MGD but consistency is good and glands are open

[synes89]

Hi. I've posted on this forum a couple years ago and have sort of been coasting with my evaporative dry eyes. I went to yet another eye doctor who seems to be more informed about dry eyes than any other doctor I've been to. She put me on FML (did very little, if anything at all), told me to take omega-3s, and keeps insisting on warm compresses daily. She diagnosed me with MGD.

Now, what she noticed (and something that seems to not be very common around here, unless I just haven't come across the correct post) is that my meibomian glands aren't blocked at all. They look clean. When she presses on them, she says she sees the oil coming out clear and freely. So in this case, are the oils just naturally not coming out as frequently as they should? And if that's the case, what could be done to promote the oil production other than warm compresses? I was under the impression that warm compresses were used in order to melt thick oil that blocks the glands. But what about when the oil is already thin enough to come out and there's no blockage? And what would cause the oil to still not flow in that case?

[cathy8889]

Hey, could you be a partial blinker? An optometrist I paid to see in London did a lipiview and it found that I didn't do complete blinks, I've started doing blinking exercises which I think is helping. Cath

[Daniel2]

I have the same exact problem as you. I feel like im getting worse everyday but I have 15 glands opened in each eye. The problem is the quality and thickness of the tear film which is very bad.

How is the quality of the oils in your glands? Had they done any tests to determine how is it (Lipiview, etc)?

[synes89]

I have the same exact problem as you. I feel like im getting worse everyday but I have 15 glands opened in each eye. The problem is the quality and thickness of the tear film which is very bad.

How is the quality of the oils in your glands? Had they done any tests to determine how is it (Lipiview, etc)?

No tests like that. Just looking through a slit lamp. And if it's quality of tear film, wouldn't artificial drops work? I've tried them all (including steroid drops). I can't say that they provide any "relief". They just make my eyes wet, then once the drop clears up, it's back to how it felt before I put the drops in. At times, drops would actually irritate my eyes more.

[fourchimneys]

Hi Synes,

I am like you when my eye is pressed oil comes out. My optician then did a teaf flow diagnostic test where he left a piece of paper in my eye for a set amount of time to see how many tears were produced. The paper stayed dry despite the fact that when he pressed on my lids oil came out. Therefore i feel that i am like you the oil is there but does not come out!!

Thanks

[indrep]

What diagnostic test was performed to determine that the issue is MGD?
There are four components needed to maintain tears on the ocular surface.
First healthy epithelial cells are needed across the entire corneal surface. Without healthy epithelial cells the mucin layer does not have the ability to bind to the cornea and hold water. Epithelial cells themselves will not hold water.
Second, there needs to be sufficient goblet cell densities to produce enough mucin to cover the cornea. If there is not enough mucin then there will be dry areas on the cornea.
Third, There must be enough aqueous (water) produced from the small lacrimal glands to cover the the ocular surface.
Fourth, there needs to be adequate lipids produced and secreted by the meibomian glands to regulate the evaporation of the water.

These must all be happening simultaneously and in the correct amounts. Too much of any given one is as detrimental as too little.
If your glands are secreting good lipids, your lids may turn out and the secretions are not reaching the ocular surface.

[synes89]

What diagnostic test was performed to determine that the issue is MGD?
There are four components needed to maintain tears on the ocular surface.
First healthy epithelial cells are needed across the entire corneal surface. Without healthy epithelial cells the mucin layer does not have the ability to bind to the cornea and hold water. Epithelial cells themselves will not hold water.
Second, there needs to be sufficient goblet cell densities to produce enough mucin to cover the cornea. If there is not enough mucin then there will be dry areas on the cornea.
Third, There must be enough aqueous (water) produced from the small lacrimal glands to cover the the ocular surface.
Fourth, there needs to be adequate lipids produced and secreted by the meibomian glands to regulate the evaporation of the water.

These must all be happening simultaneously and in the correct amounts. Too much of any given one is as detrimental as too little.
If your glands are secreting good lipids, your lids may turn out and the secretions are not reaching the ocular surface.

What kind of test would measure all of these factors? Will something like Lipiview show this stuff? The ophthalmologist I went to did a TBUT test with fluorescein and also manually pushed on my lids. She said she could easily see the oils coming out clear, but the TBUT was very little. She did a TBUT after expressing the glands again and said that it's a lot better. I would say my eyes did feel better too, for at least some time after that.

[indrep]

No single test can determine the many factors that can contribute to ocular surface issues. Most times ocular surface dryness issues are multifactorial.
Lissamine green testing can show the damaged epithelial cells. A TBUT is good for confirming dryness and yet cannot distinguish the cause. For instance, if the epithelial cells are damaged the aqueous(water) is not going to stay on the eye regardless of the lipids being secreted. If there is a healthy epithelial cell layer and minimal goblet cells there will not be enough mucin to hold the aqueous(water). If the lacrimal glands are not secreting enough aqueous then the TBUT will be low even with good meibomian gland secretions.

All of these issues can be addressed with various therapies available. In order to achieve improvement it takes knowledge of these therapies, an eye care provider committed to trial and error of them to find the correct recipe for each patient and a compliant patient with patience to give the therapies time to work. Many times the disease has been years in reaching its current state and will take months to reach a tolerable level.

[fourchimneys]

Hi Synes,

Any improvement?

Thanks

[synes89]

Just wanted to write up an update. First and foremost, it is very important to find the right eye doctor. I am thankful I found someone who takes her time and listens to me, as well as tries anything possible to help my situation.

Now, I've gotta say, I am seeing huge improvement. My doctor gave me semi permanent (3 mo) punctal plugs, which seems to be helping a great deal, over time. Also, I started taking Sea Buckthorn Oil Omega-7 (after reading some posts here) this brand http://www.amazon.com/dp/B004BKR31E. I don't know if this is helping, but it's certainly not making anything worse. I read it takes a while for it to take effect. Lastly, I bought myself a warm compress mask, which does 2 things. It does absolutely give me instant relief after having it on my eyes for about 5 minutes. But, there is also a long term effect if used several times a week. Seems to promote better oil production.

Anyway, having said all that, the three things I've done (plugs, sea buckthorn oil, warm compress mask) definitely is improving my eyes. I am hopeful that it isn't just because of the summer and that I'm sleeping more these days, the latter of which is definitely a necessity. But I have been trying different types of contact lenses again! I've tried several brands - some that I couldn't tolerate (which is made worse due to my having to wear toric lenses), and some that I actually wore for several hours with no repercussions and very minimal discomfort! Started off with 1-day lenses but I've been given a 2 week pair that I will try in a few days.

By the way, on my last visit, my doctor did a TBUT and said that she saw a lot of improvement, that the oils are actually not evaporating as fast as they used to, so it seems like what I am doing is definitely helping. Time may also be helping a lot.