Atrophied meibomian glands

[SusieD]

Thanks for that.

So when I try and express the oil after a warm compress, Its not likely I'll actually see the oil come out? My eyes get blurry after doing this for a short while but thats the only indication I get that Im doing anything right.

Im just wondering what you see when you do this on a patient.

[DrG]

Upon digital pressure or massage, I see either droplets of clear liquid forming at the gland orifice, droplets of cloudy liquid, a thicker toothpaste-like substance, or nothing.

[Jade9923]

I can easily see the oil coming from my glands on the lid when I use my fingertip or a qtip to apply pressure right directly underneath the edge of the eye lid.

[Judy]

Jade,

I'm thinking you are referring to your lower eyelid. You don't actually put your finger or the q-tip inside your eyelid do you?

[ericdinn]

I have not had a special meibomian gland test so far as I know. My doctor -- M. Reza Dana -- informed me that accutane caused my M glands to atrophy. There is no expression of oil from the glands if I press on them or apply compresses. I just have dry eyes.

[Bennyboy]

Why don't most opthamologists tell you that the inflammation and scarring can lead to atrophying? I have been to so many opths over 7 years and have never ever been told that before even when my lids were in a terrible state. I have only been shown ways to get the inflammation down to make my eyelids look and feel better I was never informed it was to save my glands. If I knew I would have taken so so much more care with them. I have tried my best but if I knew this I would have tried even harder.

[untkicker29]

So, I am a bit confused as to how one can get atrophied meibomian glands. Is it from a prolonged period of time when there is constant inflammation? It seems a bit scary that you can actually get atrophied glands that are permanently damaged!!

[Jade9923]

Judy,

Yes, I place the qtip underneath the edge of my eyelashes. I don't put anything inside the eye when I'm trying to express the oil.

Jade

[DrG]

So, I am a bit confused as to how one can get atrophied meibomian glands. Is it from a prolonged period of time when there is constant inflammation? It seems a bit scary that you can actually get atrophied glands that are permanently damaged!!

I don't believe that all cases of meibomian gland atrophy/dropout are caused by inflammation.

Here is a selective quote from one online source:

Chronic inflammation is an inflammatory response of prolonged duration - weeks, months, or even indefinitely - whose extended time course is provoked by persistance of the causative stimulus to inflammation in the tissue. The inflammatory process inevitably causes tissue damage and is accompanied by simultaneous attempts at healing and repair. The exact nature, extent and time course of chronic inflammation is variable, and depends on a balance between the causative agent and the attempts of the body to remove it.

On healing and repair:

Resolution.
Dead cellular material and debris are removed by phagocytosis (mainly by macrophages) and the tissue is left with its original architecture intact.

Regeneration.
Lost tissue is replaced by proliferation of cells of the same type, which reconstruct the normal architecture.

Repair.
Lost tissue is replaced by a fibrous scar which is produced from granulation tissue.....Fibroblasts migrate into the damaged area along with the capillaries to form a loose connective tissue framework. This delicate fibrovascular tissue is granulation tissue.

So, the result of chronic inflammation can be that the original tissue is replaced by another type of tissue by fibroblasts. This "secondary healing" can result in the loss or diminishment of the original normal function.

[SusieD]

Accutane doesnt cause functional loss in everyone who takes it though. I think it does in most people while they are on the the drug. However for the majority of people this returns to normal or near normal upon stopping the drug.

The sebaceous glands on my face shrunk while I was on the drug and produced significantly less oil - yet now they are the same size they were before and producing equally as much (if not more) oil. I dont see why it couldnt be the same scenario with the oil glands in the eyes, which are afterall a kind of sebaceous gland (albeit a lot smaller).

Having said that, inflammation is very complex and for me at least, Im sure I had some issues prior to use of accutane.

I dont know anymore.

[DrG]

In order to avoid another contoversial discussion, I removed the reference to isroretinoin (Acutane) from my post. Interested parties can do a Google search and form their own conclusions.

[fernellen]

atrophied meibomian gland

This is very interesting and seems to be new. Rebecca, is it possible to put meibomian gland discussion in its own section rather than keeping it in the general discussion forum? fernellen

[SusieD]

Im sorry, I fail to see whats controversial about it???

Im merely talking about my own experience in that Im sure I must have had other issues beforehand, inflammation certainly one of them.

Of course people can google it - won't come to any conclusions either way though, there isnt really ANY conclusive evidence on the long term effects of this drug. None that Ive found in any case.

I won't post on the subject any more if thats preferred.

[Nikki]

mgd dropout

Hi,

I had conjunctivochalasis - which was recently excised. I also recently learned that I have some atrophy / dropout of meibomian glands . Could the very frequent use of artificial tears that I used for the dryness caused by the chalasis have contributed to the blepharitis that I developed, and the dropout as well? I had the chalasis for (I think) 6 years, and I never did lid scrubs / warm compresses to remove the debris from the artificial tears until I was informed that I had blepharitis this May. I wonder if the lack of eyelid hygiene would have started an inflammation cycle of my eyelids that never ended. I never thought of the close connection of the eyelids to the ocular surface health, and certainly would have done eyelid scrubs and warm compresses for the past 5 or 6 years had I been aware of the importance of the eyelids for providing the lipid layer.

My current ophthalmologist seemed to indicate that my glands would recover over the long term - which I hope. I take it that meibomian glands are just like any other sebaceous gland - which can shrink/atrophy in response to stress/inflammation? I'm unclear the mechanism of the dropout. My understanding is, the actual gland is still there, but the acini shrink or disappear, or lose their connection to the gland? Also that the outside opening of the gland can be inflammed or closed, and, the lipid can change in consistency and chemical composition in response to bacteria or blepharits or inflammation?

Would DHEA or androgen eyedrops be helpful for someone with dropout of their meibomian glands? Do you need to have a minimum amount of functioning glands in order for the DHEA or androgen to work? And, wouldn't there be some way for researchers to re-establish the connection from the acini to the gland itself, get the acini working again, or to transplant new acini or something? It seems that, when oil glands are found throughout the body, researchers should have studied atrophied glands elsewhere and looked into mechanisms for recovery.

Scott

[Rebecca Petris]

These are all really tough questions in areas that are not well understood even by many leading researchers. They are questions I find myself asking more and more frequently too. Some good sources for more information are David Sullivan at Schepens (Boston) and Steven Pflugfelder at Baylor (Houston).

My personal (unscientific, layperson's) thoughts on one of the possible patterns common to some of the folks here is something along these lines: There's a chronic low grade inflammation (or other mechanism) causing a slow progressive dysfunction of the meibomian glands but either without accompanying symptoms apparent to the patients or with the symptoms not being recognized and treated. Possibly this has an equally slow knock-on effect on the lacrimal glands in some cases. Eventually some new factor is introduced - be it a new systemic disease, a new moisture-draining medication, LASIK, change of environment, hormonal change or what have you - and this pushes things over the edge into a more rapidly escalating cycle and presto, we're symptomatic. We then spend the next (month? year? years? depending on the patient and his/her doctor(s)) vainly attempting to solve things with treatments aimed solely at lacrimal deficiency before anyone spares a thought for the meibomians. By the time anyone does, they've shrivelled up like leaves in autumn.

Can the meibomians be coaxed back into productivity at this point? I don't personally have any confidence they can become self-sufficient, but I've been monitoring some interesting cases (from a distance...) lately and I'm hopeful about improvements at least, to where you can with effort get something out of them on a regular basis.

The recipe that I *think* stands a reasonable chance:
- EFFECTIVE heat treatment (without battering the lids with high temperatures or high frequency)
- Attention to hygiene (without introducing any potentially irritating substances)
- Careful, regular expression
- Omega 3 supplementation
- Periodic courses of Doxycycline
- Appropriate lubrication and environmental control to keep things comfortable and safe, but within reason (no chemistry experiments on the ocular surface please).

I am not a doctor, etc. etc. Just my hairbrained theories at work.