Question for people with atrophic MGD

[malteaser123]

Thanks for replies.

An update on how my treatment is going...

I had my fourth IPL treatment last week and unfortunately my glands had become more blocked! This was pretty disheartening especially knowing i already have some gland dropout & i'm trying so hard (plus worn no eye makeup or contact lenses for 3 months)

Also despite taking preservative allergy drops for the last month, my eyes are still itchy and i still have inflamation in my upper inner corners.

My optometrist last week thinks i have demodex which may be slowing any progress down so am now trying to get rid of that well as the mgd/allergic inflamations.

[Betsy]

meiboian you are so knowledgeable and we thank you for sharing it all with us, you are awesome!

[meibomian]

It’s not uncommon to develop dry eye symptoms after using isotretinoin products like Accutane. Ophthalmologists like to give complex sounding names like meibomian gland dysfunction, evaporative dry eye disease, posterior blepharitis, tear break up time, etc. But there’s a much simpler way to conceptualize dry eye using another disease that’s even more common – acne. The pathophysiology of dry eyes is almost identical to that of acne. Almost all dry eye cases are due to clogging of the oil glands on the eyelids which can lead to inflammation and even infection. An almost identical series of events occur with acne formation. Under slit lamp examination, the clogged meibomian gland looks just like white heads and a thick, cylindrical rod of oil can be expressed with pressure on eyelids affected by MGD, just like with a whitehead (blackheads are just oxidized whiteheads). It’s the secondary inflammation cascade that leads to dry eye symptoms. This is why rinsing your eyes with saline flushes out all the inflammatory components and gives immediate dry eye relief, assuming there’s no significant secondary inflammation of the cornea (keratitis). It’s therefore not surprising that the same drug (Accutane) that is useful for treating acne can prove counterproductive for dry eyes. Retinoids such as Accutane cause cellular death of oil glands, which is beneficial for addressing facial acne but it also causes apoptosis of the meibomian oil glands on the eyelids, which leads to dry eyes!

Anyone with dry eyes needs to have the lacrimal system thoroughly evaluated. Tear drainage plays a critical role in preventing dry eye symptoms but it is barely mentioned and rarely evaluated. Simply stated, only water evaporates and almost all other components of tear must leave the eye via the lacrimal system. If tear drainage is inadequate, the aqueous portion of tear still evaporates out and all you have left are the solutes, which will increase in concentration and lead to dry eye symptoms. Even in eyes without an anatomic lacrimal obstruction, there is often a physiologic obstruction. Irrigating the lacrimal by inserting a blunt tip cannula attached to a saline-filled syringe into the lacrimal punctum (tiny hole/dot found on both the upper and lower eyelid, on the nasal side) is the best way to assess lacrimal obstruction. If there’s persistent dry eye symptoms after trying multiple medications, have the lacrimal system flushed. Ointment can cause lacrimal obstruction and if you’ve ever wondered why sinus congestion leads to more dry eye symptoms, it’s because the exit point in the nose for the lacrimal system is blocked.

[Jahcpa]

My eyes do feel slightly calmer but i don't know if that's more to do with my chronic allergic conjunctivitus being treated (allergy eyedrops 4 times a day + night ointment).

My opthalmologist said that in my first IPL session when he expressed the glands, most of the oils were solid or toothpasty but that in the second treatment, they were becoming semi solid. Did your opthalmologist notice any improvement with your eyes even if you haven't felt a difference? Have you been doing blinking exercises?

Yes my opthalmologist says he same thing but do not notice any improvement in my symptoms. He says my pores look better. I have my 4th treatment on Wednesday. We will see.

[malteaser123]

malteaser
Do you notice much improvement after 2 IPSs? I've had 3, and have not noticed much yet.

My eyes do feel slightly calmer but i don't know if that's more to do with my chronic allergic conjunctivitus being treated (allergy eyedrops 4 times a day + night ointment).

My opthalmologist said that in my first IPL session when he expressed the glands, most of the oils were solid or toothpasty but that in the second treatment, they were becoming semi solid. Did your opthalmologist notice any improvement with your eyes even if you haven't felt a difference? Have you been doing blinking exercises?

[Jahcpa]

malteaser
Do you notice much improvement after 2 IPSs? I've had 3, and have not noticed much yet.

[malteaser123]

Just an update on this post... i had my 2nd IPL session today & to my relief...there was a miscommunication between me & the opthalmologist before..i do not have 70% atrophied glands like i thought!

I have 70% blocked in one eye, 60% in the other at the moment but the opthamologist is confident can be improved with treatment. Some glands are atrophied but just a small amount. Extremely relieved

[waterbee]

[QUOTE=Betsy;n199485]


Waterbee, what made your glands improve and when you say "tear deficiency still 2" do you mean tbut? Is your pain better too?

hiya

yes it seems i now only have a aqueous tear deficiency, with no current signs of MDG. my TBUT was 2.0 and 2.5 last April 2015, and this month its 10.5 and 11.0.

My eyes no longer stick in the mornings, and ive stopped using gels. still some odd pain, but its occasional more then constant and i dont get that gritty feeling when i blink. my eyes look better too, no more bleph.


my tears are still lacking at only scoring 2 ( on a the little tabs they put under your eyes to record the water content) but my lower plugs are correcting this and im going to have upper plugs done next month which should help a bit too as its poss this will mean i wont need to use drops at all and thats better for the eyes since i have some allergies.

Im not sure what ive done to get the huge improvment in my MDG, if i knew for sure i would share it with the world, but i did stop taking a long term medication in November ( Funny thing is ive been on this medication for 5 years almost, and when my dry eye started i stopped taking it right away for three weeks really hoping that was the reason, but with no change i went back on them as i couldnt sleep without them which in turn made me eyes so much worse at the time.)
it seems coming of meds do take longer to effect the eyes, and the turn around was pretty rapid one it started just a few weeks ago. Im still waiting to see if its a long term.... or if this is even the reason for it.... but ive gone from using drops every 5-30 mins to every 4 hours so some thing has changed.

The other change was i started taking some vitamins as i found out i was low in some really important vitamins for eyes (zinc, vit c) one the main one being magnesium, which regulates water in the body. i really recommend everyone try taking some, its pretty cheap and if you get it in citrate form your body can absorb it much better.

[Betsy]

In April last year I only had approx 70% working glands, the rest that worked had a very low oil production rate.
My last test showed (just last week!) I had a 90% working glands and normal oil production rate. I didn't think that was possible! (Although I still have a tear deficiency (below 2!) my mdg is largely now under control, so things can certainly improve.
My old optometrist told me dry eye is only progressive if we don't do our masks and massage and all though tear production slows down as we age it doesn't do so dramatically enough to warrant major disruptions. Made me feel better! It was actually one of the first things I asked her when this happened.

Waterbee, what made your glands improve and when you say "tear deficiency still 2" do you mean tbut? Is your pain better too?

Murphy can you please tell me what is scaling?

Over the years the opthamologists never expressed my glands. Is this unusual considering how bad off I am? It seems so being so many here get them expressed....worries me I may be better off today if it was done over the last dozen years I've had this. Still searching for a doctor to help me.

[malteaser123]

Most of my glands atropied after taking accutane. I think my meiography was pretty much the same. I have abour 30 to 40% functioning left. My dry eye symptoms were so severe i wore goggles for awhile. After taking doxy, regular gland expression and scaling, hot compress and lotemax once a day i am able to wear normal glasses again. I have anxiety when i think about the future so i try not to think about it. Progression can at least be minimized with maintenance and hopefully new drugs will come out soon.

Sorry to hear so many of yours have atrophied too. That's one positive that you can wear glasses again .

I know what you mean about the anxiety when you think about it all too much! I'm suddenly noticing loads of symptons that i wasn't consciously aware of before (e.g eyelashes are definately falling out. Keep seeing them on my cheek and can visibly see the worse eye has much fewer lashes than the other).

[Murphy321]

Most of my glands atropied after taking accutane. I think my meiography was pretty much the same. I have abour 30 to 40% functioning left. My dry eye symptoms were so severe i wore goggles for awhile. After taking doxy, regular gland expression and scaling, hot compress and lotemax once a day i am able to wear normal glasses again. I have anxiety when i think about the future so i try not to think about it. Progression can at least be minimized with maintenance and hopefully new drugs will come out soon.

[waterbee]

In April last year I only had approx 70% working glands, the rest that worked had a very low oil production rate.
My last test showed (just last week!) I had a 90% working glands and normal oil production rate. I didn't think that was possible! (Although I still have a tear deficiency (below 2!) my mdg is largely now under control, so things can certainly improve.
My old optometrist told me dry eye is only progressive if we don't do our masks and massage and all though tear production slows down as we age it doesn't do so dramatically enough to warrant major disruptions. Made me feel better! It was actually one of the first things I asked her when this happened.

[malteaser123]

I don't know it depends. You don't need all the glands for a healthy TF. MGD is progressive because it's a cycle. What are you allergic to? Are you saying that in the matter of 1 year since your diagnosis your glands have atrophied? That is concerning.

I mean i was diagnosed with MGD a year ago but my glands weren't properly tested at that time. They were probably badly damaged at that point though.


Only had a meibography last week where i was told loads of glands were atrophied (stage 3) & told about chronic allergic conjunctivitus being the cause (& that my daily use of contact lenses/eye makeup from age 14 had made it worse).


I think all the damage was happening slowly but surely for years undetected as opposed to just the last year. I'm not sure what precisely im allergic to though but this is the first time i've been given allergy drops/ointment to reduce the inflamation

[savino]

.............

[malteaser123]

Keeping the glands open, inflammation to a minimum which means having a decent tear film would be a good situation. Dr. Latkany told me that it takes typically years for the glands to start atrophying due to chronic inflammation unless there is medicine or trauma involved. How many years? Don't know. I have been told that Dr. ****** has seen glands regrow once things were under control or improved. But if they are already in bad shape then it's a road to hell imo. I've seen pictures of only 1 gland per lid - how these people continue to live a decent life is beyond my understanding.

Oh gosh that doesn't sound too promising re glands already in bad shape. Most were completely gone in the tests & remaining very damaged . I think the untreated chronic allergic conjunctivitis has been eroding them for years