Meibomian Gland Dysfunction - can we open this up again for discussion MGD 101?!

[Margaret]

I have been recently diagnosed with Meibomian Gland Dysfunction to the point of some glands becoming atropied (all within 10 months of time). Can we all discuss MGD in terms of what you know about it, how you treat it, what you think helps the most, etc. My lids feel swollen, sticky, itchy, most of the time. If I use heat it only inflames things so I'm currently doing nothing which isn't going to help over time either. Actually I am taking Doxy, but that's about it for a routine.

But I'm really just asking for a discussion about MGD.

Is the dry eye community hopeful for new therapies on the way (I've heard of Lipiflow, but are there others)? How about in the next five years?

Is there anyway to improve the oil production other than heat (I've heard of expressions around 1x a month with doc)?

Are there researchers out there that we can all be helping out either monetarily, as subjects for their research, etc.?

I'm not sure what to ask really, since I just really want to hear a discussion about MGD for people like me who are newly diagnosed.

Thanks for any discussion!

Margaret

[csm-meibomiam]

I hope this information is helpful.

I also have MGD. Was diagnosed a few months following hypothyroidism. Sounds like you may be hypo with the way you describe your lids, which may result from being hypo. Anyway, I also learned about lipiflow and there are no clinical trials at this time, only pending FDA approval.

Have you tried sterilid for your eyelid scurbs/hygiene? I started using it yesterday and boy is it great. Nothing has helped my bleph better than this product. I start with a clean/fresh wasclth/hand towel and always wash my hands with a liquid antbacterial soap first, rinse my eyelids with warm water, wash my hands again (to remove cross contamination), apply one squirt of sterilid to my left hand index and middle fingers to clean my left eyelid and eyebrow, then squirt on my right hand fingers for my right eyelid and brow. While the solution remains for the required 60 seconds, I wash my hands again and rinse thoroughly. Then I rinse the sterilid from my lids (using left hand for left eyelid and right hand for right eyelid to further prevent cross contamination). I rinse each lid until I feel/hear the squeaking clean feeling/sound of each lid's skin then wash my hands one last time then pat dry eyes and hands. I don't do anything else, no ointments, eyedrops,compresses, nothing!

You may want to read Margaret's (a.k.a. dry eye veteran) post about her blepharitis cure. Very interesting info on the correlation between her blepharitis and her harmone imbalance. Sounds very promising.

[rlt]

Hypothyroidism connection

CSM, can you elaborate on the connection between your thyroid condition and your dry eye? I also suffer from hypothyroid and have thought here was a connection but not sure. Are you taking synthroid? Does it help the dry eye?
Thanks
...robert

[manitobaskyline]

I have also had MGD for 18 years and was the primary reason for my dry eyes. The main treatment for me was and is eyelash/lid scurbs. I use baby shampoo but there are other solutions/pads on the market specifically for this. The MGD causes me to have a lot of oily gooky stuff on my eyelashes all the time. I do the lid scrubs 4
times a day and have been doing so for 18 years. This is the only thing that keeps the MGD under control for me. When I have all of that debris on my eyelashes/lids, I am dry, and my eyes burn. I really have to wet the eyelashes and create a lather with the baby shampoo (really just like you are cleaning your hair) I then rinse really good. My eyelashes then feel squeeky clean. For me, it's been all about keeping the eyelashes/lids squeeky clean. This together with punctum plugs have kept my dry eyes under control for many years.

Best of luck to you, I wish you the best with your MGD.

[Margaret]

thanks for the posts. No, so far I don't see any gunk on my eyes at all. There is one tiny spot that gets a tiny flake or two on it, and that is also where the atrophy is occurring, but otherwise nothing much. I go in to see the doc next week and am curious as to how he'll describe my oils. My eyes are still so puffy in the am and sore throughout the day. I am starting progesterone cream today for a couple of weeks as well. I had my thyroid tested, but it's normal, low normal, but normal.

I just get frustrated because MGD seems to be the same for everyone. Maybe not the reasons as to why you get MGD, but that the oils seem to change from clear to "toothpaste" or "butter", etc. All docs describe it the same way because it sounds like the changes of our oils are the same. So, why then, can't researchers figure out what is making the oils white (some sort of extra protein or enzyme, keratinization, etc.) and create a drug that blocks that change?!

At any rate, that's my thought for the day....

Margaret

[Rebecca Petris]

I am starting progesterone cream today for a couple of weeks as well.

That's very interesting - keep us posted!

I just get frustrated because MGD seems to be the same for everyone. Maybe not the reasons as to why you get MGD, but that the oils seem to change from clear to "toothpaste" or "butter", etc.

Hmmm

Interesting

I don't really know that that's the case. I mean, in my own case, I don't have any idea what my MGs looked like within a year of LASIK because I didn't even know what an MG was back then. But I know I'm not toothpaste or butter now. Clear, just not producing. And I talk to an awful lot of people on the phone with MGD and I think they're all over the map. Of course most of them don't know because their doc either doesn't look or doesn't talk about it but of those that do, some are in toothpaste-land, others don't produce, others seem to just clog almost instantly. The wide range of what's going wrong with oil is something I think of as one of the barriers to finding treatments that work for a large percentage of people.

I haven't really been paying as much attention as I'd like to all the MG research going on. But I think there's a lot of it. Sometimes in unlikely spots. I think some of the optometry schools - like at Ohio State, SCCO and SCO - are housing some of the really good folks with innovative research.

[Margaret]

Well, good to know! My other theory is that a lot of us aren't pumping it out properly and there doesn't seem to be any test for that. I appreciate your answer. I am such a newbie at this stuff and I was hoping we could all just discuss MGD so that I could learn more. I feel frantic trying to figure out what would help my situation as far as the MGD and since there is so little understanding it seems futile sometimes.

Thanks again,
Margaret

[Rebecca Petris]

I really wish we all had access to the same kinds of tests. For example meibography - it might be quite revealing to see how similar (or dissimilar) we are on that.

[Margaret]

Well, we could go to the same doc and test it out

Again, I'm just thinking up hairbrained ideas since I have no knowledge yet of any of this, but it seems to me when they put the suction ring around my eye that a bunch of oil came out, so much that it blinded me (temporarily during the Lasik surgery). I wonder if that damaged my/our glands? I remember that specifically during surgery.

I guess the test would be to use the suction ring around a bunch of people's eyes and not do the surgery at all on these subjects! I don't know who would want to test that, and how many people it would take until they found significant findings (if any)!

I'm curious about that and production rates. Are they not producing enough? Why? Due to severed nerves? Would there ever be a fix for that? Restasis is suppose to help stimulate the lacrimal gland, is there something that could one day stimulate the meibomian glands?

If you were me, what should I learn about MGD? I was just reading about atrophic vs. inflammation MGD. Is any of this important to me? Does it matter what it is if the end result is the same (warm compress, doxy, etc), or is there a difference that would be meaningful to me?

Thanks again,
Margaret

[y-gwair]

thyroid eye disease

CSM, can you elaborate on the connection between your thyroid condition and your dry eye? I also suffer from hypothyroid and have thought here was a connection but not sure. Are you taking synthroid? Does it help the dry eye?
Thanks
...robert

There is a connection between hypothyroidism and dry eye disease. Thyroid antibodies can be attracted to ocular tissues as well as the thyroid gland and cause inflammation which can lead to damage of the lacrimal gland, and oedema of the tissues around or occasionally behind the eye, which can lead to changes in the shape of the eye, retraction of lids or symptoms like double vision. Usually the more severe symptoms are associated with overactive thyroid (Graves') disease, but can occur with autoimmune hypothyroidism (which doesn't seem to respond to suppressive hormone treatment). Many doctors think eye symptoms only occur with Graves', it was news to me when my ophthalmologist said it can also happen with hypothyroidism.

Taking a suppressive dose of thyroxine (so that your TSH levels are at the bottom of the normal range) should resolve this problem according to most medical sources, but this won't help reverse aqueous deficiency if your lacrimal gland is damage by scar tissue, or the corneal nerves desensitised by long-term dryness, or if there is additional connective tissue associated with the thyroid autoimmunity. I think there is usually a correlation with elevated levels of Thyroid peroxidase (TPO) antibodies and eye disease symptoms, so get an antibody test done if you haven't already.

Thyroid disease also causes neuropathy that damages the chemical messaging of exocrine glands generally, inhibiting normal perspiration and heat regulation of the body. If you have ongoing eye problems you need to look into it as there can be other conditions that cause similar symptoms.

[y-gwair]

I'm curious about that and production rates. Are they not producing enough? Why? Due to severed nerves? Would there ever be a fix for that? Restasis is suppose to help stimulate the lacrimal gland, is there something that could one day stimulate the meibomian glands?

I'm curious about meibum flow too. My ophth. says that my glands (originally) looked fine; most of them seem to readily produce thin meibum if gently expressed. A couple are slightly blocked, and this does seem to be associated with localised marginal redness / burning. I guess that even if what they produce looks ok, it may still not be biochemically 'normal' (hence recommendation for omega 3 supplements to alter secretions into less inflammatory balance of lipids). Maybe a certain amount of inflammatory substances in meibum is fairly common and would usually be diluted and washed away by normal tear flow, but can have huge effect on those of us who have severe aqueous deficiency, and/or plugged ducts.

I can't see how warm compresses help if the meibum is thin and free-flowing, particularly if the problem is related to heat-triggered inflammation in rosacea.