Could artificial Tear gel cause blocked meibomiam gland ducts?

[HYPERHEAD]

Hi all...

Right I have been using new blink intensive plus tear gel before bed for a couple of months and they do really help lubricate my dry eyes.

The concern is I noticed the gel crystallises Or hardens on the nozzle when I checked the bottle the next night...so is it possible that the gel can harden on the lid margins when it fully drys and cause further obstruction the the gland ducts!

I only ask as I have noticed 2 white heads on my upper lid margins ? They are not the usual yellow clear bumps which disappear after a day or so these are more hardened white opaque heads which don't go?

It's usually looks like this especially after a shower:



But now it looks more like this but not as big and protruded:



And definetly like this after expressing?

http://www.rootatlas.com/videos/meib...lepharitis.mp4

Should I be concernened about future gland atrophy if I don't pop these plugged Gland ducts? I have a nhs optholomogist appointment soon so should I ask them to squeeze the lids to unplug the blocked ducts or should I try it myself with a cotton bud inserted into the inner lid and use my finger on the outer skin to unblocked the head..you know a bit like popping a zit..lol?

[Joseph]

I have thought of that myself and it is a great question. I would think that the gel like any fluid would flow to the lowest spot and that would be any glands on your bottom lid. So since the gel gets hard and crusty my morning it would make sense that if there is an open gland, the gland would be full of hardend gel.. I don't have any facts to back this up but I can't see how it would not..

[littlemermaid]

Hypes, You have difficult mgd, don't you? Are you OK clearing the blocked glands with warm compress/shower? Do you want to try oral antibiotics? How's the diet + fish/flaxseed oil thing going?

[ishkane]

I use celluvisc during the day and while i notice crusting along my lash line, i don't it clogs... Same with genteal gel. When I was using the thicker ointments like muro 128 and lacrilube, I could definitely feel and sometimes see the blockages.

[HYPERHEAD]

I havent tried the flaxseed ..how would it help? Does it help thin oil secretions? I do express in the shower but getting more thicker paste like secretions on some parts of the lid margins! Not a big fish lover but would eating more fish help with secretions also? I would be willing to try doxycyclines but who can prescribe them?

Thanks LM and nice to hear from you

[littlemermaid]

Yep, being careful with dietary fats and taking fish/flaxseed oil supplements is considered to be anti-inflammatory and/or thin the meibom. The DEWS Report tells us more about this and other treatments to try.

Have you seen there's a public access Eye Clinic at Cardiff University School of Optometry? http://www.cardiff.ac.uk/optom/eyeclinic/index.html One of the staff, Christine Purslow, is on the Board of the Tear Film & Ocular Surface Society in the US with dry eye interest.

Oral antibiotics would be prescribed by GP or hospital docs, or even a prescribing optometrist but those guys are hard to find. It's worrying that you're managing this mgd alone although I remember you have an optometrist you quite like. It would be good to know you're getting regular eye checks.

Very good news you've got an NHS Ophthalmologist appointment. As a good and clued-up patient, very useful to type up a complete short notes treatment history and list of questions before you go so you can do a good consultation and get the best out of 'em. Don't forget to talk about that reaction to the topical antibacterial and all your eye sensitivities so they can advise on drops instead of just giving you the standard. It doesn't rule out future topical antibacs but they need to know exactly what it was and what happened to your eyes when you put it in. Once you're on a consultant clinic 'list', you go back with any treatment management problems or drug reactions so they can have a re-think, no matter what follow-up time they give you.

Your question about blocked glands: we don't poke about popping and scraping in case of damage, but blocked glands or follicles or chalazia further down the gland are relieved by gentle warm compress. The ophth does a bit of gentle pressing on the eyelid sometimes to relieve things. He says this gunk pumps out and burns the eye surface. If it gets infected, we use a topical antibacterial. Personally, I just complain that the kid isn't doing her warm compress and eye rub well enough, not wanting to get involved with anyone else's zits. I gently squeeze externally using clean fingers (very short nails) or cotton bud for a bit of external pressing, but for us it's all about the warm compress and hygiene to keep the glands moving, which sounds a bit like you too.

But the question for the docs for us is rather how to achieve clear healthy meibom.