What if your MGD is Caused By Ocular Rosacea?

[regularjoe]

Hello,
I have MGD like many (probably most) here. In my case, it is caused by Ocular Rosacea.

What are the implications of MGD from Rosacea, as opposed to other causes? For instance, I have never noticed any eyelid debris, and have been told my eyelids, while inflamed, are clean, naturally.

I have moderate dry eye. My primary symptom is styes and chalazia, and general, permanent irritation of my eyelids. All the same, I have 50% Meibomian blockage in my left eye, and 40% in my right. My eye doc said he was amazed my eyes weren't even dryer than they are. I want to do what I can to protect my existing glands.

But are there special considerations when it is Rosacea at the root of your eye problems? Am I just as likely as others to suffer from bacterial issues and Demodex infestations, or is my situation really just inflammation that wreaks havoc on my glands?

My eye doc told me to do warm eye compresses, use lid scrubs (with tea tree oil) and apply an eye ointment (Tobradex, a steroid/antibiotic combo). I kinda felt like this was a cookie cutter approach, and not tailor-made for my situation, and not taking into account my Rosacea? But maybe EVERYone with MGD does very similar treatments, regardless of the root cause? Maybe the Rosacea doesn't even matter, as far as treatment for MGD is concerned?

On a related note, I am wondering if there is an in-office intervention -- probing, Lipliflow, IPL or Blephex -- that is best suited to Rosacea sufferers?

Thanks. *smiley icon*
Joe

[PG]

I also have ocular rosacea, no debris, with inflamed glands. The rosacea means that your blood vessels are dilating, contributing to the inflammation. Yes, you are getting a cookie cutter treatment plan. Go to the rosacea website and check out the rosacea triggers. They provide a list. A trigger is whatever really sets it off. If you can identify your triggers you can reduce your symptoms. Also, if you have oil reduction but not tear reduction, you are the right fit for IPL (like me). The IPL zaps the troublesome blood vessels and melts the oil in the glands. Then the doc manually expresses them. You do this once a month for four months. This gets the clogged glands going again. Inflammation is the issue. You are just as likely to suffer from bacterial infections because you don't have a normal tear film to protect the eye due to the compromised oil layer. You are not more inclined to have demodex, but everyone has them and they are certainly not helping the situation. Cliradex wipes for 3 months 2x per day gets rid of them.

Not specific to rosacea: Take a LOT of fish oil. 3000 mg or so, to improve the consistency of the oil. Do a wet warm compress, but do it more often and longer than the doc says. Along the lines of 15 min, three times a day. Get that oil to soften up. When you are doing the warm compress, squeeze your eyes together hard many times. The lid scrubs are great, especially if you wake in the middle of the night. They remove the inflammatory enzymes that collect on the lid margin. I do them before bed also; I notice the difference when I forget.

[MGD1701]

Hi PG
You mention, ''The lid scrubs are great, especially if you wake in the middle of the night. They remove the inflammatory enzymes that collect on the lid margin.''

question
1. Lid scrubs - I assume you use wipes since it is easier when in bed? which brand you use?
2) inflammatory enzymes: how can I know if I have such?

I really feel sad that we can NOT trust doctors - why they tell us useless info?
For MGD warm compress (wc) is the most critical.
Why they do such things, lack of knowledge or...??
I visited more than 10 doctors only 2 checked glands and told me 10 min. wc,
only ONE told me my oil is thick, showed me how my glands looked like and how to massage etc.

thanks!

[regularjoe]

Yes, you are getting a cookie cutter treatment plan. Go to the rosacea website and check out the rosacea triggers....Also, if you have oil reduction but not tear reduction, you are the right fit for IPL

I will ask my doc if I have "oil reduction but not tear reduction". He offers Lipiflow, but I am more interested in IPL if these cookie cutter changes don't help enough.

You are just as likely to suffer from bacterial infections because you don't have a normal tear film to protect the eye due to the compromised oil layer. I think demodex may be more associated with blepharitis.

Are you implying Rosacea sufferers do not have blepharitis, and therefore do not have demodox? (Just wondering what you mean there... pretty sure we all have blepharitis since it is just inflammation of the eyelids...)

Not specific to rosacea: Take a LOT of fish oil. 3000 mg or so, to improve the consistency of the oil. Do a wet warm compress, but do it more often and longer than the doc says. Along the lines of 15 min, three times a day.

Yes, I have taken 4000mg of fish oil for years. Tons of other supplements, too.

Can you describe your own wet compress protocol? What do you use? How do you keep it the right temperature? (15 minutes is a long time for warm temp...)

Thanks a ton! *smiley icon*
Regular Joe

[PG]

Hi Regular Joe,
My doc also has Lipiflow and that is an option as well. He chose the IPL however, and I did not ask why. Probably because the laser gets rid of some of the problematic blood vessels and the Lipiflow does not do this. BTW, if your doc has LipiFlow, see if he has LipiView Interferometer. It's an imaging device and they can see exactly what is happening with your glands. Pretty cool.

I skimmed over demodex too quickly, so I revised my original response above. You asked if you were more prone to demodex. I meant no, that I think people with blepharitis may be (I don't have that, so not an expert there). Everyone has demodex. I treated for them, and it helped but only a bit. However every little bit helps and this is a slow healing process. Blepharitis is the oily flakes at the base of the lashes, crusted eyelashes, greasy eyelids (I am thinking, demodex hot fudge sundae).

For the wet compress I use a rice bag which I heat up in the microwave. Not hot because you can warp your cornea, just very warm. I put two cotton squares, put them in a bowl and add a few drops of boiling (from an insta-hot) to get them wet. The point is to have the moisture and be sanitary because these are like cotton balls. I put the cotton squares on my eyes and the rice bag over it. It does stay warm for 15 minutes. The moisture helps to retain the heat, I think. It really does stay warm. After 5 min or so I blink hard to get the oils going. Yes, the bag gets a little damp. I did try putting the rice bag into a plastic bag, but it was pointed out to me by a member that the plastic contains toxins emitted when exposed to heat. I guess you could heat, and then put it in a plastic bag. I get the bag from the dry eye store. My doc recommended a warm washcloth for 5 min, which does not stay warm and is not sanitary enough. I think he may have never tried it himself because it was such an unrealistic recommendation.

[MGD1701]

Hi PG
thanks for sharing your wet compress (wc). I also have the same concerns - plastic bag + sanitary issue on washcloth.
Would you mind confirming your steps:
1) wc x 15 min
2) after 5 min (why so?) you blink hard to get oils going - how many blinks you roughly do?

3) Do you still massage, do lid scrubs (with specific brands cleanser?), put drops after wc? the exact order?

Thank you!

[PG]

Hi MGD1701,
I use Systane wipes. They are easy to use when you wake up in the middle of the night with eye discomfort. You don't need to get up, and they provide so much relief.

My third doc was the right one. I researched all of the docs on my insurance plan, looking for at least an expressed interest in dry eye at a minimum. I searched for docs that were offering treatment targeted at dry eye, because that means that they have put some thought into this condition. They have studied up on it. So you go for the ones who say they do LipiFlow or IPL or whatever. These are the docs with dry eye patients flowing through their practice, so they gain knowledge. My first doc was the one that I had been with for years and years. He specializes in glaucoma. Nice guy, good doctor. But he did not even recognized the MGD, did not diagnose it. I went to a second doc out of my mind, as I was in severe stage by then, and got a diagnosis. So this is a specialty within a specialty. Not their fault; eyes are very very complicated.

As far as the enzymes go, I am talking about pro-inflammatory cytokines. Google that. Dry eye patients over produce cytokines. Here's a good one:
http://tvst.arvojournals.org/article...icleid=2593403

[PG]

MGD1701,
About the compresses, I do them for 15 minutes. If the oils don't come (and they never did before IPL!), then I will actually reheat the compress and do it again (this doesn't happen often anymore). I found that you have to keep those oils going or it just gets worse. I wait for 5 min to blink because the oil needs to melt. If I blink before that, nothing happens. And oddly enough, a link that you messaged to me confirmed my approach. Here it is back at you http://www.luxotticalearning.co.nz/d...-3-management/. Go to Warm Compress and look at the picture. That article is generally pretty good and have it bookmarked. Worth studying, so thanks for that. I found that it contained many of the things that took me months and months to discover. But like I mentioned before, that treatment table at the beginning is wanky. Way to extreme, IMHO.

I still do massage, immediately after the compress. But I find that the blinking is more effective at releasing the oils. I massage by swiping from inside to outside because that is what my doc said. But I have had luck massaging from the bottom up as well. Not sure the massage approach is that important.

I do not do drops right after warm compress. It seems to disrupt the balance of the tear layer that just got a dose of oil. I do the drops later, whenever my eyes start to feel dry.

[regularjoe]

About the compresses, I do them for 15 minutes. If the oils don't come (and they never did before IPL!), then I will actually reheat the compress and do it again (this doesn't happen often anymore). I found that you have to keep those oils going or it just gets worse. I wait for 5 min to blink because the oil needs to melt. If I blink before that, nothing happens.

How do you know if "the oils come" or not? Do you "feel" it? Or do you actually see them, somehow? Or some other method?

[Jahcpa]

I also have mgd and ocular rosacea. My doctor said rocacea is the leading cause of mgd. If you pulled down my lower lid, it was a bright burgundy color. I had 6 IPL treatments. She also told me that IPL treatments work to correct the rosacea and hence the mgd rather than the symptoms. Over the course of the treatments I talked to many patients and all of them saw tremendous improvement. Unfortunately, they did not help me. I was actually finally diagnosed with Blepharospasm. I've been getting the botox injections and it has helped me a lot. For some weird reason, the botox has also helped with the dry eye symptoms which I understand is unusual. Usually the botox will cause more dryness at least in the short term. Since I have been receiving the botox, when you pull my lid down, it is a normal pinkish color.

Everyone is so different. I hope this info helps you a little.
Good luck to you.

[Jahcpa]

Oh and a second thing. I use a product called Medi Peds for hot compresses. They make the procedure so much easier - you just pop them in the microwave and use. I bought them on Amazon for about $35. I now have a couple so I can wash and air dry one while using another. I usually use them upon first waking when my eyes are their driest. My eyes feel oily directly after. It's a good feeling. !!

[regularjoe]

Oh and a second thing. I use a product called Medi Peds for hot compresse... I bought them on Amazon for about $35.

Hmmm, is that the exact name: "Medi Peds"? When I type that into Amazon, I get some sort of diabetic sock? (Maybe you mean "medipads" or "medibeads" or something similar?) Do you have an exact link, or the company that makes them?

Thanks for your reply! *smiley icon*

Joe

[MGD1701]

Thanks PG

Massage:
your method (swiping from inside to outside) sounds interesting - I have never heard about it.
Would you mind explaining it a bit? or any viedo at Youtube? with fingers, Q-tip?

Why massage: to get rid of old oil (, dirts, bacteria etc.) in order NEW oil to generate, hopefully, what I have learnt recently.

Oil secretion the more the better, I have read but dont know why?

Monitor glands/oil status: Do you use any tool? I use 20-fach mirror which is really helpful.

[PG]

Joe, you feel the oil.

[Jahcpa]

Well that is interesting. First of all I typed it wrong. They are MediBeads. But when I search them on Amazon I do not get them either. However when doing some searching I realize the name has changed. These are the items. When I look at mine I the outside says MediBead, but the label says Bruder.
Good Luck to you.