Desperate newbie here: what caused my meibomian glands to drop out???

[Julissska]

Hello everyone,

A brief introduction: about a month ago, I woke up with inflamed red eyes. I was told I had conjunctivitis, and some of the redness cleared up after using antibiotic drops (Tobrex).
However, the burning/gritty sensation and some expanded red veins in my eyes never disappeared.

Trying to get to the bottom of my problem, I saw a dry eye specialist who conducted all the regular tests. Turns out, my eyes are pretty damn dry, and each has about 40% meibomian gland dropout. (Is this the same as atrophy? - that's what I figured. ) The rest produce clear oils, just that they are somewhat deficient to keep my eyes lubricated.

A bit more about me: I'm a 29 y/o female, been spending as much time on the computer as your average university student/office worker, plus probably some more in my leisure time. 8-9 hours a day, I guess. I also regularly wear (or rather, wore) heavy eye make-up and eyelash extensions, and worst of all, got some botox in my crow's feet 3 months ago by someone really unskilled.

At 19, I took a year-long course of Accutane for cystic acne, albeit a low dose (which I can't really remember anymore) - 10-20mg a day or so. The acne did came back at around 22, so I took a shorter course with a higher dose.
The acne came back, again. Ever since then, I'm on a daily dose of Spironolactone 100mg, which made my skin and hair perfect. I'm pretty sure it contributes to my dry eyes (blocking testosterone and acting as a diuretic). I just decreased my dose to 75mg, wonder if it's gonna make any difference. I can't even dream about quitting - anyone who had cystic acne won't want to experience this shit again

Overall, I'm pretty sad and desperate at the moment. I use lid hygene and artificial tears, stopped using eye make up, and just about to start IPL next week. I'm also seeing an endocrinologist and getting examined for demodex.
This whole thing just came out of the blue, I never ever had an issue with dry eyes before. Some days I still can't believe this isn't some prolonged eye infection but my reality from now on.

My question to you, first and foremost, is if you think the Accutane could have caused all those glands to drop out?? And if so, why am I only showing symptoms 7-9 years after? Is there anything I can do to stop the damage?
As for the Spironolactone, I would need confirmation that this is the culprit of my symptoms - I just can't quit and sacrifice my clear skin AND have sore irritated eyes at the same time, that would make me suicidal (which I already am...)

Sorry for being so verbose. Any piece of advice is MORE THAN welcome.

Julia

[edmunder]

Yes accutane caused your issues. I had the same problem. I took accutane 15 years ago for cystic acne and in the last year my ryes went to hell.

There is a large facebook dry eye syndrome group. Many accutane users.

It does something to the oil glands on a cellular level. I hate to be the bringer of bad news.

Yes you will need IPL. warm compress teice a day. Hypocholoric acid on the lids twice a day. Fish oil. Etc.

[Guest]

Hey, thank you for the reply. Do you also have meibomian gland dropout? Why do you think it took 15 years to experience symptoms?

[Rebecca Petris]

edmunder

Yes accutane caused your issues....

Yes you will need IPL. warm compress teice a day. Hypocholoric acid on the lids twice a day. Fish oil. Etc.

It's natural to make correlations when we see similar patterns but at the end of the day, we really don't & can't know what happened to someone else. Suggesting possibilities is great, making pronouncements... not quite so helpful. Please no internet diagnosing or treating here Thanks

[Guest]

Julissska Often with dry eye the tear film isn't perfect but you will feel ok. Then something will push the eye over the edge (e.g. working more computer hours, allergies, drugs, a scratch to the eye e.c.t.) Then inflammation starts because the eye is dry. Inflammation will irritate the glands and they produce poorer quality oil and become more blocked. It all spirals down.

To get better you need to get the oil flowing again and reduce inflammation and hopefully everything can get back to being in balance. Different things work for different people so it can be hard to find what works.

As for drugs, these also affect people differently. Spironolactone works by reducing oil production so it could be a problem but I don't think you could ever know for sure unless you came off it for a length of time to let your body reset its natural balance.

[Guest]

Anti-androgen's can potentially cause a problem with the meibomian glands, though this study is quite old - https://www.ncbi.nlm.nih.gov/pubmed/11134156
Maybe try and find out if you are deficient in any hormones?

Our results demonstrate that patients taking antiandrogen treatment, compared with age-related controls, had a: 1) significant increase in the frequency of appearance of tear film debris, an abnormal tear film meniscus, irregular posterior lid margins, conjunctival tarsal injection, and orifice metaplasia of the meibomian glands; 2) significant increase in the degree of ocular surface vital dye staining; 3) significant decrease in the tear film breakup time and quality of meibomian gland secretions; and 4) significant increase in the frequency of light sensitivity, painful eyes, and blurred vision. In addition, the use of antiandrogen pharmaceuticals was associated with significant changes in the relative amounts of lipids in meibomian gland secretions. Our findings indicate that chronic androgen deficiency is associated with meibomian gland dysfunction and dry eye.

[edmunder]

edmunder



It's natural to make correlations when we see similar patterns but at the end of the day, we really don't & can't know what happened to someone else. Suggesting possibilities is great, making pronouncements... not quite so helpful. Please no internet diagnosing or treating here Thanks

Have to disagree. Especially with the second high dose she took. The amount of people saying exactly the same thing and having terrible mgd 5-10 years later is too high for chance.

If its not “the cause” its a very high amount of the cause. There is an accutane dry eye group on Facebook and everyones story is the same. Yes it would be great if i had a few graduate students to put in the time for tesearch. Until then thousands of people saying the same thing is as good as truth gets.

[Guest]

Edmunder, could you please point me to that Facebook group? (I'm the topic opener, from another device) also, did ipl work for you at all?

[Guest]

Guest :thank you for linking that study. I'm trying to find out about my hormone levels, but I heard even if they are within a normal range, my mg-s can still be out of whack. ( I wonder if decreasing the dose will do anything for me. I feel like I need an endocrinologist who's also an eye expert, that's not gonna happen any soon.

Also, I understand hormone therapy can affect mg oil secretion, but to cause total dropout?? I also think Accutane is more likely the culprit. I still get mild pimples here and there so i don't think Spiro could cause glands to atrophy?

[Rebecca Petris]

Have to disagree. Especially with the second high dose she took. The amount of people saying exactly the same thing and having terrible mgd 5-10 years later is too high for chance.

edmunder

The only thing I spoke to in my post was your wording, not Julia's dry eye cause. So I assume that's what you're disagreeing with?

No matter much any of us here (myself included!) thinks we know, we don't ever acquire the right to diagnose and treat others here.

To be clear, I'm simply asking you to use appropriate wording. Suggestions, not pronouncements/declarations.

[Guest]

Hi all. I just had my first IPL treatment two days ago. After the procedure I felt immediate relief. Now not too sure, maybe my eyes have improved but it might as well be placebo effect. Does anyone have any experience?

Interestingly, I also noticed a small bubble of oil on my eyelid that seems stuck. Not sure if it's a plugged up meibomian gland, but it looks like the treatment did something at least to get oil flowing.