Why does Lasik "bring on" MGD

[bernmee]

I know that to some extent or another alot of people have MGD and never feel it. But why is it that MGD can flare up and cripple some people who have Lasik. I understand when the nerves are severed that tear production can be reduced...but why does that effect the glands and cause a flair up in MGD.

My bottom eyelid is inflammed and sore, but my top one seems to be fine, at least I have no pain there, and I thought the top lid had more glands. Why is this?

Thanks,

Bernadette

[indrep]

I would suggest that the intial onset has already started before the procedure, then the increased inflammation from the procedure puts it over the edge.

[YGB]

The explanation given to me by a physician is that post-LASIK "dry-eye" can be a multi-stage process. The first stage is the severing of the nerves that affects the aqueous production. Stage 2 can then be that the oily level of your tears is impacted. The reason is that the oily part of your tears requires some of that aqueous production to keep the oil fluid. Just like anyplace else, oil in a very dry environment will clog and become dysfunctional. Thus you get meibomian gland dysfunction which also brings on inflammation that further cause issues. Doxycycline can help with the inflammation caused by MGD.

In simple terms, your meibomian glands use some of the water part of the tears to keep it flowing properly. Without it, they can clog and cause MGD. That's why it's REALLY important to do warm compresses during the time that a person has a schirmer score of say ... 0 or something like that and has MGD. If you don't do the compresses which serve to melt the oil that is clogging your glands, then your MGD will likely get worse. Hopefully as tear production starts to return, the oils from the meibomian glands will begin flowing better again.

MGD can improve BUT warm compresses are typically a MUST for people with MGD. Based on my experience, I recommend 5-10 minutes of warm compresses followed by an eyelid scrub using Ocusoft or Sterilid, whichever you prefer. Of course, you have to try what you feel works best for you based in part on trying different things in stages.

[bernmee]

That makes sense, I just couldn't make out the connection.

I have a schirmers score of 30mm, but I guess I am still suffering from my immediate post Lasik experience when I was so dry. I am doing the compresses and have just been told to do the scrubs and massages. I was so afraid that I would dislodge the flap but I have to get over that, and just be careful. I have a tear break up time of 7 seconds taht I thought would be ok, but I guess not good enough.

The Doxy made no difference. I have just started using Azacite drop, and when I put the drop in I get immediate relief for about ten minutes. I do hope this works!

Thanks for the info. I find the more questions I have the better I progress in my understanding and treatment. Its when I have no questions that I feel I have hit a brick wall in my treatment.

[LasikLady]

This also explains to me why when my eyes are so wet with all 4 ducts plugged, I still get burning at times. My doctor did say my oils seem to be "thicker" than normal. That was never mentioned to me pre surgery. I do the hot compresses 2x daily but I'm wondering if once would be okay, say just before bed. Then I do the massage and I know it's working cause my eyelashes feel oily after I've done it most times. That is then followed with a brief period when there is no burning at all (I could hold my eyes open for a very long time without getting any burning, the eyeballs seem coated in oil)
None of this was an issue pre surgery. Maybe like indrep said I may have had a tendency toward this but the surgery pushed me over the edge.

So is once a day enough to do the hot compress?

[bernmee]

http://www.eyeworld.org/article.php?sid=2707

Above is an article on MGD and Lasik. I really think it is terrible that this is not exaplined to us before surgery, and many of us search for a long time to find this information after surgery.

Lasiklady, this article seems to be saying twice a day.http://www.refractivesource.com/pati.../meibomian.htm

I am doing three times a day...third time lucky and all that!!

[LasikLady]

Thank you Bernmee for those very interesting articles!

This really makes sense to me now. I was wondering how come with eyes so wet I still have some burning issues. It's the oils. It also explains how come my eyes feel so darn good after I do the warm rice baggie.

I will continue on with my 2x daily regimine.