Milo007 you seem to misread my comment. Apart from the meibum being hard near the opening, you've repeated the same thing I said in more specific terms.
What I said: "bacteria is not in the glands, it is on the lid margin (and somehow in the oil)". I suppose by extension that means that the bacteria is in the glands but I chose to word it the way the researchers did.
What I said: "Everyone has bacteria but MDG folks may have more hence the obstruction problem."
Yepp, good strategy, I think most people do that. One problem is that not being in the medical field, I find it harder to distinguish good study designs from bad designs when things get very technical.
Good to know. My ophthalmologist used a callus analogy in the lid margin context.
It is not completely wrong. In many cases once the hard oils are pushed out, good ones come out right away. I am one of those people. That means the oil stagnation/hardening, whatever you want to call it, happens not deep inside but near the lid margin opening (still inside but near the margin). I agree though, it can happen deep inside, too. I thought that in the bacterial case it happens once the oil is closer to the orifice (but still inside the gland obviously).
And yes, I've watched that animation before. I think most folks with MDG came across it as the video is one of the top results. Also, Korb talks about it a lot in his Spanish conference.
I was originally interested in reading the studies you had used to create your first comment since neither of us are professionals (correct me if I am wrong). Totally fine that you don't remember anymore where you got the info from. I was also hoping for a friendly open discussion. In my personal view, this is not the case so I will not go into this topic further. I do appreciate you sharing your learnings here though.
You seem not to carefully read the content you have published. It says bacteria is present in the the lid margin but is also cultivated in freshly expressed meibum in normal patients and patients with blepharitis.
Well it's not the presence of bacteria that's the critical factor but their "overgrowth" and "over population" as a result of some "abnormal" conditions that help them to multiply in such large colonies and manifest their presence creating "abnormal" biochemical changes after sometime.
TFOS DEWS might be the single most comprehensive source of information but it doesn't include all independent research findings happening across the globe or even new findings that has taken place after the publication of TFOS DEWS II report. So I rely on more dynamic sources of information.
So removing the epithelial covering by abrasion will only invite more epithelial formation and gland capping. I don't repeat the procedure too often as repeated injury to lid margin can result in scar tissue formation which is what I am afraid of most.
Your assumption is totally wrong when you assume that meibum hardening takes place once it reaches the lid margin. Meibum hardening takes place inside the glands and that's why you need warm compresses to melt it internally. Watch the animation of the lipiflow procedure to get an idea of what I have said.
And yes, I've watched that animation before. I think most folks with MDG came across it as the video is one of the top results. Also, Korb talks about it a lot in his Spanish conference.
I was originally interested in reading the studies you had used to create your first comment since neither of us are professionals (correct me if I am wrong). Totally fine that you don't remember anymore where you got the info from. I was also hoping for a friendly open discussion. In my personal view, this is not the case so I will not go into this topic further. I do appreciate you sharing your learnings here though.
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