjunctivochalasis can cause pain when blink, some even can identify the location.

[MGD1701]

Plugs vs inflammation

Most experts in USA will only put plugs in when there is no (or very low?) inflammation.
Some do not like the idea (as when there is inflammation, they need to remove plugs).
Prof. Clara Chan, from Canada, only uses it as the last step as plugs could make eyes more red/inflammed.

Even Dr Toyos mentioned (often) doctors do not check/treat inflammation,
yet inflammation is the most important issue.

[mbperso]

- LLT=100 + TBUT=8 sec + TBUT=1 sec last year =>makes me think that it could be a aqueous issue.=> Did you do a Schrimer or PRT test ?

- I don't understand the contradiction : LLT=100 and semi solid meibum expressed ! => Did you see yourself 100 on the paper ?

- Regarding symptoms agree that it could be papillary conjunctivitis but it could be follicular conjunctivitis or both (I had it). This implies irritation
The cause could be allergen or because of a foreign body or contact lens.
=> I would recommend to ask your doc to revert the upper lid and see on the slit lamp if there are follicles and irritation
Treatment is allergic drops
Doxy and cyclosporine could be a great help

[Meibum Ian]

Thanks all for the replies. Very busy at the moment but will do my best to address the questions asked etc in a day or two!

[hopeful_hiker]

Since I have blinking pain, too, here are my ideas:

-LWE: your lid wiper could be damaged by dryness. You can speed up recovery by using oil-emulsion drops and steroids.

-CCH MGD1701, loose conjunctival layer could be the cause. Usually the pain is always present and by closing eyes and pinpointing gently on the eyelid you can replicate pain.

-Neuropathy: Through dry eye damage, nerves could grow in strange ways becoming sensitized even to innocuous stimuli. Serum drops can help.

-Pappilae: This is what Dowork123 has experienced. I also had papillae or small bumps on the inner eyelid. It could be mechanical damage or it could be from allergies.

-Styes, hard meibomian bumps. Docs should be able to spot that as well.

-Sticky oils. Not scientific, but I found one post here specifying that as a blinking pain cause.

-Lack of sleep. If I don’t sleep enough, it aggravates the sensation.

My symptoms. Pain is not limited to a spot. The whole eyelid wiper area or parts of it rub against my eyes and cause pain. On better days I feel scraping but no pain. On even better days, I feel smoothness but also eyelid muscles “kicking”. On the best days I feel nothing or almost nothing. At this point this is one of my only symptoms.. I do have MDG and some aqueous deficiency.

I have to say, blinking pain is an odd symptom. Right now I only know of Dowork, myself, and now you, and to me it sounds like we don’t have the same causes.