What does it mean to have "dormant" meibomian glands?

[Alix]

I had Lipiview done a couple of months ago and on the screen saw about 4 full glands in each upper eyelid, with the rest atrophied or faded out. I was told that the faded out ones were "dormant". The faded out ones were full length.

Does anyone know what dormant glands are? I searched around on the internet but couldn't find any information on this.

In hindsight I should have asked at the time what "dormant" meant, but I was in too much a shock at seeing the state of my glands in general, and I am not going back to the clinic so don't know who else to turn to.

[Milo007]

This could be interesting. I think they meant by "dormant" glands that the glands have stopped functioning (secreting lipids) due to chronic blockage but they are not fully lost morphologically. By dormant glands they perhaps meant that these glands have shrinked recently so they might have the potential to regenerate if the blockage is removed early and the channel of lipid flow reestablished.

I am saying all these out of my common sense and understanding but I am really excited about the possibility of your glands growing back. Perhaps you should visit them once again and ask if they think treatments like lipiflow, IPL or probing can help the glands regenerate.

[Alix]

Hi Milo I am hoping you are right about the glands, the reason I am asking now is that I started taking probiotics a week ago, and am seeing small improvements (eyes not burning as much as long as I'm not in air conditioned places). Seems too good to be true so am keeping my expectations low.

I don't really want to go back to the clinic as I will have to pay hundreds of pounds in consultation fees. I already had 2 IPL sessions there so they will probably tell me to have more, but I am not too keen as the first 2 had no effects whatsoever and it is too expensive at 200 pounds a time.

I am annoyed at myself at not having asked at the time, and at them for not having explained what the dormant glands meant but maybe they had assumed I already knew.

Not sure about probing either, it is even more expensive and there are many horror stories floating about which are very off putting.

[Fenix]

Alix I'm glad to see that probiotics are helping you. Regarding the IPL treatments, I know that usually people see improvements after 3 or 4 treatments.
I would do at least another treatment, and I would ask what dormant glands means and if that glands can regrow.

[Milo007]

Hi Milo I am hoping you are right about the glands, the reason I am asking now is that I started taking probiotics a week ago, and am seeing small improvements (eyes not burning as much as long as I'm not in air conditioned places). Seems too good to be true so am keeping my expectations low.

I don't really want to go back to the clinic as I will have to pay hundreds of pounds in consultation fees. I already had 2 IPL sessions there so they will probably tell me to have more, but I am not too keen as the first 2 had no effects whatsoever and it is too expensive at 200 pounds a time.

I am annoyed at myself at not having asked at the time, and at them for not having explained what the dormant glands meant but maybe they had assumed I already knew.

Not sure about probing either, it is even more expensive and there are many horror stories floating about which are very off putting.

Do you have the images of your glands?

Is it possible for you to travel to US for a potentially beneficial treatment?


The problem is it seems only US has the best doctors around who can provide cutting edge treatments. Probing might work but it has to be done by someone who's trained. If you have the gland images you can opt for an online consultation with Dr. Sandra Lora Cremers via "healthtap" for 49$. She might clarify better looking at the pictures if probing or any other treatment would bring back your glands. Worth an enquiry at that cost I guess.

[Meibum Ian]

Alix - I think it would be completely reasonable for you to ask the clinic by email what they mean by it. If it's the clinic I think it is, it shouldn't be a problem.

[Guest]

I already had 2 IPL sessions there so they will probably tell me to have more, but I am not too keen as the first 2 had no effects whatsoever and it is too expensive at 200 pounds a time.

I've read articles and watched videos where docs say that one needs a at least 4 IPL treatments to be effective, and for some patients, 6 of them. After that, things should be improving and one can go onto a maintenance schedule of an IPL treatment every 6-12 months. So if you've already had 2 IPL, maybe go ahead and schedule 4 more of them... then after you've had 6 treatments, decide if it's worth continuing with.

[deep_dry_eye]

I had Lipiview done a couple of months ago and on the screen saw about 4 full glands in each upper eyelid, with the rest atrophied or faded out. I was told that the faded out ones were "dormant". The faded out ones were full length.

Does anyone know what dormant glands are? I searched around on the internet but couldn't find any information on this.

In hindsight I should have asked at the time what "dormant" meant, but I was in too much a shock at seeing the state of my glands in general, and I am not going back to the clinic so don't know who else to turn to.

Recently, among doctors, there's been a new unpublished theory -- based on anecdotal evidence without solid proof. The theory is that MGD sufferers, a subset of the patients, dont actually have dead glands despite what meibography (i.e., LipiView) shows. But rather, the "dark areas" of the glands are "dormant", i.e., the tissue is not dead , but just not active. The theory is that, if we can somehow control inflammation and give the glands the right environment, they can be recovered and made active again (produce good quality oils again).

The intuition is backed by many drs who see patients with "dark" (dormant, or previously thought dead glands), but somehow able to recover and secret oil. Some treatments that *may* help include IPL, Xiidra, and Restasis. The theory is that these treatments can reduce inflammation, and create an environment for the glands/tissue to recover.

[deep_dry_eye]

Hi Milo I am hoping you are right about the glands, the reason I am asking now is that I started taking probiotics a week ago, and am seeing small improvements (eyes not burning as much as long as I'm not in air conditioned places). Seems too good to be true so am keeping my expectations low.

I don't really want to go back to the clinic as I will have to pay hundreds of pounds in consultation fees. I already had 2 IPL sessions there so they will probably tell me to have more, but I am not too keen as the first 2 had no effects whatsoever and it is too expensive at 200 pounds a time.

I am annoyed at myself at not having asked at the time, and at them for not having explained what the dormant glands meant but maybe they had assumed I already knew.

Not sure about probing either, it is even more expensive and there are many horror stories floating about which are very off putting.

Every patient is probably different. Some patient may experience symptomatic improvement after 2 sessions, some need 4-6 (i.e., farmgirl , after years of MGD , needed 5-6 IPL treatments and she experienced massive improvements).

Additionally, not all IPL protocols are the same. I personally found a doctor who follows Dr Laura Periman's protocol (you can YouTube/Google/Twitter find her), wherein the protocol does upper and lower eye lids. I (via personal experience) find that this protocol to be substantially better than Toyo's protocol which only did lower lids. Some patients, lower lids only is fine, some need both. I am personally on IPL monthly. I went from being bedridden to back to work in front of computer 10+ hrs a day. Obviously every patient is different, but you don't know till you try.

I would put off probing, I personally was ready to fly to Florida to visit ****** for probing. However, after consulting with many doctors, the risk of probing outweighed the benefit for myself personally. I would suggest you exhaust the more conventional treatments (i.e., IPL, Xiidra, Restasis, Azithromycin, Doxy) before attempting probing.

Best wishes!

[Alix]

@Fenix - Thank you I read your post about taking probiotics and decided to try as well. I am taking quite alot of other supplements at the same time, so perhaps the probiotics are helping with vitamin absorption? I'll carry on taking them to see where this goes.

@Milo007 - I don't have the images of my glands. Unfortunately I do not have the time or the funds to go and get treatment in the US. Even if I did, according to Dr Cremers' video, probing only lasts 7 months, so I can't really justify the expense/time off work required.

@Meibum Ian - Good idea I will email them, hopefully they will remember who I am!

@SAAG - The last IPL session I had was 2 months ago, do you think if I had a third one say this month, it would be like starting over again from scratch? I bought the Blephasteam but I'm still waiting for it to arrive, I think I would like to use it for at least a week before thinking about going back to IPL.

@deep_dry_eye - There is nowhere in the UK as far as I know that does IPL on the upper lids. It is encouraging to think that the dormant glands may become active again, I will need to find out what percentage are dormant. Unfortunately I stopped using cyclosporine ie. Ikervis a couple of weeks ago, as despite using it twice a day, it wasn't doing anything. Perhaps I should have tried for at least 3 months as that is when the effects are supposed to kick in but it was getting too expensive and I didn't want to get dependent on it. Hope this wasn't a mistake.....

[quattroboy]

Recently, among doctors, there's been a new unpublished theory -- based on anecdotal evidence without solid proof. The theory is that MGD sufferers, a subset of the patients, dont actually have dead glands despite what meibography (i.e., LipiView) shows. But rather, the "dark areas" of the glands are "dormant", i.e., the tissue is not dead , but just not active. The theory is that, if we can somehow control inflammation and give the glands the right environment, they can be recovered and made active again (produce good quality oils again).

The intuition is backed by many drs who see patients with "dark" (dormant, or previously thought dead glands), but somehow able to recover and secret oil. Some treatments that *may* help include IPL, Xiidra, and Restasis. The theory is that these treatments can reduce inflammation, and create an environment for the glands/tissue to recover.

This is my docs theory. He is very skeptical about the claims made about gland dropout. Just because the image doesn't show them doesn't mean they're not there.

He found one study where lippview was done a group of juveniles where nearly 50% showed gland dropout, but none had symptoms! He found both facts very hard to believe.

Reckons it's the power of marketing over common sense.

[TARYN]

deep_dry_eye I tried probing and it neither helped or hurt. I did not have great results with IPL with Dr Toyos either. I had a total of 3 IPL. The first 2 had very little results and the 3rd actually kicked up inflammation in my eye and I needed a round of steroid drops to calm the inflammation

[Guest]

SAAG[/U] [/B]- The last IPL session I had was 2 months ago, do you think if I had a third one say this month, it would be like starting over again from scratch?...
I bought the Blephasteam but I'm still waiting for it to arrive, I think I would like to use it for at least a week before thinking about going back to IPL.

Hard to say... but knowing what I know now, I suspect 2 treatments isn't enough. But either way, the Blephasteam plan sounds good.

Unfortunately I stopped using cyclosporine ie. Ikervis a couple of weeks ago, as despite using it twice a day, it wasn't doing anything. Perhaps I should have tried for at least 3 months as that is when the effects are supposed to kick in but it was getting too expensive and I didn't want to get dependent on it. Hope this wasn't a mistake.....

I don't think getting dependent on it is an issue.

Also, the effects all along for me with cyclosporine drops (Restasis, 0.05%) were subtle and a slow build up. So I think cyclosporine drops are best used at least 6 months before deciding anything... preferably a year. It takes 4-6 weeks for it to kick in, then it takes time after that for your eyes to start recovering from the inflammation (that is now being suppressed by the cyclosporine drops). If one's eyes are bad enough, I don't think a quick recovery/major improvement over a couple of months is likely.

When Restasis first came out standard advice was that it takes 1 month to work. Now I commonly see articles where docs say to try it at least 6 months, which mirrors my own experience with using it because at 1 month the effect was tiny compared to the effect months later.

[Topher3]

Hi Milo I am hoping you are right about the glands, the reason I am asking now is that I started taking probiotics a week ago, and am seeing small improvements (eyes not burning as much as long as I'm not in air conditioned places). Seems too good to be true so am keeping my expectations low.

I don't really want to go back to the clinic as I will have to pay hundreds of pounds in consultation fees. I already had 2 IPL sessions there so they will probably tell me to have more, but I am not too keen as the first 2 had no effects whatsoever and it is too expensive at 200 pounds a time.

I am annoyed at myself at not having asked at the time, and at them for not having explained what the dormant glands meant but maybe they had assumed I already knew.

Not sure about probing either, it is even more expensive and there are many horror stories floating about which are very off putting.

I’m interested in the probiotic theory, what kind of probiotics are you taking if I may ask. I could really do with something helping my internal gut flora. I believe I could possibly benefit from probiotics. Thanks

[Milo007]

Alix - I think it would be completely reasonable for you to ask the clinic by email what they mean by it. If it's the clinic I think it is, it shouldn't be a problem.

You are right. But I am doubtful if the authorities who checks the emails would convey the query to the doctors at all. Most clinics instead ask for booking another appointment with the doctor to clarify any queries. Some doctors are too professional to pass on any information via email or telephone. I have experienced this myself but emailing the clinic is definitely worth a try. Nothing to lose!