How difficult is it to diagnose MGD?

[ishkane]

I seem to have all the symptoms of MGD:

- blepharitis (though a mild case)
- evaporative dry eye (without my 7eye's, commuting/being outside is just painful)
- warm compresses/massaging always make everything better
- drops only work for a few minutes at a time

But when I had my appointment with an ophthalmologist, he told me that my meibomian glands were doing just fine. He's the one who didn't seem to think there was really anything wrong with my eyes. In fact, he seemed to think that when one has dry eyes, there is an overproduction of oil in the eyes, not less (is this nonsense?). He suggested that if I did indeed have a dry eye problem, then it had to do with the lacrimal glands, but I'm not sure. I mean, when I cry (and these days I cry often), I'm able to produce a boatload of tears. There's absolutely no problem there!

So I guess I'm wondering, is MGD hard to diagnose? I feel as though I exhibit the symptoms so I'm a bit confused.

[y-gwair]

I'm not sure it's always as straightforward as it seems. I appear to have both aqueous deficiency (from thyroid/autoimmune disease) and problems with inflammation of the lids, I'm sure it's possible to have both.

Initially my ophthalmologist said I had an insignificant amount of blepharitis, with no mgd. Nearly 6 months on, eyes haven't really responded to anything as expected; the problem is clearly something to do with the eyelids, have a diagnosis of some sort of rosacea-like skin problem and a referral to an ocular inflammation specialist. So sometimes things don't always present or respond in the way even experts expect them to. Even when she thought it was simple aqueous deficiency, Ophth. still recommended warm compresses, flax oil etc to try and stabilise the tear film as much as possible.

I'm not sure crying is necessarily a guide to your lacrimal function (unless you have advanced Sjogren's and the gland is completely destroyed), it's usually more the case that the nerves on the surface of the eye lose the ability to communicate with the gland to tell it to produce enough tears. Some forms of dry eye can result in a lot of 'reflex' tearing which isn't normal either.