question about Meibomian glands and blepharitis

[rhad]

hello, I have a question about the relation between meibomian gland function and blepharitis. I have read that inflammation destroys or makes your meibomian glands produce less oil or no oil. And I also know that many believe that blepharitis is a condition that follows meibomian gland dysfunction. but couldn't it be the other way around. so my question is this: If you can get the inflammation down or eliminate blepharitis, will your glands most likely create more oil?, or does the inflammation affect the function of the meibomian glands? can someone please make this clear?

[dryeyes2]

I agree

Hi rhad,

I have wondered the exact same thing. It is my gut feeling that my dry eye situation is this and not the other way because of the decrease in hormone level paralleled my dry eye issue. I am on the DHEA drops and there is a difference for me. There is more oil production. If those drops are supposed to be targeting androgen receptors in the eye and androgens create more oil, it seems like by having the gland function properly gets rid of the inflammation.

A good experiment might be is to have a woman with low hormones to use a drop or medication that just focus on decreasing inflammation. (Let's say Restasis). By decreasing inflammation, does this increase oil production? In my case no. In fact, I don't even think it actually got rid of the all the inflammation. I have been on Restasis for 11 months. There was no oil increase. My eyes did not feel better, that is why I have tried the DHEA. I am hoping to evenually get off Restasis. Although I have also wondered if there is a synergistic relationship between the DHEA and Restasis that they work better. I was having trouble tolerating the DHEA drops alone when I tried going off Restasis for a week. It could also be that my eyes were not doing as well because I haven't been wearing my goggles as much(they were feeling dry) and my doctor wanted me to decrease my DHEA dose to one drop per day. Once he saw that my eyes were looking more inflammed and uncomfortable, he said I could increase my dose again. I am still not to the comfort level I was before, but I think that will improve. I just haven't been on the highest dose for long enough yet. It is kind of a complicated situation.

Anyway, that is my opinion based on what I have experienced.

dryeyes2

[dryeyes2]

Sorry Rebecca

I just realized I posted this under the wrong forum.

Perhaps this thread could be moved?

dryeyes2

[stella]

I have always understood that if you have blepharitis ie inflamation of the eyelids - this causes the problems with the tiny meibomian glands which are embeded in the eye lids -up to nearly 50 in all ,for each eye, top and bottom.
These glands in turn become inflamed and dont function properly ie they produce waxy like secretions which block the ducts hense we need heat and massage to unblock them.Or they dont produce oil at all ,or only poor quality oil or sometimes they secrete oil and other times not ,or the blockages can produce cysts (chalazions)- hense the term mebomian gland disfunction.
So you have to treat the symptoms - reduce the bacteria on the lid margins and keep the oil liquid and the glands from blocking with eye lid hygiene
Then you must address the cause of the blepharitis which may be hormonal or an allergic reaction or the result of an infection - thats the difficult bit knowing what the underlying cause is
Then because your eyelids are inflammed and the glands disfunctional you get evaporative DE and all the attending symptoms of that
Some body correct me if i am wrong

[dryeyes2]

more thoughts

I know that is what I have heard too Stella, but my situation doesn't seem to fit into that category in my mind. I have used Restasis, Theratears nutrition for dry eyes, warm compresses, lid massages and occasionally I have done the lid scrubs. Nothing helped until I used the DHEA drops. I truly think that my glands became inflammed because there was no oil. I don't think the inflammation was there first. I maybe wrong, but thats what I think based on my experience. The only thing that would otherwise be possible is if the DHEA is actually treating the inflammation first and then producing oil, but since it is an androgen, that is why I think it is producing oil first and then reducing inflammation.

dryeyes2

[stella]

Yeah - that sounds reasonable - The underlying cause of your disfunction must be at least partly due to hormonal factors if DHEA is helping -- Wish i could get that stuff (in the UK you are lucky to get treatment of any sort let alone having any options)
I suspected my underlying cause was hormonal - at least in part - so i persauded my GP to let me change my HRT from estrogen only patches(I am post hysterectomy) to tibolone which contains a weak androgen
That was 7 months ago - I really cant say if it helped - Something has helped as i am a lot better now .(The tibolone certainly raised my mood so that in itself makes it worthwhile
I think really good eyelid hygiene + the use of the tiniest smear of antibiotic ointment - in my case it has to be chloramphenicol - which in GB is an over- the- counter ointment for the eyes .I understand it is never prescribed in USA .I would have prefered erythromycin or azasite or doxycillen --- all unavailable over here ,so it has to be chloramphenical.It has definately helped mind - I use it only on the lid margins and lids, and try not to get it in the eyes - 'though it does migrate into the eyes and blurs vision a bit.Another problem i encountered was that i could only use a certain brand of chloramycetin ointment since most of them contain mineral oil and i seemed to react badly to that The one i use contains liquid parafin and soft white parafin and is OK
I have never quite acertained whether it is the antibiotic component of the ointment or the lubricating effect which helps - or maybe both

[sazy123]

Inflammation is definitely one of the main causes of MGD, but i dont think its the only cause, like- what caused the inflammation in the first place?.

The best thing i have found for inflammation in the lids is Progesterone cream, This is the only thing that has done anything for me, i dont have blocked MG's so the cause is either inflammation/vascular effects (i have rosacea) or unresponsive glands, but maybe the inflammation and vascular effects make the glands unresponsive.

Anyway i would recommend anyone with MGD to try Progesterone cream you dont need to have hormone issues ( i dont-im 23) as it just works on reducing inflammation, its improved my eyes about 40%, my eyes are still not good so im still looking for other options, but others may find that the progesterone cream is enough to give their eyes comfort, my eyes were just so bad to start with- P cream it goes directly to the glands whereas drops would be an indirect route, DHEA drops did nothing for me.

Pester your doctors for progesterone cream or find one who will prescribe it its the ONLY treatment i will recommend and ive tried EVERTHING!

[rhad]

Progesterone cream and Testosterone cream

Thanks sazy123 for you input,

But Is Progesterone cream only for woman to use, or is Testosterone cream better for men??

I have MGD, and inflammation because of blocked glands, my glands produce so thick of oil, that it seems like even with doing warm compresses for 15-30 minutes, it just doesn't soften the lipids up... when ever I get those small oil 'bumps" on my lids, they just don't seem to loosen up or come off....

[eva b]

progesterone cream

Sazy,

which type of progesterone cream are you using - is it the one which is avaiilable on prescription only essentially for menopausal symptoms?

I used such a cream for several years (called Pro-Gest) which helped hugely with my symptoms, but stopped a while back. Perhaps I will try re-starting it again?

Do you put the cream just around your eyes, on the lids or what?

thanks

[strider1]

is Progesterone cream only for women?