Too much meibomian?

[Steve]

The optho I'm seeing here is grouchy and doesn't like having to speak English, so she gives very short, one-word answers to my questions and won't volunteer anything. I dragged out of her the diagnosis that my lipid layer (meibomian) was overproducing. This seems different from what I've seen here so far. Could it be?

I was on the Atkins diet for over a year before this, could that have upset my
fatty acids balance or something? Anyone else seen something like this?

[SusieD]

Hi Steve and welcome.

Ive never heard of meibomian glands over-producing, but I suppose if they can underproduce they can overproduce also.

I wish mine would over produce - Im at the other end. Do you know what type of dry eye you have (well obviously its not a lipid problem) Do you have less of the watery part of the tear?

I cant really understand how you can have dryness with too much lipid - maybe the quality of the lipid is not good? I dont know maybe someone else here can offer a better answer!

What do your actual symptoms feel like - do your eyes FEEL dry?

[Steve]

They're dry all right

Thanks for the reply!

Yes, they *feel* dry now, but they didn't when I was first diagnosed -- they just felt sore and light-sensitive.

If I understood my grouchy monosyllabic doc right, it's only my lipid layer that's screwed up, and that layer is too thick, which apparently is as damaging to the total film lifetime as if it were too thin.

Then again, I could have misunderstood her. She was pretty clear that there was nothing wrong with my production of liquid layer. And she recommended eye wash & massage, and lots of drops. She just said that punctal plugs would do no good, since there was enough water already.

She didn't mention diet, but I would guess that it might be somehow related to my previous funky diet (I was eating very low-carb, high protein and fat for 18 months. I have since stopped and started eating a full-spectrum healthy diet and lots of supplements, just to be safe)

[neil0502]

Hey, Steve....

I really know like nothing about the condition that you describe, but ... if I'm understanding you correctly, then maybe ... just maybe ... a guy like you could benefit from simply using saline solution to rinse out his eyes a few times a day.

I mean: if your meibomians are producing too much fatty/oily layer, then ... wouldn't thinning it just a touch, while--at the same time--rinsing out any potential gook that built up, likely help??

All the best,

Neil

Hey, by the way: what are you doing in Scandinavia and--if my wife and I wind up there at some point on our trip (leaving 7/15 for several months in and around Europe)--should we stop by for a cup of coffee or something??

I've heard incredible things about Stockholm....

[Lucy]

Neil, I think you might get into trouble in Sweden--or was that the Netherlands? I wonder if you'll run into Homes on your tour?

[neil0502]

Lucy...

If I have banked any karma at all in this life ... then I will get in trouble everywhere I go

I forGOT about Homes.

May just have to e-mail that boy.....

[neil0502]

Back to Steve, incidentally....

You may also want to find a POLY-syllabic eye doc (if you can) and ask about the ups and downs of punctal plugs. Again, if your soup is too thick ... maybe keeping a few extra tears in place will thin it out a bit.

Just a thought....

Neil

[Steve]

Thanks for the thoughts!

Interesting that nobody has heard of meibomian overproduction. That makes me wonder if the doctor might have been incorrect or I may have misunderstood her. I'm using mostly just preservative-free Visine single-use droppers anyway. (Visine Intensive for dry-eye, not the allergy/red-eye drops of course!)

Looking around for a second opinion is a serious challenge in Sweden, doubly so in the summer -- I had to jump through hoops just to find an eye doctor who was taking new patients before September. Most doctors go on vacation in the summertime, and those who are left are full up.

As for a visit, please do drop by, but beware -- my vacation starts July 15 too. I'll either be out of town, or in town, for the three weeks after that. Come on by, just write first or IM. I think my info's in my profile. I'm right by the lake, and Stockholm in the summer truly is gorgeous.

[kakinda]

Hello,

never heard of meibomian over production either in all my years of experience of DES (including all the docs and other patients I met)...
I wonder if i could get a diploma for that
I really wonder if this isn't in fact a communication problem as as you suggested.
Meibomian glands can get clogged or produce thick lipids (sometimes acid) contributing to an instable tear film... If you were just overproducing lipid you would then be suffering from over lubrication... I don't quite see that could be a cause of dry eyes.

Again, DES is always more complex than one can imagine, but I am betting on the communication error.
take care
kakinda

[neil0502]

Steve,

IF it IS meibomian gland dysfunction, then you would quite likely get at least a BIT of relief from using warm compresses [1] followed by "gland expression" [2], as this regimen should get the works unstopped a bit.

If that DOES help you, then you may want to search this forum a bit for "MGD" or "meibomian gland dysfunction." There are a few ways it can be managed.

As to the doctor, if you can get her to perform, and give you the results of, your "Schirmer's" and "Tear Break Up Time" tests, you'll have a *better* idea of what's going on. MGD causes tears to evaporate too quickly, leading to a sub-normal Tear Break Up Time.

If you have a low T-BUT but a good Schirmer's, then MGD is quite likely.

I'll stay in touch regarding our schedule. So much to see......

[1] some people like the corn or rice bags (vs. a washcloth). See, for example http://www.diamondthreadworks.com/mi...ating_bags.htm
[2] basically light-pressure massage to get the meibomian glands to produce more meibum

[kakinda]

and if it is indeed MGD,you may want to read about doxycycline next and possibly discuss a short term trial with your ophthalmologist.

But be sure to try Neil suggestions first, once and if MGD is confirmed. If I may just add the following, maybe clean your lids diluting the smallest portion of baby shampoo in a saline solution using with a Q-tip (cotonette) after the expression.

I have tried something lately, I not sure I should mention this , so consider that I'm not suggestiong anyone to do this but I'm reporting a personal experience and impression. I recently started using cyclosporine on the Q-tip to clean the lids at night, and I really have the impression it has improved things ... but maybe that's a coincidence and wrong conclusion of another DE desperate sufferer!

The improvement started well before I started praying the Dry Eye god for those of you wondering!

if it's overproduction, then I'd gladly exchange a few glands with you (I meant meibomian glands of course.... otherwise it may sound like a weird suggestion ) to balance things up. You may want to consider selling in vials...
but then i wonder how one goes about sharing under-production (here's a tough one for you, Neil, that I hope we can discuss over "café lyonnais"... If you want to do a tour a European coffees may I suggest Portugal - Lisbon and then possibly Italy. Did you know that French people usually consider American coffee as being "du jus de chaussette" : sock's juice (hey back to our favorite topic... just kidding -sorry I guess the last ulcer I had affected my brain... it's better today, the ulcer I meant). The French are not always as diplomatic as they should be, but i would agree with them on this one.

Take care
Kakinda

[indrep]

Steve,
Your tear film osmolarity sounds like it could be the problem. When the tear film has hyperosmolarity then your tears are actually pulling moisture from your cornea and this can cause the eyes to feel dry. Having an over production of lipids could then be keeping the moisture robbing tear film in contact with your cornea even longer. I am not famliar with the visine drops osmolarity but you should make sure they have hypoosmolarity.

[Steve]

Re: Osmolarity

Thanks, great clue!

I haven't yet determined the osmolarity of the Visine (it's a product that doesn't seem to match any of the US branded Visines), but I found this very useful reference page:
http://www.agingeye.net/dryeyes/drye...gtreatment.php

So I will be checking the tonicity from now on, I promise. And whether my lipid layer is deficient or overflowing, I will start to work on both assumptions. First step is to take plenty of Omega 3's and rebalance my formerly high-animal-fat diet.

[Steve]

Neil?

Neil, are you really coming to Stockholm in July? I'd be happy to pay you for a supply of Dakrina/Dwelle which I can't get here.

Let's see, how about... 5 of each?