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

[khmedia]

Hi guys,

I've a query on my MGD. At the moment I am applying hot compress and this is providing relief. However I'm worry that as times goes on that perhaps this won't be the case. Is there a possiblity that the glands which currently secrete oil at this present moment will give less in the future or prehaps none at all.

So I guess my question is can MGD worsen as time goes on.

I've read articles about the glands actually dissappearing and this has me scared about the future.

Kevin

[spmcc]

Hi Kevin,

I don't have an answer to your question. Sorry. I just want to tell you about my uncle who is 76 years old... he's had MGD for a long time (decades) and he told me that as long as he does his compress and expression in the shower every morning (he said he *cannot* skip ONE day), his eyes feel normal and he can get through the day (he's a prof at Stanford Univ).

So, I really hope that after you learn your schedule of compresses (and perhaps expression), you will have "normal" eyes. So, if you need to, make yourself a rice baggy that can be heated in the microwave. They hold heat longer than a warm, wet washcloth. Or you can buy one already made (e.g., Dry Eye Shop has one).

I read in your other post that you are wearing moisture chambers too. You are a VERY smart guy!! They work great and I'm wearing mine right now (as I do all day long).

Good luck with everything. Please keep posting because I'd like to hear *when* you've got this thing licked!!

All the best.
Sheila

[spmcc]

Hi again Kevin!

I was thinking about how I didn't answer your question... and I'm still not able to (sorry again!), but I thought I'd bring up the topic of meibography.

Meibography is the measurement of the number and condition of the meibomian glands in the eyelids.

I myself haven't had any real meibography done but I'm planning to find a place that will *really* assess my glands and tell me where I am.

Anyway, I did a little google search and two articles came up:

1) Journal of Optometry Jan-Mar 2013 Historical Overview of Imaging the Meibomian Glands http://www.journalofoptometry.org/en...culo/90184686/

2) Saudi Journal of Ophthalmology Oct-Dec 2012 Meibography: A Review of Techniques and Technologies http://www.sciencedirect.com/science...19453412001130

Since you said you're concerned about the longer-term health of your MGs, it might be a good idea to find someone who can perform some sort of meibography on you. This might give you some peace of mind.

[khmedia]

Thanks for your reply (replies!) Sheila. This is much appreciated. Your uncle's story has given me some hope! And it is good that you emphasize not missing one day. As I believe this is where I went wrong. I played down the importance of hot compress after the first specialist advised me to do so (I mentioned this in my intro story). So I am now doing the hot compress (with the rice bagy) at 7am, 10am, 2pm, 6pm and 8pm (I hope this isn't overkill).

So far the combination of compress, massage and use of these moisture glasses is working out for me. I'm glad you too are feeling the benefits of wearing them too Sheila!

I think your suggestion for meibography is a great idea. I'll do a bit of research on this. I am located in Ireland so that can be quite restrictive in terms of this service, so I guess a solution may involve travel - but of course that could be well worth it. Thanks for the references. I will give them a read - they seem very interesting.

This is all new to me so very much appreciated!!! Thanks for taking time to post.

Kevin

[spmcc]

Hi Kevin,

I'm happy to hear that you feel better after compresses. Just be careful not to burn yourself! After a while, you might find that you can get away with fewer compresses. I had a doctor who told me to use compresses "as hot as you can stand them, as long as you can stand them, as often as you can stand them". But I couldn't do that! My rosacea just got worse (thanks to my Irish father). Anyway, if they help, definitely contiinue.

As for meibography in Ireland, I can't recommend anyone. I'll check pubmed and if I find a name, I'll post again.

All the best,
Sheila

[spmcc]

Well, nothing came up when I searched pubmed for "meibography Ireland", but when I searched "meibography UK", there was one paper from 2009 out of Glasgow: http://www.ncbi.nlm.nih.gov/pubmed/19516145

You can even email the lead author to see if she sees patients or who she would recommend for meibography (keep in mind that there are *many* techniques and technologies for meibography so it would be good to get specifics about what a doctor means when they use the term).

Good luck!

[khmedia]

Thanks for doing the research Sheila! Much appreciated. This is great. I think I'll email the author of the paper and see what this leads to. You've been super with your help!

Kevin

[khmedia]

I attempted to email Louise the author of the paper you mentioned Sheila. However her email bounced back. I presume she is no longer with Glasgow Caledonian University (GCU). I then contacted the Eye Clinic (Department of Vision Sciences at GCU) themselves at their general email address. They may be able to either let me know where Louise now practices - or they themselves may be able to offer/recommend someone.

[unicorn]

Just want to add I had a very thorough and useful assessment at GCU where they run a Dry Eye Clnic. It didn't include meibography however, which I'd still like to have done. I have posted before about two places in the uk that do it- one in London and one just outside Bristol.

If you can get to Glasgow I'd highly recommend the clinic at GCU. The contact there I had was Eilidh Martin I think.

[khmedia]

That's great Unicorn. Great to hear your experience with GCU was a positive one. I'll take note of Eilidh Martin's name.

Thank you,
Kevin

[peter56]

Hi khmedia,
unfortunately MGD is chronic and progressive!
Especially when MGD patients have to work at the PC screen for hours every day.

Preventing the progression of the MGD means,
careful MG Expression at least one time every week,
wearing blink reminder-enforcer glasses while working at the screen!

Please watch this 90 min video of dr Korb on MGD!!!

http://www.youtube.com/watch?v=AYjBuWB7jrg

After watching this video you will know more about MGD-Dry eyes than most ophthalmogists do know!

You also may read this full text article about the Blephasteam goggles vs hot compresses.
Especially the table on the BUT results.

http://www.ncbi.nlm.nih.gov/pubmed/24752646

[khmedia]

Thanks for your reply Peter. That talk with Dr Korb is very interesting. Thanks for posting. I had no idea it existed. I never tripped over it when doing normal searches on dry eye! So that is great.

I will also read that article too.

By the way, it is interesting that you said "careful MG Expression at least one time every week". Currently I am expressing 4 times a day. Twice in the morning and twice in the afternoon. Perhaps even a 5th time in the evenings. Does this sound like overkill! ?

Thank you,
Kevin

[Max52]

Thanks for your reply Peter. That talk with Dr Korb is very interesting. Thanks for posting. I had no idea it existed. I never tripped over it when doing normal searches on dry eye! So that is great.

I will also read that article too.

By the way, it is interesting that you said "careful MG Expression at least one time every week". Currently I am expressing 4 times a day. Twice in the morning and twice in the afternoon. Perhaps even a 5th time in the evenings. Does this sound like overkill! ?

Thank you,
Kevin

That seems like a lot. Why so often? Are you actually seeing liquid come out? Aren't your lids sore?

[Max52]

Hi khmedia,
unfortunately MGD is chronic and progressive!
Especially when MGD patients have to work at the PC screen for hours every day.

Preventing the progression of the MGD means,
careful MG Expression at least one time every week,
wearing blink reminder-enforcer glasses while working at the screen!

Please watch this 90 min video of dr Korb on MGD!!!

http://www.youtube.com/watch?v=AYjBuWB7jrg

After watching this video you will know more about MGD-Dry eyes than most ophthalmogists do know!

You also may read this full text article about the Blephasteam goggles vs hot compresses.
Especially the table on the BUT results.

http://www.ncbi.nlm.nih.gov/pubmed/24752646

Well Peter...after watching Korb, if he's right, with the exception of lipiflow there isn't much hope at this time. Wish he would have mentioned autologous blood serum, but maybe it doesn't have an effect on MGD. I would think it would help with the destruction of the cornea that mgd can cause. For me lipiflow didn't work but I will soon be using the drops along with azythromicin and keeping my fingers crossed.

[khmedia]

That seems like a lot. Why so often? Are you actually seeing liquid come out? Aren't your lids sore?

Hi Max,

In terms of why so often. I guess the answer is 2-fold

a) This derives from the horrible experience I suffered 2 weeks ago - prior to this I was very poor at doing the hot compress at all. So my knee-jerk reaction was "I'm going to do it 4 times at day"
b) Because I don't know any different. I've received no advice from opticians, doctors or specialists on what the the recommended number of times you should do the hot compress/gland massage.

I am seeing some liquid come out when I do it. Sometimes it varies.

My lids don't seem to be sore as a result.

Kevin