Meibomian gland expression: maintenance or murder?

[Rebecca Petris]

Please see Sandra Brown MD's article on appropriate and inappropriate use of meibomian gland expression. I would love to get feedback from patients and doctors on this topic. It is a big concern of mine lately.

http://dryeyezone.com/encyclopedia/mgcare.html

Also see parallel discussion in Patients forum.

[DryEyeOD]

Dr. Brown's Excellent Article

Dr. Brown brought up several points that are often overlooked. First, too much MG expression can be worse than not enough. Second, the whole point of MG expression is to get the contents to flow. Once that has been established, treatment can usually be less aggressive.
One point that should be emphasized is that heat alone is really not all that helpful. Heat with expression immediately afterward, if performed properly can be very effective. Azasite can be considered as "heat without the heat". Azasite lowers the freezing temperature (or if you'd rather, the melting temperature) of the MG contents. So, Azasite by itself is only helpful as far as the modest antimicrobial activity is concerned. However, Azasite with expression can be highly effective. The advantge that Azasite has over heat, is that the melting effect lasts long enough to make a good expression possible - much longer than the few minute window that heat provides.
Dr. Brown really hit the mark with her comments. Many thanks to her.

[fundryeyes]

This has always been my opinion on the subject and unfortunately there are a lot of well known doctors, some who have written books, who believe this(expression) is a viable treatment. I wonder what the doctor feels about even more radical expression treatments like Lipiflow. Not believing the hype about expression, I was definitely not going to pay thousands of dollars for an unproven technology. I fear that all the opportunists are coming out of the woodwork to benefit financially from this common condition . What I'm not seeing enough of is research to get the abnormal glands to function as they should. Surely the hormonal connection should be investigated in more detail as this condition is most common in post menopausal women ? I see tons of studies on new strengths of existing drugs and anti-inflammatory rx when we should be fixing the root cause. Anyways, thank you Dr Brown for having the guts to tell the truth about this often recommended expression procedure. It never worked for me. I am on Restasis, low dose doxy, and two lower punctal plugs. Honestly, the only thing that has made me feel better is a $ 40 pair of Harley Davidson motorcycle glasses with foam gasket that I wear around the house. That is sad indeed.

[Rebecca Petris]

I don't think Dr. Brown is dismissing self-expression - rather that she's saying it's only appropriate in certain cases and can easily be overdone.

Which raises an interesting point doesn't it? How many treatments out there about which the exact same thing can be said? I share some of your concerns about up-and-coming MG treatments. IF they're targeted really carefully, fine, but once something gets commercialized, it's inevitably going to get pushed to a really, really broad group to maximize profits.

Take Restasis. Rejected twice by the FDA till they whittled down the patient group to the ones it actually seems to help. Really seriously unimpressive clinical data. But... like so many drugs, once it's approved by the FDA, it gets prescribed indiscriminately - to all kinds of people complaining of dry eye symptoms from any number of causes whether or not related to the lacrimal insufficiency it's supposed to help. It became a blockbuster drug just because the market 'needed' something. Don't get me wrong, it's an important drug... but because it helps SOME people, IMHO, just like compounded cyclosporine did before Restasis came on the market.

I actually really appreciated Dr. Latkany's book section on the meibomian glands because it educated a lot of people about the role of MGs in dry eye, which was badly needed - and got people asking their local doctors more questions. I think his eye spa routine is pretty gentle if done as described but it's so easy to take these things to extremes.

Bottom line for me... neither the successes nor the failures of any dry eye treatment should be extrapolated as applicable to everyone.

In fact, I don't think there is anything as universally safe & appropriate - though not universally effective 'treatment' (if you can call it a treatment) is the one that's helping you (fundryeyes): moisture chambers.

[Sammy B.]

What a great article. I just need more doctors who do expressions, mainly those who are familiar with when and how to do them, to move to my area!

Rose

[mgshutterbug]

Anyone know of any trials out there re: prescribing minute dosages of androgens to hopefully increase MG oil production in peri and post menopausal women?
Maria