Meibography Grade

[insidious988]

What is the meibography grade of you all?

I have grade 3...out of 4.

And I'm only 30 years old. I don't know where this will lead...it's devastating.

[Milo007]

What is the meibography grade of you all?

I have grade 3...out of 4.

And I'm only 30 years old. I don't know where this will lead...it's devastating.

Do you have your meibography images?

Grade 3 means you have lost more than 50% of your glands (by area) . It's not the end by any means if you can make the remaining glands work well.

How bad are your symptoms?

I am only 27 years old and I am also totally devastated. I can definitely feel your agony. But we cannot expect a normal life at this stage as long as some miracle happens.

Did you work on computers for long hours?

[insidious988]

Unfortunately I don't have the images, only the letter from the doctor's office where it says grade 3.

My symptoms depend on the day. Sometimes, over very long periods, I have very bad symptoms. Burning all day, red veins, grittyness, light sensitivity and so on. Then again there are days where I'm almost normal. But my TBUT is almost only between 3 and 7 seconds. How about you?

I also had 4 chalazia already. 2 on the upper left lid in 2011/2012 and 2 on the upper right lid in 2017. They got removed chirugically. And this means the glands were gone after that because a chalazia is a blocked gland and it gets removed...

I work on computer all day, yes. Since 2009 and about 9 hours a day. Bad, I know. But I have to work for a living.

How do you cope?

[Milo007]

Unfortunately I don't have the images, only the letter from the doctor's office where it says grade 3.

My symptoms depend on the day. Sometimes, over very long periods, I have very bad symptoms. Burning all day, red veins, grittyness, light sensitivity and so on. Then again there are days where I'm almost normal. But my TBUT is almost only between 3 and 7 seconds. How about you?

My TBUT was initially 3s each eye (July 2018). On December 2018 it went up to 6s on each eye. But it's highly variable.

I have moderate gland loss (grade 1) but what's important is that if the glands are performing well even if few of them are remaining. So you may ask your doctor the next time about the quality and quantity of your secretions.

I also had 4 chalazia already. 2 on the upper left lid in 2011/2012 and 2 on the upper right lid in 2017. They got removed chirugically. And this means the glands were gone after that because a chalazia is a blocked gland and it gets removed...

I work on computer all day, yes. Since 2009 and about 9 hours a day. Bad, I know. But I have to work for a living.

How do you cope?

You have been getting so many chalazia and yet doctors didn't warn you of glands getting blocked due to stagnant meibum?

This is strange.

Long term daily computer usage accompanied by a reduction in blink rate is the most likely cause of your MGD. I would suggest you to immediately start warm compresses (strictly between 42-45°C) along with blink exercises (following warm compresses and also every 20 minutes while working on computers for 2 minutes at least). Put on moisture chamber glasses all waking hours to prevent evaporation induced inflinflammation. Avoid AC spaces and sitting directly under air vents in office or under AC or ceiling fan at home. Use a preservative free artificial tear drop (with lipids) every 20-30 minutes while on computers or AC spaces. Take breaks from work every 20 minutes and do blink exercises. Switch to a very healthy diet (very high in omega 3 and low in sugar, refined carbs, omega 6 and meat). Avoid all junk food entirely. Use a safe anti inflammatory drug like restasis or xiidra. If you can tolerate start taking doxycycline 20mg or 50mg once daily for at least three months. Consider use of "preservative free" topical azithromycin eye drops (from a compound pharmacy) for one month followed by the first and third weeks of every month. Have a sound sleep of at least 8-10 hours a day. Avoid staring at digital screens unless absolutely necessary.

Use a personal humidifier in your work environment (if permitted) and home to maintain around 60% humidity or more.

I am personally not doing very well though. Have been getting inflammation from various sources that sets back my secretions badly. I am a victim of a demodex infestation along with usual MGD.

[Dryinvancity]

I recommend the I-Drop Pur Gel drops. They are preservative free.

[Milo007]

I recommend the I-Drop Pur Gel drops. They are preservative free.

Lipid based drops would stabilize the tear film for around 15 minutes and possibly more with MCGs. So systane balance single use vials are a good option.

[insidious988]

@Milo07:

Thank you very much for your exhaustive and informative message. Unfortunately, I have tried most of these things you mentioned already - keep in mind the whole thing started 2010/2011 - so I have this disease now almost 10 years! You can imagine how my 20s were - and these years should be some of the best of ones life. Sometimes I just lay in bed in a dark room when symptoms were on it's peak again - I couldn't stand light etc.
But, I never went bedridden. I got to work every day - I'm just this kind of person who keeps going, as bad as it is, you know?
But I don't expect much from life anymore - this disease is terrible as it get's worse and worse with years. This is my experience, sorry.

Doctors around here are also terrible. As of now I have seen many, many of them. I went to clinics etc.
Most of them don't know much or just don't care - some of them almost make fun of you as they don't think all of this is a big issue. They think we are exaggerating. Doctors told me so many wrong information that I noticed when I started to learn things for myself - I spent hours and hours online reading, watching videos from experts etc. I'm pretty educated on the subject now over all these years. But the thing is - I't doesn't get much better, no matter what I did. Last thing was IPL - 4 sessions - thought it got a little bit better but I'm not really sure so it didn't do much in the end.

Situation has improved a little bit now with doctos - but not much. No one told me in 2011 when I got my first 2 chalazia that there is a thing like MGD and what I need to do. Only in 2017 I got more infos on this. I'm on blephasteam since a few months, I tried azithromycin orally and topical, every drop you can think of (strange thing is that lipid drops burn more than normal ones etc.), I'm on doxy 40 mg since almost a year, tried tto and now again on tea tree oil as I think I have demodex too (in my case I have rosacea and rosacea patienst are infested with demodex), tried Ikervis (Restasis) but dind't help, got a humidifier at work.

What I didn't try as of yet are moisture chamber glasses - you know I just can't take the stares, life is hard enough as it is for me. People even look strange at me with a humidifier next to me at work - all of this worsens the situation when people give you the looks. Same with diet. I eat a lot of healthy food as I'm working out - but I won't dismiss meat etc. entirely as this is just part of life - life is bad enough already and food is a part of quality - sometimes I will eat junk because I don't want to live like I'm dead already.
I take 3 g omega 3 every day and also 1 mg of GLA - didn't notice much difference though.
It is all very hard.

[insidious988]

How's your schirmer by the way? Mine was 3/4 last time. So I got a low tear volume, too. Sadly.

[MGD1701]

Hi insidious
you can easily find the grading pictures from google.
Maybe good to get a copy of your image so you can compare in the future.

Moisture chamber glasses is so useful/important to protect eyes from desiccating stress. Make a big difference.

omega 3, GLA might take 2-3 months to see the result. If you have never taken them, might need higher dose or longer.

[Milo007]

How's your schirmer by the way? Mine was 3/4 last time. So I got a low tear volume, too. Sadly.

My schirmer's were (last three recordings) :

1. 29 mm & 31 mm
2. 25mm & 25 mm
3. 12 & 11 mm

Just don't know what were the durations for the readings taken. First two must have been of more than 5 minutes. The last possibly of 5 minutes.

What were your schirmer's results back in 2011?

[Milo007]

@Milo07:

Thank you very much for your exhaustive and informative message. Unfortunately, I have tried most of these things you mentioned already - keep in mind the whole thing started 2010/2011 - so I have this disease now almost 10 years! You can imagine how my 20s were - and these years should be some of the best of ones life. Sometimes I just lay in bed in a dark room when symptoms were on it's peak again - I couldn't stand light etc.
But, I never went bedridden. I got to work every day - I'm just this kind of person who keeps going, as bad as it is, you know?
But I don't expect much from life anymore - this disease is terrible as it get's worse and worse with years. This is my experience, sorry.

I am sorry to hear that. Assuming that we live for at least another 30-40 years naturally how is it even possible to manage this dreadful disease?

I am losing hope when you say it gets worse and worse with years. We need regenerative medicine. There's no substitute of these precious glands. It makes you basically handicapped.

Moisture chamber glasses can make a big difference to your life. I would suggest you to get one that would fit your face well. They are not only important to manage your daily life but also to prevent further damage from inflammation. Please don't worry about what people would think of you. They won't help you if your eyes get damaged further. It's all about making your life more manageable now and wait for some miraculous medical treatment that will bring back to the glands or substitute their function.

Another option that you might not be aware of are scleral lenses. If the situation is already too bad it might be worth a try at least for the duration you work with computers.

[insidious988]

My schirmer's were (last three recordings) :

1. 29 mm & 31 mm
2. 25mm & 25 mm
3. 12 & 11 mm

Just don't know what were the durations for the readings taken. First two must have been of more than 5 minutes. The last possibly of 5 minutes.

What were your schirmer's results back in 2011?

Wow - 29 and 31 mm! This must be heaven. I can't even think of how this must feel..
Sorry to hear the scale dropped so dramatically over time.

Unfortunately, back in 2011/2012, no doctor did a schirmer for me. First schirmer I got in 2017 - if I could I would sue the doctors who did not treat me as necessary back then - now glands are alreday gone.

You know what one doctor told me - drink more water

[Milo007]

You know what one doctor told me - drink more water

I doubt if it's a medically relevant advice. Drinking more water won't generate more tears!

[insidious988]

I agree with you - I just posted this because it shows how dumb and non-caring doctors were then and are now still, too

[Alix]

@insidious988 I have Grade 3 as well, so understand your pain. I wouldn't say doctors are dumb, I just think that based on my experience here in the UK, they are only interested in sight threatening conditions like cataracts or glaucoma as they like to feel like they are saving lives or being heroic. Have had doctors openly telling me that they have more important things to do than dealing with people like me, with dry eyes.

Would you ever consider getting scleral lenses?