Clear oil, still have MGD?

[Hopeful2]

Is there anyone else who has experienced this; clear oil and symptoms of MGD? Any comments would be appreciated.

I appear to have oil flowing freely from almost all my meibomian glands. The oil is visible as wet points at the gland orifices, following mild pressure on lids. It is even expressable without warm compresses. . . seems like healthy glands. . .

On the down side, there are visible bubbles on the surface of my eye after gland expression. The bubbles suggest saponification of the lipids (thought to be from bacteria). Also, my eyes burn and I have a short tear break up time. The symptoms suggest that I have meibomian gland dysfunction, despite clear expressable fluid.

Would doxycyline be useful in improving the quality of meibum when it is already thin and clear? Would an antibiotic ointment be more appropriate if it is bacteria which is breaking down the lipids? Would I not have other symptoms if I had a bacterial infection of my eyelids?

When I use warm compresses and have a warm shower, the following burning is more intense than usual. More of the clear thin meibum is excreted and it just adds to eye irritation.

All I have read about MGD refers to irregular lipid secretions as being thick and cloudy. Doxy is supposed to thin the secretions, but could it help in the case where the secretions are already thin. I have a sensitive gut and hate to have to take antibiotics.

Is there anyone out there in a similar situation? My MGD after lasik, but I suspect that anyone could have MGD with a similar profile.

Thanks!

[irish eyes]

My problems are not lasik related but I can identify with this.

My left eye is more inflamed, swollen and painful than the right but the consultant tells me the right eye is significantly more dry.

The glands on the left eyelid look more blocked but when I try to express the oil, some of it is fairly clear; my consultant said that in his opinion, they are hardly blocked at all.

The glands on the right eyelid do not look as blocked but the oil is much thicker and a different colour.

Both eyes produce visible `bubbles' after expression. The lower glands on both eyes seem to be completely blocked and they are very sore.

Like you, I have a sensitive gut (and developing an ulcer) so I take monocycline - which is more slowly absorbed. I take breaks from it whenever my eyes improve.

[Hopeful2]

Hi irish eyes,

Thanks for the detailed response. It looks like we have similar signs of MGD.

My left eye is also more inflamed, often feeling like it is on fire. It also tends to get more foam to it.

When you say the oil is a different colour, what do you mean? What colour is the fairly clear oil?

I think it is the bubbles which cause the inflammation and irritation.

What kind of relief do you get when you take the monocyline? . . . fewer bubbles? . . . less irritation?

What has been your experience with warm compresses? I think they make my situation worse.

[irish eyes]

Yes, my eyes can feel as though they are on fire but I can draw on more graphic comparisons. Over the years of suffering with this, it is something I had to resort to if I was going to get my point across. I got to the point when I sounded like a voice-over for National Geographic.

I cannot tell if the minocycline is having any impact on the condition; I just take it when the consultant suggests it might be a good idea - after he has looked at my eyes through the microscope. It probably is a bit better but not noticeably so.

Colour of oil; it can be anything from white, cream, yellow, beige....I make it sound like a paint palette but that is my experience. The clear(ish) oil is just opaque, no colour but a bit on the thick side. Maybe it is meant to look like that.

Warm compresses; can provide relief but I'm careful not to use anything too hot because it makes things worse. When doctors started treating this condition (years ago) I was given conflicting advice; ranging from "compresses as hot as I could stand" to "cold compresses and avoid anything hot". Confusing or what? I concluded that anything hot certainly makes things worse. My eyes are mega-sensitive so now I ignore much of what I'm told and see how it makes me feel.

[y-gwair]

When I use warm compresses and have a warm shower, the following burning is more intense than usual. More of the clear thin meibum is excreted and it just adds to eye irritation.

It makes me quite angry that ophths are quite so ready to recommend hot compresses without really understanding the underlying causes behind this type of MGD which sounds to me like ocular rosacea. Rosacea is a condition where the nerves that cause small blood vessels to dilate in the eyes and face (to help release heat from the skin) respond abnormally to normal temperature fluctuations, causing burning pain, swelling as the overloaded tiny blood vessels leak lymph fluid, and also inflammation of the Meibomian glands resulting abnormal quality meibum, which can be highly variable in its presentation. The fact that heat is obviously making it worse suggests you probably have this sort of MGD. Apart from once, when some of the glands were clearly blocked and infected, hot compresses have only ever made things worse for me. It took until my face suddenly started flushing and burning severely to realise this was what had been happening in my eyes for months before. It's taken a long time, but my eyes are now comfortable and functioning. I can't say that any of the ophthalmic interventions helped me much at all apart from ciclosporin, which did normalise MG function without easing the neural discomfort.

I've been on a combination alpha blockers for 6 months which do seem to have started to calm the problem to the extent the flushing flares are no longer triggered by environmental changes. It's very difficult with these conditions, most ophths aren't really clued up on the dermatological aspects of these conditions (and vice versa with skin specialists).

[Hopeful2]

I have never been told that I have Rosacea. . . but I do get pretty bad hot flashes which may be causing MGD symptoms in relation to temperature fluctuations. I had decreased my hormone supplement, thinking maybe I could go off them. I started to get more intense hot flashes and interestingly enough, my eye discomfort increased. Heat really does seem to be a problem.

Thanks for getting me to think about the heat aspect of MGD.

I am curious about the alpha blockers. Are there side effects?

[littlemermaid]

Hopeful2, It might be useful to think of rosacea as hypersensitivity; not everyone shows the most typical signs.

[Alan27]

Is there anyone else who has experienced this; clear oil and symptoms of MGD? Any comments would be appreciated.

I appear to have oil flowing freely from almost all my meibomian glands. The oil is visible as wet points at the gland orifices, following mild pressure on lids. It is even expressable without warm compresses. . . seems like healthy glands. . .

How do you do this test? If I apply presure on my lower lids, oil is supposed to come out from them?

[Hopeful2]

Yes, although you might need to pull your lower lid away from your eye. Often in MGD the glands are shifted towards the back of you lower lid, rather than in the middle of the lower lid.

You would need to be looking in a 10X mirror with very good illumination. You should apply the mild pressure for about 6 sec. The easiest section to see is the area closest to you nose.

[Pearl25]

Hello Hopeful2 I have the same clear oil that when I press comes out of the glands in both eyelids but fro some reason they are both swollen..are your eyelids swollen?