MGD, Posterior Bleph & Plugs

[jlg_uk]

I know this has been raised before, but after reading some old threads I thought I'd make a new post just to distill the current wisdom that is out there I will be raising the questions below with my NHS eye doc person (when I finally get another appointment), but the quality of DES related care/knowledge has varied so much in my experience that I like to have explored the issues myself beforehand.

I've been feeling that my most problematic symptom is inner eyelid irritation, presumably caused by hyperosmolatirity, caused by evaporation of tears, caused by excessive/poor mebium, caused by (erm, not sure at this point, I'm thinking dermatological problem right now).

Had an unanethetized Schirmers of 10 in right and 9.5 in left. One of the people I recently saw said plugs might help. I'm trying to answer the following questions:

- I understand plugs are mostly used for aqueous deficiency which I don't seem to have. Potentially useful with posterior bleph/MGD?

- Inflammation is something to consider before using plugs. I know my inner lids are redder than normal, and this worsens when they are exposed to hostile environment and when my eyes feel generally sore - my eyes themselves don't go particularly red (a little injection maybe if I look close sometimes). I wouldn't say my eyes are red - and I've just come off 6 weeks of topical steroid drops which didn't help much. Would this still count as an inflammatory environment?

- I think 3 month plugs perhaps just in the lower puncta might be the way to go. Sound reasonable?

- Does it matter what make/type of plugs (aside for 3 month ones)?

I'm prepared to give plugs a go if it seems to make sense in my situation. But at the same time just because someone at the hospital suggested them that doesn't mean they are appropriate for me.

Any thoughts anyone?

[eva b]

Hi jlg,

i always follow your posts with interest, partly because of us both being in the UK, and partly because our problems seem tobe similar.

I, too, have realised that my main issue is with the inner eyelids (ie posterior) and inflammation. Though (if I remember correctly) you were told at some point that you were producing too much meibum?

I have been producing too little, or of poor quality...particularly in the upper eyelids it is apparently more like toothpaste than the liquid it's meant to be...

So I started to think this is a dermatological or systemic issue - which is showing up as a localised symptom in a vulnerable area.

No external medication - lubricating drops, steroid drops etc - have ever helped, in fact they've always irritated the situation more - sometimes even saline can irritate.

So I decided to try homeopathy - first saw one recommended by a knowledgeable friend, and I have to say after about 6 weeks of taking the remedies he prescribed I am cautiously optimistic.

I've written here before about the wonderful optometrist I have who sees me on a weekly basis now (he has a special interest in MGD) for general monitoring and maintenance. He regularly expresses any blocked glands he sees...and they are becoming fewer, and the fluid seems to be becoming slightly less thick and easier to express.
Of course I still do 4 warm compresses a day as well!

So I'm not sure which of these approaches is the more significant, I suspect it is a combination of both. But I have a deep "gut" feeling that the homeopathic remedy has an awful lot to do with it, because there was no obvious cause for the inflammation (which was causing the malfunction in the first place) that anyone could find.

Sorry to have rambled for so long - hope it makes some sense to you

feel free to pm me if you want more details or to discuss

[jlg_uk]

Hi jlg,

i always follow your posts with interest, partly because of us both being in the UK, and partly because our problems seem tobe similar.

I, too, have realised that my main issue is with the inner eyelids (ie posterior) and inflammation. Though (if I remember correctly) you were told at some point that you were producing too much meibum?

Hi Eva

You are right there - although I was first told by MGs were blocked, in seems to have turned out that actually I produce too much meibum (I still not 100% convinced by this, but am leaning in this direction). I think the fundamental problem is similar though in that if the meibum isn't the right consistency and in the tear film properly, it doesn't do it's job right and there's too much evaporation.

Although I personally am pretty skeptical about alternative treatments like homeopathy, I'm glad that things seem to be going better for you. I'm sure we'd all be glad to hear of your progress.

I'm thinking the underlying cause for me is to a large degree dermatological, as my skin has never been the best (ache when younger, oily, flaky skin) and a parent has excema. Not too mention our problems are with glands that are very skin based (I'm prepared to be corrected on this).

[irish eyes]

Eva and jlg

Hi

I follow your threads with great interest too. My inner eyelids are particularly inflamed just now - the left one in particular looks a bit of a mess. (Is it possible to do any damage when one expresses the oil from the glands?)

The consistency of the oil varies; sometimes it is clear but lately it has been yellow and more viscous. The pain and discomfort really gets me down because I can never really be `away' from it - and this is not all in the mind is it? It can be so severe as to wake me up and of course that adds to the exhaustion.

I have asked my GP to refer me again to someone in the private sector, not that they necessarily have any more knowledge, but they can give me a bit more time. I daresay it is a costly way to find out that my knowledge might be equal to theirs but there might just be something new on the horizon. I learnt from someone at Moorfields that there were ongoing Restasis trials in the UK but I don't know what phase they are at.

Eva, my experience with homoeopathy was not positive so I would be interested to know how you go on.

Jlg - perhaps a trial of plugs in the lower lids might be worth trying. My consultant plugged the lower puncta just to see if it helped because I was in a lot of pain. Then he thought plugging the upper ones might make a difference but it was dreadful. There was nowhere for the bacteria to flow and it resulted in huge cysts, making my lids horrendous for weeks. My eyes were certainly `wetter' but not in a way that was helpful. It became increasingly difficult to `function' and I spent a lot of time at the hospital in a state of distress. The lower plugs were taken out and the upper ones remain. I think the NHS use silicone plugs.

Sorry if the account is overly dramatic. Let me know how you go on.

[stella]

Be sure if you are getting plugs that you dont have an underlying allergy in the eyes - 'cos if you do ,and you get plugs you are trapping in the allergens ,and making it very hard to wash them away

[jlg_uk]

Be sure if you are getting plugs that you dont have an underlying allergy in the eyes - 'cos if you do ,and you get plugs you are trapping in the allergens ,and making it very hard to wash them away

Good advice Stella. Any idea how I should go about ensuring this? I did try a few weeks of sodium cromoglycate drops in the early days with out much success - but I didn't really know I had DES then. a) they had BAK and b) don't you have to try for well over a month?

I consider allergy quite possible still although I don't itch very often.