Still getting my meibomian gland openings capped...

[Milo007]

Hello everyone,

In one my posts I wrote about my observations on my lid margins and more specifically the gland openings. Every now and then I could see tiny yellow cappings on my gland orifices. They typically develop in a few hours. For example, if I do a lid margin scrub in the evening and clear up those cappings and check my lid margins at night for no further cappings before I go to bed, it's of no surprise to see quite a few cappings develop by the time I wake up in the morning. I have been rubbing them off with a dry q-tip for the last two weeks only to find some temporary relief.

I have observed a few things regarding the development of these cappings. They develop almost always after I take a nap of 2-3 hours or after a good night sleep of 8-10 hours. But I didn't observe cappings develop during the time I am awake and working. Because I have the tendency to check my lid margins as as often as 2-3 times an hour I can rely upon my observations.

In my last post, meibum Ian mentioned a good point on the possibility of sleeping with my eyes open. So all the while I was alert on this possibility and indeed I think I am sleeping with my eyes partially open. There are days when I wake up with my eyes red specifically my right eye as if I had contacted conjunctivitis. The right eye feels itchy too when I am half asleep and I tend to rub my eyes vigorously (right eye). This has been the case for the last few years but I never cared about it before.

Also taking a few pictures of my eyes trying to close the lids gently I find that my lids never close completely until I really press hard in an attempt to do so. Specifically my left eyelids won't touch even if a press a bit harder than a gentle effort. And the lower left eyelid is the one that gets a lot of tiny cappings every morning. My right eye however opens up more when I am in deep sleep confirmed by the fact that my right eye would itch, get red and irritated really badly maybe as frequently as every alternate nights when I wake up rubbing my eye to alleviate the itchiness. A point worth mentioning is that I have been experiencing twitches in my right eye for the past 4-5 years that generally happens after heavy computer use. I have also been told I am a partial blinker and I sometimes sleep with my eyes open. I do sleep under a ceiling fan at night.

Taking note of everything, I have a few queries that need to be answered :

1. What could be the reasons I am developing those cappings on my gland orifices?

Is it only the fact that my eyelids are not touching to cover up the gland openings, the lipids are drying out at the base of my lid margins?

2. What are the options for managing my condition?

I have tried hot compresses but they don't seem to clear up the cappings even at temperatures as high as 50°C.

The only thing that works is a lid margin scrub with a dry q-tip to repeatedly rub off the cappings. I am afraid this procedure is not ideal to continue with since repeated mechanical abrasion could result in scarring of the gland orifices and thickening of the lid margin. I have alo tried a baby shampoo - water solution dipped q-tip to dissolve the cappings but to no success. They are like microscopic amber that tend to stick even in the presence of mildly strong alkali.

I have contemplated on the idea of heating up a blunt needle and touch the cappings with the heated needle tip to melt the cappings. But backed away from the idea as it could lead to cauterization of my gland openings.

Haven't tried ocusoft or avenova lid scrubs and not sure if they would work.

3. I am considering a night time moisture chamber goggles like tranquileyes mini or eyeseals 4.0 that might definitely help retain moisture to manage dryness and irritation arising due to nocturnal lagophthalmos.

But would they halt the development of cappings on my gland openings since my eyelids would remain mutually untouched even under the eyewear?

4. I am also considering the most viable option (apparently) of taping my eyes using skin friendly adhesive tapes. But I am afraid if I develop allergy to adhesives or tape materials after prolonged use. The only way to ensure that my eyelids touch each other while I am asleep seems to be by the use of adhesive tapes or external eyelid weights sticked to my eyelids.

Has anyone tried sticking external eyelid weights to manage nocturnal lagophthalmos?

How common is the incidence of an adhesive allergy or silicone allergy for people who have used tapes in the past?

Any input is highly welcomed and appreciated.

Thank you

[MGD1701]

Rub eyes - please do not rub eyes - many side-effects. Dr Korb mentioned it in 2016 videos too.

Healthy diet should help, avoid sugar, processed food, red meat. drink enough water etc.

sleep under a ceiling fan at night making eyes drier.

baby shampoo: better make sure soap-free, otherwise it removes the oil.

[Milo007]

Rub eyes - please do not rub eyes - many side-effects. Dr Korb mentioned it in 2016 videos too.

Healthy diet should help, avoid sugar, processed food, red meat. drink enough water etc.

sleep under a ceiling fan at night making eyes drier.

baby shampoo: better make sure soap-free, otherwise it removes the oil.

Can you provide me link to Dr. Korb's videos that describes the side effects of rubbing eyes?

[edmunder]

Get a hypocholoric acid spray for yours eyes. Asap. Hypochlor by occusoft. Like that.

Nighttime goggles are a must. I use lab goggles and sleep on my back. No fans.

[Milo007]

Get a hypocholoric acid spray for yours eyes. Asap. Hypochlor by occusoft. Like that.

Nighttime goggles are a must. I use lab goggles and sleep on my back. No fans.

Will hypochloric acid dissolve the hardened meibum cappings?

Is nocturnal lagophthalmos the sole reason I am developing the cappings?

[marilyngrant]

Milo007 This video shows Dr. Korb discussing the risks associated with rubbing your eyes https://youtu.be/W7iNnF0DUco

[Guest]

Will hypochloric acid dissolve the hardened meibum cappings?

Is nocturnal lagophthalmos the sole reason I am developing the cappings?

You can try the scrub and I’m assuming you do hot compress now correct? I had to heat my bruder compress to 45C, apply it for 5 minutes, then reheat it and repeat for 20-25 minutes. So getting the heat perfect is important. I use a laser thermometer to check and make sure it’s not too hot. I had some caps that still wouldn’t melt. I wouldn’t call my meibum toothpaste, I’d call it candle wax. The only thing that really helped me was azasite, but it stings bad and has a preservative. Doxycycline, great drug, has probably helped the most for my oil quality. Steroids, they just really help with the inflammation.

i think that the glands being dry from exposure, inflamed, infected...can be from the lagopthalmos. There may be other things going on, as I’m sure there are, but that’s a big piece of the puzzle. If you can control the eyes opening at night, get with your dr about maybe trying a new drug regimen to target your disease, I think you can improve A LOT.

[Milo007]

You can try the scrub and I’m assuming you do hot compress now correct? I had to heat my bruder compress to 45C, apply it for 5 minutes, then reheat it and repeat for 20-25 minutes. So getting the heat perfect is important. I use a laser thermometer to check and make sure it’s not too hot. I had some caps that still wouldn’t melt. I wouldn’t call my meibum toothpaste, I’d call it candle wax. The only thing that really helped me was azasite, but it stings bad and has a preservative. Doxycycline, great drug, has probably helped the most for my oil quality. Steroids, they just really help with the inflammation.

i think that the glands being dry from exposure, inflamed, infected...can be from the lagopthalmos. There may be other things going on, as I’m sure there are, but that’s a big piece of the puzzle. If you can control the eyes opening at night, get with your dr about maybe trying a new drug regimen to target your disease, I think you can improve A LOT.

I am not doing warm compresses now for the last two months because warm compresses would almost always result in inflammation even if the temperature is below 45°C.

Regarding the cappings, they are "fluid filled cysts" and not "hardened" meibum cappings as I previously thought. I pop them with a sterile needle. Even today I popped three of them. My meibum is having a perfectly clear olive oil consistency and I can see them flow under close observation. But when I get these cappings my meibum yield becomes low and I can feel the menthol sensation in my eyes. When I use a dry q-tip to gently rub off the lid margin to clear up the cappings I could almost immediately feel a relief and difference. The menthol sensation vanishes within minutes. If the cappings are big enough as in the picture I pop them with a needle, the the sac is punctured and the lipids immediately drain out.

If you have solidified meibum as the key problem I would suggest you to start with a gentle lid margin debridiment with a sterile dry q-tip to unblock the gland orifices from any cappings. This will allow passage for any melted meibum to flow out without building pressure inside the glands.

I used azithromycin and doxycycline for a month in the month of June this year. It really helped me a lot as my symptoms were absolutely worse before then.I occasionally use loteprednol eye ointment once a day to control inflammation.

After taking your advice I have been taping my right eye for the last 7 days and it's making a big difference already. My right eye used to be quite inflamed earlier everyday upon waking up. I also used to rub my right eye unconsciously in sleep that aggravated the inflammation. Taping has brought things under control.

But the current issue is my eyelids feel a light burning sensation on the lid margins and the inner surfaces of my lower eyelids on each eye. I think it might be due to my vigorous blinking that is making my eyelids fatigued or maybe too frequent hard blinking has caused the eyelids to smash against each other causing some irritation. I consciously try to hard blink each time as I am a partial blinker.

It's like every time I try to address a specific issue new problems begin to crop up.

Dowork123 has been of immense help. I think he's one of the very few in this forum who thinks a lot in an attempt to decode the roots of the problem which I think is the key to betterment.

[Milo007]

Milo007 This video shows Dr. Korb discussing the risks associated with rubbing your eyes https://youtu.be/W7iNnF0DUco

Thank you marilyngrant!

[Guest]

I am not doing warm compresses now for the last two months because warm compresses would almost always result in inflammation even if the temperature is below 45°C.

Regarding the cappings, they are "fluid filled cysts" and not "hardened" meibum cappings as I previously thought. I pop them with a sterile needle. Even today I popped three of them. My meibum is having a perfectly clear olive oil consistency and I can see them flow under close observation. But when I get these cappings my meibum yield becomes low and I can feel the menthol sensation in my eyes. When I use a dry q-tip to gently rub off the lid margin to clear up the cappings I could almost immediately feel a relief and difference. The menthol sensation vanishes within minutes. If the cappings are big enough as in the picture I pop them with a needle, the the sac is punctured and the lipids immediately drain out.

If you have solidified meibum as the key problem I would suggest you to start with a gentle lid margin debridiment with a sterile dry q-tip to unblock the gland orifices from any cappings. This will allow passage for any melted meibum to flow out without building pressure inside the glands.

I used azithromycin and doxycycline for a month in the month of June this year. It really helped me a lot as my symptoms were absolutely worse before then.I occasionally use loteprednol eye ointment once a day to control inflammation.

After taking your advice I have been taping my right eye for the last 7 days and it's making a big difference already. My right eye used to be quite inflamed earlier everyday upon waking up. I also used to rub my right eye unconsciously in sleep that aggravated the inflammation. Taping has brought things under control.

But the current issue is my eyelids feel a light burning sensation on the lid margins and the inner surfaces of my lower eyelids on each eye. I think it might be due to my vigorous blinking that is making my eyelids fatigued or maybe too frequent hard blinking has caused the eyelids to smash against each other causing some irritation. I consciously try to hard blink each time as I am a partial blinker.

It's like every time I try to address a specific issue new problems begin to crop up.

Dowork123 has been of immense help. I think he's one of the very few in this forum who thinks a lot in an attempt to decode the roots of the problem which I think is the key to betterment.

I’m glad I’ve been of some help. Yeah your issue is unique and I’m not sure what those “sacs” are. I’m wondering if it’s skin/scar tissue growing over the gland opening, when the oil tried to come out, the skin prevents it from escaping and forms a bubble. Wonder if it’s a biofilm from bacteria, I would think not because you clean your margins regularly it seems. When I tried moving hard piece of meibum with a qtip, it wouldn’t move. So I’d heat it for 5 mins, went from yellow to clear, still wouldn’t budge. I heated another 20 mins and the piece of meibum stayed hard. I could see oil expressing from around the cap, but it wouldn’t come out with heat, expression and a qtip. The next morning, it was gone.

was the eyelid burning there before you started taping? It could be from the adhesive on the tape. If you don’t think it’s the tape, have you been cleaning your lids twice a day with hypochlorous acid? When my lids burn it’s usually a hygiene issue or they’re just super dry. Can you use ointments or are you allergic? Sometimes an ointment on the outside of the lid and on the margin, helps that skin feel soft. It could also be from the blinking, make sure before you do your blinking exercises, add a drop to each eye to lubricate it.

I have the same issue, I fix one problem, it causes another, I do a compress for my lids, my eyes get dry. I tape my eyes to reduce exposure, I’m seeing more glare and halos. There’s no good answer that will make everything right, seems like every treatment is give and take.

[ebi1368]

Dowork123 I tried to tape my eyes but the problem is after a few minutes, my eyes get itchy and I have to tear the tape. Do you get this problem?

Thanks

[Guest]

Dowork123 I tried to tape my eyes but the problem is after a few minutes, my eyes get itchy and I have to tear the tape. Do you get this problem?

Thanks

Yes, I had to try many different tapes because I was “allergic” to most of them. The mepitac tape I found to be the only one I can stand. I think you may have a problem with the adhesive. Try a different brand, I suggest the mepitac, but it’s trial and error. Learning how to properly apply the tape, so it doesn’t come off and it keeps the lid secure is trial and error too.

It’s take me 3 weeks of taping to get a good routine and I’m still having problems. I’m literally thinking about buying a night vision camera and recording myself in my sleep. I’d like to know if I’m physically pulling the tape off or if I’m ripping it off as I toss and turn. Be patient with the taping. Get a new brand, what are you currently using?

[ebi1368]

I use the one from dry eye shop. I can not remember the brand.

[Milo007]

I’m glad I’ve been of some help. Yeah your issue is unique and I’m not sure what those “sacs” are. I’m wondering if it’s skin/scar tissue growing over the gland opening, when the oil tried to come out, the skin prevents it from escaping and forms a bubble. Wonder if it’s a biofilm from bacteria, I would think not because you clean your margins regularly it seems. When I tried moving hard piece of meibum with a qtip, it wouldn’t move. So I’d heat it for 5 mins, went from yellow to clear, still wouldn’t budge. I heated another 20 mins and the piece of meibum stayed hard. I could see oil expressing from around the cap, but it wouldn’t come out with heat, expression and a qtip. The next morning, it was gone.

was the eyelid burning there before you started taping? It could be from the adhesive on the tape. If you don’t think it’s the tape, have you been cleaning your lids twice a day with hypochlorous acid? When my lids burn it’s usually a hygiene issue or they’re just super dry. Can you use ointments or are you allergic? Sometimes an ointment on the outside of the lid and on the margin, helps that skin feel soft. It could also be from the blinking, make sure before you do your blinking exercises, add a drop to each eye to lubricate it.

I have the same issue, I fix one problem, it causes another, I do a compress for my lids, my eyes get dry. I tape my eyes to reduce exposure, I’m seeing more glare and halos. There’s no good answer that will make everything right, seems like every treatment is give and take.

Yes you are right! It's skin growing in front of the gland openings and preventing the meibum from coming out that forms a bubble eventually. But why do you think it could be scar tissue?

Can you show me how does scar tissue look like?

I don't do a lid margin debridement daily. I do it around once in 3 days when I see a decent amount of cappings develop. It could be bacterial biofilm but certainly it looks like a epithelial lining.

For the problem of hardened meibum, I would suggest you to thoroughly look at your diet and medications if any. It's almost certain that some people are getting hardened meibum because their eyelids are providing ideal conditions for bacteria to over grow and cause esterification. That could be due to bad diet, bad hygiene or abnormal hormone levels. I think you need to re-examine your diet to start with.

Yes my eyelid margins or their inner surfaces used to burn even before I started taping. I don't use hypochlorous acid yet but I am considering it. Just waiting for the doctor visit to get her advice on the topic. I don't want to use ointments because ointments block my glands and I have to do more lid margin cleaning to remove the petrolatum covering my gland openings every time I use ointments.

I am still trying to figure out a solution to the capping problem. More importantly I am trying to figure out what are these "sacs" exactly and why are they getting formed.

[Guest]

Yes you are right! It's skin growing in front of the gland openings and preventing the meibum from coming out that forms a bubble eventually. But why do you think it could be scar tissue?

Can you show me how does scar tissue look like?

I don't do a lid margin debridement daily. I do it around once in 3 days when I see a decent amount of cappings develop. It could be bacterial biofilm but certainly it looks like a epithelial lining.

For the problem of hardened meibum, I would suggest you to thoroughly look at your diet and medications if any. It's almost certain that some people are getting hardened meibum because their eyelids are providing ideal conditions for bacteria to over grow and cause esterification. That could be due to bad diet, bad hygiene or abnormal hormone levels. I think you need to re-examine your diet to start with.

Yes my eyelid margins or their inner surfaces used to burn even before I started taping. I don't use hypochlorous acid yet but I am considering it. Just waiting for the doctor visit to get her advice on the topic. I don't want to use ointments because ointments block my glands and I have to do more lid margin cleaning to remove the petrolatum covering my gland openings every time I use ointments.

I am still trying to figure out a solution to the capping problem. More importantly I am trying to figure out what are these "sacs" exactly and why are they getting formed.

When I had capped glands, that was about 4 months ago. Now my oil runs clear. Yes, diet played a role I believe. So I changed it and I believe it’s definitely been beneficial. Here’s my diet with minor changes...

5 whole eggs over easy, 2 sprouted grain toast (Ezekiel), 2 Canadian bacon

300g Greek yogurt, 1 scoop chocolate flavor protein powder (dymatize), 150-220g fruit, strawberry, pineapple, blueberry, all fresh.

Post workout 2 scoops protein and 1 banana or apple.

240g beef tenderloin, 150g potato (only salt), 300g broccoli with olive oil and fresh lemon juice

before bed, meat and vegetable only 7 chicken wings, salt, pepper, oregano, olive oil, splashed with lemon. A salad or maybe broccoli again.

I was 247lbs when I started this diet, 3 months later I’m 219lbs. I eat other things, tuna, cottage cheese, I’ll cheat and order ribs or Mediterranean food. But I try to limit it and keep it very clean. Almost no sugar also. I’m training again, somewhat regularly.

Im currently on 200mg testosterone every 10 days. That seems to be the sweet spot on my labs. So my hormones are pretty well controlled. Thyroid is good, adrenals are good.

im on doxycycline and that’s helping my oil a lot. I hate medication, but it’s a good one for my eyes.

as for the hypochlorous acid, it will help a lot for the external lid burning. Once you clean up those margins and kill all that bacteria, you should feel better in a month or two unless there’s another cause.

As as for the ointment, I meant to use it externally. But I think you need the hypochlorous cleanser to clean it off frequently on either care. I just thought that if the burning was from dry skin or excsema, the ointment would help. Some people use virgin, organic, cold pressed coconut oil if they can’t use ointment.