Question for people with atrophic MGD

[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.

[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.

[Betsy]

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

[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.