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I was going to post this under the thread "Should lid massage hurt" but I decided to start a new thread. Under that thread many people were asking questions about where the meibomian glands are, what they look like, about the secretions that come from them. I wanted to take the time to start from scratch and explain how they work etc.
It seems like a refresher course in the composition of tears is a good place to start. It will help you understand these meibomian glands, where they are, and what their purpose is.
Tears have 3 layers. A mucin layer (sticky). A aqueous layer ( watery layer) and a lipid layer (oily layer) The watery layer sits on top of the mucin layer, and the lipid oily layer sits on top of the watery layer.
The oily layer is secreted from miebomian glands that look like tiny pin holes on your eyelids. They sit directly above your eye lashes (on lower lid) and directly below your eyelashes on your upper lid.
Healthy miebomium glands, when expressed with your finger or a q-tip, secrete this lovely free flowing oil that is runny. It spreads easily over the surface of the eye with every blink, protecting the precious aqueous watery layer of our tears from evaporating. If the glands are not working correctly, either not secreting anything or only secreting a thick toothpaste like secretion, then either no oil or a limited amount of oil is being spread over the surface of the eye causing the watery part of the tears (acqeous) to just evaporate. This is what causes the dry eye feeling. The meibomian glands must flow freely spreading this runny oil over the top of the watery layer (aqueous) to protect our tears from evaporating.
How do you fix unhealthy meibomian glands? First and foremost, you need to have a doctor who understands dry eyes and who can diagnosis and confirm that this is your problem. (I swear, some doctors don't even check these glands!!) Once established that you have MGD (meibomian gland dysfunction) there are many things that can help fix or make the problem better:
1. Regular lid cleansing/heat & massage. Let me break this down into two parts:
A. Lid Cleansing: Remember, your eye lashes need to be as squeaky clean as the hair on your head. If your eyelashes feel sticky with hard or whitish debris on them, those glands will not be able to secrete as easily. This was a huge part of my problem. If your eyes burn, many times it is because your eyelashes are coated with this sticky debris. So cleaning your eyelashes/doing lid scrubs can only help your situation. Feel your eyelashes during the day. If they don't feel very clean like the hair on your head, then do your lid scrubs with baby shampoo or other lid scrub pads on the market. This helped me tremendously. To this day and for the last 16 years, I need to do lid cleansing 3 - 4 times a day with baby shampoo and q-tips to keep my eyelashes clean.
B. Heat/Massage: The heat/massage part of lid hygiene helps to soften the consistency of the meibomian gland secretions. The goal is to make them softer so they become more runny. A thinner oil coats the surface of your eye more easily, thus preventing the watery part of your tears from evaporating.
2. Many doctors use a long term Doxycline or other similar antibiotics to help correct the problem.
3. Regular use of fish oil supplements has helped many people.
4. RESTATIS seems to help this problem tremendously in many people.
My doctor diagnosed my MGD many years ago. She would tell me that my meibomian gland secretions were thick, they looked like mushroom caps when she expressed the glands. Once I started the lid cleansing system, it helped tremendously. Once I was on restatis for six months, she said it was amazing to see. She would express these glands and NOT see mushroom cap secretions come out of the glands any longer, but instead, this lovely runny oily liquid flowing freely from them spreading easily over the surface of my eyes protecting my watery tears from evaporating.
It has never been determined why I have dry eyes. But it was confirmed that my dry eyes are caused by 2 of my 3 tear layers not working correctly: MGD from the oily layer not working right and also, not having enough of the aqueous layer of tears. Getting the MGD under control is a huge part of gaining comfort. Once my glands were working normally again, I had punctum plugs inserted in all 4 punctums (to help retain the limited watery, aqueous layer of tears I made) and my eyes were 95% improved. I went from total pain of dry eyes, not even wanting to live type pain, to almost normal. This whole process took many years to unfold. I still have the plugs, still do the lid hygeine, still take restatis and oil fish supplements and my life has gone from total hell to mostly total comfort.
I'll end the lesson now (if anyone still is awake) and encourage you to keep trying new doctors until you find someone interested/knowledgeable about dry eyes and MGD. By the way, the first doctor I saw about this problem was a leading, highly regarded opthamologist in my area who told me to keep using eye gels at night and that there wasn't much else we could do for my dry eyes. ALL DOCTORS ARE NOT CREATED EQUAL, even if they have a good reputation. When I arrived on the doorstep of my second doctor, she told me my meibomian glands were almost permanently scarred shut. She diagnosed the MGD, got me on lid scrubs, gave me doxy, put plugs in my eyes, got me on restatis and fish oil supplements and in a word, saved my life. In the beginning, she would spend 30-45 minutes with me on each visit trying to figure this all out. I would go out into her waiting room after the visit and see a room full of patients waiting for her. She cared and had the patience and interest to help me with my dry eyes. Dry eyes are not a money maker for doctors. They are very time consuming to deal with. It takes a doctor who is compassionate, who truly cares about your pain, and is knowledgeable about dry eyes to help you find comfort.
End of soap box. Hope this helped someone
It seems like a refresher course in the composition of tears is a good place to start. It will help you understand these meibomian glands, where they are, and what their purpose is.
Tears have 3 layers. A mucin layer (sticky). A aqueous layer ( watery layer) and a lipid layer (oily layer) The watery layer sits on top of the mucin layer, and the lipid oily layer sits on top of the watery layer.
The oily layer is secreted from miebomian glands that look like tiny pin holes on your eyelids. They sit directly above your eye lashes (on lower lid) and directly below your eyelashes on your upper lid.
Healthy miebomium glands, when expressed with your finger or a q-tip, secrete this lovely free flowing oil that is runny. It spreads easily over the surface of the eye with every blink, protecting the precious aqueous watery layer of our tears from evaporating. If the glands are not working correctly, either not secreting anything or only secreting a thick toothpaste like secretion, then either no oil or a limited amount of oil is being spread over the surface of the eye causing the watery part of the tears (acqeous) to just evaporate. This is what causes the dry eye feeling. The meibomian glands must flow freely spreading this runny oil over the top of the watery layer (aqueous) to protect our tears from evaporating.
How do you fix unhealthy meibomian glands? First and foremost, you need to have a doctor who understands dry eyes and who can diagnosis and confirm that this is your problem. (I swear, some doctors don't even check these glands!!) Once established that you have MGD (meibomian gland dysfunction) there are many things that can help fix or make the problem better:
1. Regular lid cleansing/heat & massage. Let me break this down into two parts:
A. Lid Cleansing: Remember, your eye lashes need to be as squeaky clean as the hair on your head. If your eyelashes feel sticky with hard or whitish debris on them, those glands will not be able to secrete as easily. This was a huge part of my problem. If your eyes burn, many times it is because your eyelashes are coated with this sticky debris. So cleaning your eyelashes/doing lid scrubs can only help your situation. Feel your eyelashes during the day. If they don't feel very clean like the hair on your head, then do your lid scrubs with baby shampoo or other lid scrub pads on the market. This helped me tremendously. To this day and for the last 16 years, I need to do lid cleansing 3 - 4 times a day with baby shampoo and q-tips to keep my eyelashes clean.
B. Heat/Massage: The heat/massage part of lid hygiene helps to soften the consistency of the meibomian gland secretions. The goal is to make them softer so they become more runny. A thinner oil coats the surface of your eye more easily, thus preventing the watery part of your tears from evaporating.
2. Many doctors use a long term Doxycline or other similar antibiotics to help correct the problem.
3. Regular use of fish oil supplements has helped many people.
4. RESTATIS seems to help this problem tremendously in many people.
My doctor diagnosed my MGD many years ago. She would tell me that my meibomian gland secretions were thick, they looked like mushroom caps when she expressed the glands. Once I started the lid cleansing system, it helped tremendously. Once I was on restatis for six months, she said it was amazing to see. She would express these glands and NOT see mushroom cap secretions come out of the glands any longer, but instead, this lovely runny oily liquid flowing freely from them spreading easily over the surface of my eyes protecting my watery tears from evaporating.
It has never been determined why I have dry eyes. But it was confirmed that my dry eyes are caused by 2 of my 3 tear layers not working correctly: MGD from the oily layer not working right and also, not having enough of the aqueous layer of tears. Getting the MGD under control is a huge part of gaining comfort. Once my glands were working normally again, I had punctum plugs inserted in all 4 punctums (to help retain the limited watery, aqueous layer of tears I made) and my eyes were 95% improved. I went from total pain of dry eyes, not even wanting to live type pain, to almost normal. This whole process took many years to unfold. I still have the plugs, still do the lid hygeine, still take restatis and oil fish supplements and my life has gone from total hell to mostly total comfort.
I'll end the lesson now (if anyone still is awake) and encourage you to keep trying new doctors until you find someone interested/knowledgeable about dry eyes and MGD. By the way, the first doctor I saw about this problem was a leading, highly regarded opthamologist in my area who told me to keep using eye gels at night and that there wasn't much else we could do for my dry eyes. ALL DOCTORS ARE NOT CREATED EQUAL, even if they have a good reputation. When I arrived on the doorstep of my second doctor, she told me my meibomian glands were almost permanently scarred shut. She diagnosed the MGD, got me on lid scrubs, gave me doxy, put plugs in my eyes, got me on restatis and fish oil supplements and in a word, saved my life. In the beginning, she would spend 30-45 minutes with me on each visit trying to figure this all out. I would go out into her waiting room after the visit and see a room full of patients waiting for her. She cared and had the patience and interest to help me with my dry eyes. Dry eyes are not a money maker for doctors. They are very time consuming to deal with. It takes a doctor who is compassionate, who truly cares about your pain, and is knowledgeable about dry eyes to help you find comfort.
End of soap box. Hope this helped someone
) If your MGs can't make nice thin runny meibum, you may or may not pin down the exact reason why not, but in the meantime if you want to see and feel OK, you help them limp along, be it with heat, hygiene, massage, antibiotics, fish oil, acupuncture or whatever seems to work for you. If your MGs have atrophied beyond all hope in this world, you put on a pair of moisture chambers and/or sclerals to protect your surfaces. If you have no idea and every doctor has completely different answers, you do what you can to get comfortable while you hunt down better answers. If your lacrimal glands don't work, you do whatever you can to make more tears, keep tears on the surface, or supplement tears. Hence bulletin boards like this, where we can swap tips.... 
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