MGD query - can oils secretion decrease as times goes on?

[spmcc]

Speaking of Korb... You might want to read this abstract about recovery time for optimally secreting MGs: http://www.ncbi.nlm.nih.gov/pubmed/19387230

They write (paraphrased)

12 patients with *no* dry eye symptoms

The times to drain the gland of available liquid secretion, for the drained gland to recover, and then be redrained were measured.

* mean time to drain the marked meibomian gland was 8-20 seconds;
* partial recovery of the drained meibomian gland was 1.5-2.5 hours;
* to redrain the meibomian gland after recovery was 5-10 seconds.

CONCLUSIONS:
This report shows that (1) a single OSMG can be drained of its liquid secretion in 8-20 seconds upon application of a constant force of 1 g/mm, and (2) a partial recovery occurs after approximately 2 hours, evidenced by detectable liquid secretion which then expressed for only half of the original time.

In other words, I would think that your glands may not recover enough between compresses if you are doing them too often. But this is just MY GUESS, based on this one study of "normal" folk!

[khmedia]

Hi Sheila,

That is very interesting.

It is exactly what I was questioning recently. I guess the key thing here is to allow maximum time between expressions, to give the glands time to recover. I do my expression at 10am and once again at 2pm. I think a 4 hour gap is fine - well so far so good.

Kevin

[peter56]

Hi Kevin,
four times warm compresses and lid massages is the recommandation of the Int MGD Workshop.
But compress and lid massage is far different from a professional Basic Expression.
The compresses don't achieve the neccessary temperatures at the lid insides of >=42C, to liquify the clogged
meibum and stiff secretes. So massages have no chance to clean the glands.
That does only work for very mild MGD and Computer Vision Syndrome.
Every day four such treatments will cause more irritations and inflammation than healing!
By the way who does have the energy and Patient to do these treatments for months and years, maybe some female patients since
women do have more discipline.

So the most efficient Treatments for MGD are - facial-Sauna - Eye Steamer,
corneal shields and Collins forceps based manual expression one time every week.
In the early acute phase even 2-3 times a week.

[MGD666]

peter56 - any specific recommendations - based on your personal experiences - for best brand names/styles of facial sauna or eye steamer? Also I am really interested in the Collins forcep and corneal shields. My initial search on those awhile back left me thinking that it would be difficult to obtain them. True?
Do you think the Collins forcep is better and more effective than the mastrota paddle? Thanks in advance for any info.

[Max52]

I don't know what's going on here with all those who do manual expression..according to this..why bother...." Korb and Blackie have an article from 2011 in which they write that "Only 7% of the patients could tolerate the pressure necessary to administer complete therapeutic expression along the entire lower eyelid." So who out there does forceps, paddles, whatever. Is the goal incomplete manual expression?

[MGD666]

Well, having had Korb personally do an expression on me earlier this year, I must be among the 7% as the pain and pressure was not that bad. Of course, I had it done by one of the most qualified/experienced guys, so that may have been the reason! Still, with my condition, I am obviously interested in learning how to properly do my own expressions (taking great care to be cautious naturally)...

[Max52]

Well, having had Korb personally do an expression on me earlier this year, I must be among the 7% as the pain and pressure was not that bad. Of course, I had it done by one of the most qualified/experienced guys, so that may have been the reason! Still, with my condition, I am obviously interested in learning how to properly do my own expressions (taking great care to be cautious naturally)...

Yes...but for the other 93% of us who might not have your pain tolerance I don't understand why so many on this forum are expressing their glands with no evidence that it's doing any good whatsoever? Or, do those that do it regularly find at least temporary relief ?

[khmedia]

Hi Kevin,
four times warm compresses and lid massages is the recommandation of the Int MGD Workshop.
But compress and lid massage is far different from a professional Basic Expression.
The compresses don't achieve the neccessary temperatures at the lid insides of >=42C, to liquify the clogged
meibum and stiff secretes. So massages have no chance to clean the glands.
That does only work for very mild MGD and Computer Vision Syndrome.
Every day four such treatments will cause more irritations and inflammation than healing!
By the way who does have the energy and Patient to do these treatments for months and years, maybe some female patients since
women do have more discipline.

So the most efficient Treatments for MGD are - facial-Sauna - Eye Steamer,
corneal shields and Collins forceps based manual expression one time every week.
In the early acute phase even 2-3 times a week.

Hi Peter,

Thanks for your advice. I had no idea that the compress was different than the treatments you mention (collins, facial sauna, etc). This is interesting food-for-thought.

I agree, it is a big ask to keep up the patience of a hot compress 4 times daily. At the moment I've reduced this to 3 and what is driving me to complete it is the fact that it does give me some relief when I complete it. So in the morning before I set off to work, once in the afternoon and then once in the evening (before bed) - the key times.

I find that the moisture glasses are working quite well. I put them on immediately after doing the compress to dry and protect what the compress achieves.

Thanks again. I'm interested in looking into your suggested treatments you mention.

Kevin

[khmedia]

I had no idea that the compress was different than the treatments you mention

When I said 'different' what I meant here was 'less effective' - as you suggested.

Kevin