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http://bjo.bmjjournals.com/cgi/conte.../86/12/1403/F2
Interesting picture of Meibomian gland secretions at the lid margins in patients with obstructive Meibomian gland disease before and after infrared heating. Problem with obstructive Meibomian gland disease is this: palpitation of the eyelid is usually to be done following hot compresses and lid therapy in order to release oil from the M. gland. But depending on the severity of the MGD, it may prove impossible to release any oil with palpatation. Since oil constitutes the outermost layer of the tear, its presence helps prevent evaporative dry eye:
Tear Film:
-------------Oily Layer-----------
------------Aquaous Layer--------
-------------Mucin Layer---------
But apparently in obstructive MGD, the melting point of the M. secretions rises above the body temperature, causing the secretions to become toothpaste like, or the glands to be blocked completely. This constitutes a independent noninflammatory component of dry eye that cannot be successfully treated with Restasis or steroids. The solution, it seems is to hot compress, hot compress, hot compress.
I'm speculating, but it seems that patients with both an inflammatory component and an MGD component might use Restasis and successfully treat the inflammatory component, but still conclude that Restasis has failed because of the MGD component went untreated.
Assuming this logic is correct, it argues that hot compresses should always be used in conjunction with drops that treat the inflammatory component of dry eye.
But remember, I'm a psychologist, not an ophthalmologist.
Raj
Interesting picture of Meibomian gland secretions at the lid margins in patients with obstructive Meibomian gland disease before and after infrared heating. Problem with obstructive Meibomian gland disease is this: palpitation of the eyelid is usually to be done following hot compresses and lid therapy in order to release oil from the M. gland. But depending on the severity of the MGD, it may prove impossible to release any oil with palpatation. Since oil constitutes the outermost layer of the tear, its presence helps prevent evaporative dry eye:
Tear Film:
-------------Oily Layer-----------
------------Aquaous Layer--------
-------------Mucin Layer---------
But apparently in obstructive MGD, the melting point of the M. secretions rises above the body temperature, causing the secretions to become toothpaste like, or the glands to be blocked completely. This constitutes a independent noninflammatory component of dry eye that cannot be successfully treated with Restasis or steroids. The solution, it seems is to hot compress, hot compress, hot compress.
I'm speculating, but it seems that patients with both an inflammatory component and an MGD component might use Restasis and successfully treat the inflammatory component, but still conclude that Restasis has failed because of the MGD component went untreated.
Assuming this logic is correct, it argues that hot compresses should always be used in conjunction with drops that treat the inflammatory component of dry eye.
But remember, I'm a psychologist, not an ophthalmologist.
Raj