meibomian gland dysfunction - what are the treatment options?

[britgirl]

I couldn't wait any longer for the NHS referral so I ended up going to a private opthamologist and was diagnosed with meibomian gland dysfunction.

The opthamologist said that doxycycline & warm compresses are the best thing for MGD. I am concerned as I know there are people who have been taking it for years with only minor improvements.

What other treatment options are available for MGD?

Are punctual plugs an option?

Does anyone know anything about IPL (Intense Pulsed Light) and probing - & whether these treatments are available in the UK?

[y-gwair]

So glad to hear you've finally seen an ophthalmologist and made a start on treatment. Did they mention it might be related to a condition called ocular rosacea? I'm about to start on a similar course of treatment, so I can't comment on it's effectiveness yet. Like all treatments, it probably works very well for some people but not for others. All we can do is to try it out and hope we are lucky.

I'd be cautious about trying plugs, my MGD/blepharitis/eyelid swelling seems to have got a lot worse since I had them fitted; maybe something to consider down the line when the lid inflammation is under control.

I've only ever come across IPL as a treatment for rosacea of the skin, but I suppose treating damaged, leaky veins on the lids might have some benefit for some symptoms of ocular rosacea. Although used a lot for the cosmetic improvement of rosacea I wouldn't have thought it would be widely available as an ophthalmic treatment?

http://rosacea-support.org/treating-...sed-light.html

[littlemermaid]

britgirl: NHS Clinical Knowledge summary on MGD ie blepharitis http://www.cks.nhs.uk/blepharitis#314837002 with links to seb derm and rosacea. Also check out Moorfields and Good Hope sites. I think most UK ophths might informally mention flaxseed oil supplements and healthy diet for MGD these days.

I know there are people who have been taking it for years with only minor improvements.

I know there are people with major improvements who go on to manage it easily with lid hygiene. So relieved you've got someone on the job. Hope you get NHS follow-up. Punctal plugs definitely available if bacteria is cleared. Keep us posted!

[y-gwair]

Re. Lid hygiene

Do you have any recommendations for lid hygiene LittleMermaid?

I've been using celluvisc-dampened cotton buds which don't seem to make any difference (tried baby shampoo but seems to disrupt tear film after). Bought some Lid-Care sterile wipes on impulse which actually seem to relieve lid margin discomfort rather more effectively, but again sting and disrupt tear film (brought veins up straight away on cornea).

BritGirl, the dermatologist I saw this week re. ocular and dermal rosacea, said it would take about a month before antibiotics start to work. I know how frustrating it is, but try to hang in there a bit longer.

I've found it's best not to use compresses too hot, as I'm gradually realising that heat is probably an important trigger for me (hot food/drinks/baths/sun etc). If the compress feels hot in the hand, it's too warm; little and often (about a minute) seems better than overheating for too long. I rinse afterwards with celluvisc and it does seem to reduce the burning sensation if I do it regularly.

[britgirl]

So glad to hear you've finally seen an ophthalmologist and made a start on treatment. Did they mention it might be related to a condition called ocular rosacea? I'm about to start on a similar course of treatment, so I can't comment on it's effectiveness yet. Like all treatments, it probably works very well for some people but not for others. All we can do is to try it out and hope we are lucky.

I'd be cautious about trying plugs, my MGD/blepharitis/eyelid swelling seems to have got a lot worse since I had them fitted; maybe something to consider down the line when the lid inflammation is under control.

I've only ever come across IPL as a treatment for rosacea of the skin, but I suppose treating damaged, leaky veins on the lids might have some benefit for some symptoms of ocular rosacea. Although used a lot for the cosmetic improvement of rosacea I wouldn't have thought it would be widely available as an ophthalmic treatment?

http://rosacea-support.org/treating-...sed-light.html

Yes and was told to avoid spicy food & alcohol just in case. I've always had mildly blotchy red skin & spots but haven't seen a doctor about it because it's never really bothered me. I guess my next step if this doesn't work out would be to see a derm too.

I can't be sure of anything. Sometimes heat triggers the pain and sometimes it helps. Sometimes when my eyes are red and irritated (e.g. when crying) the pain is reduced. The ophthalmologist asked me if I was sure the pain isn't coming from the eyelid. This confused me even more.

[irish eyes]

IWhat other treatment options are available for MGD?

Are punctual plugs an option?

Does anyone know anything about IPL (Intense Pulsed Light) and probing - & whether these treatments are available in the UK?

Hi Britgirl

I'm not really adding anything new here -

Punctal plugs - I had these fitted when my eyes were unresponsive to tears & lubricants. In my case, they were not successful but that's not to say they wouldn't help you.

http://www.goodhope.org.uk/departmen...gsdryeyes.html

Probing - My consultant has heard of this but doesn't agree with the approach in view of potential damage etc. I think it's done in the UK because the probes are imported into the UK by a company called Rhein Medical.

http://www.rheinmedical.com/search/i...1546&class_id=

IPL - I have asked around about this and no-one in the UK seems to have heard of it being used for DES.

Lipiflow This is something that is available in the UK but I haven't tried it yet myself although I was initially tempted. However, there is a dearth of information / feedback on it. I have contacted the company (Centre for Sight) a number of times for updates (including today) but nothing new in the way of uptake / success etc. Here is a thread from DEZ.

http://www.dryeyezone.com/talk/showt...evice-what-the

[littlemermaid]

Do you have any recommendations for lid hygiene LittleMermaid

We have bacterial flareups to deal with, chalazion, thick or no meibom, blocked MGs. We use warm flannel in bath or shower placed over eyes only for a bit, then gentle massage of eyelids, clean underneath lower lash line. If the lash line needs it, and we look really close, we use a cotton bud with boiled water. This is the Moorfields recommendation for blepharitis on a child. In the mornings rushing before school, separate cotton wool each eye, warm water, thorough gentle clean.

Rebecca's microwaved rice bag idea has also been heaven for warming the eyelids. Depends whether you think it makes your rosacea or surface inflammation worse. Dr Latkany recommends cool compress for rosacea inflammation.

No detergents for us because pH is too acidic on eye surface already, bacteria pumping out enzymes. Makes it worse for us and stings. But that's just us. Some people like lid wipes etc. We are experimenting with different prescription antibacterial topicals on face dermatology with really good progress on the MGs, trying to identify which makes it better/worse.

[NeedMyEyes]

Treatment options for isolated MGD/blepharitis

Okay, so I am relating what I have learned over the past few months after becoming frustrated with my own dry eye issues. I cannot say I am in complete remission or that I have been cured, so take my advice with a grain of salt.

You have to do the following 3 things to treat MGD:

1) Heat the oil in the glands and then the get the oil out of the glands.

- The most available method is to do this at home. Heat your glands with a hot compress and then express them yourself in front of a mirror. MOST people are not very good at this and it is not very effective for most people.

- The next most availabe way to do this is for your doctor to express your glands for you under the slit lamp (possibly with the Mastrota paddle). My optometrist lets me heat my glands BEFORE he expresses, so if you can find one like this, this is the best option. Get this done weekly or every 2 weeks.

- The best way to do this **seems to me** to be the LipiFlow device. However, it is very new and only available in London and Toronto as of now. Also it is $700 per treatment.

- You can also get IPL which is a method of using a laser to heat your glands. After the heating with the laser, the eye doctor expresses the oil out of your glands. I don't like the adverse effects of lasers on your skin, so I'm not sure this is the best. Expensive.

- You can also get Intraductal Probing unclog the opening of the glands, followed by heating the glands, then expressing the oil out of the glands. This is only for certain types of MGD and the risks of sticking metal into your glands are unknown, so I'm not sure this is the best for most. Expensive.

2) Do something about the inflammation of the glands. The inflammation can have several different sources, so you have to determine the source of the inflammation.

Bacteria - Azasite eyedrops, Doxycycline, etc.

Ocular Rosacea - avoid your triggers, doxycycline, etc.

Seborrheic dermatitis - caused by a fungal infection, avoid the fungus, use an anti-fungal shampoo, etc.

Demodex mites - Tea Scrub (only administered by a doctor), etc.

Allergies - get tested (BOTH by a dermatologist and an allergist) to find out what your triggers are, avoid the triggers, use eye drops that don't have those triggers, preservative free, hypoallergenic shampoo, etc. Use anti-allergy eye drops.

Other causes of inflammation - treat them as appropriate.

A word on steroids - occular steroids are AWESOME at calming down inflammation. However, they cause 3 terrible side effects: glaucoma, cataracts, and corneal ulcers. The don't always go away after stopping the steroids. So you HAVE TO BE CAREFUL with steroids. Ask you doctor if you really need them.

3) Deal with your current dry eye symptoms until you get the MGD into remission:

Eye drops, ointments, gels, goggles, saunas, humidifiers, etc. etc. (all of this is available elsewhere on this site.

And that's it. It sounds simple - it isn't. It unfortunately takes months (for the really lucky ones), years (for the lucky ones) and much longer (for the less lucky).

Good Luck!

Not an eye doctor, by the way...

[bp77]

hi eye doctor,this is a great post, do u know how to change the thick, solid white oil to better oil? mine is very thick. I do the same as you said. also, if some one become allegic to the doxy after few monthes, is it ok to use mono after that ?thanks

[NeedMyEyes]

Allergies to Doxy...

Hi, bp77,

Let me say first, I am NOT and eye doctor. I am not an ophthalmologist or an optometrist. I am a different specialist. My daily practice has nothing to do with the eyes.

So, I cannot help you with you eye problems, unfortunately. You require an anterior segment or corneal specialist for your questions.

I can say from my experience (I am an patient with Meibomian Gland Dysfunction):

To get rid of the thick oil - you have to 2 things. 1)) heat the oil in the glands and then express the oil out of the glands. And 2), get rid of the inflammation that is causing the thick white oil. It isn't easy to do either of these.

Allergies to doxycycline. Unfortunately, most people with allergies to a single drug in a class of drugs will have cross reactivity to other drugs in the same class. So, this means you are probably also allergic to minocycline, tetracycline, democlocycline, etc.

Maybe you aren't allergic to minocycline... but I think it is very likely you will also be allergic to minocycline if you are allergic to doxy.

I don't know about this exactly though. Maybe you aren't allergic to doxycycline - maybe something else in the pill? Maybe you could try doxycycline from another manufuacturer that uses different ingredients? However, I recommend you involve a doctor in these decisions.

Good Luck!

Again, not an eye doctor

[bp77]

thank u so much for responding to me. of course that i see doc fo my problems but they can not help. Is there any test to determine that i am allergic to the doxy? at the time that this happened I was on doxy 200mg( I was on 100 before) for 20 days with valtrex. I started getting hive and i do not know what happened. I have stopped both. I am taking zyrtec that helps alot. do u think it is going away without stroid? It is one month that i stopped the valtrex and 5 days for doxy? thanks.

[NeedMyEyes]

Allergic reaction - hives

Well, honestly, without examining you and knowing your entire history, etc. my guess is the following:

You were on Doxycycline for 9 months before you had any problems. To me, this doesn't seem like an allergy to Doxy.

You were taking various other medicines - maybe it is one of these? Maybe it is the Valtrex or something else. I would also say it could be your laundry detergent or soap or shampoo, but those would more likely be contact dermatitis (a doctor needs to look at your rash to tell you this).

Yes you can get tested for allergies to doxycycline - you can also take Doxycycline even if you are allergic, but the doctor will have to do something special (called desensitization). You will have to go to an allergist and a dermatologist - 2 different tests.

Oh and go to the doctor now so he or she can look at your rash and tell you what kind of reaction it is.

Good luck!

I am NOT an eye doctor and this is not medical advice...

[bp77]

thanks alot for all the info.