What does it mean to have "dormant" meibomian glands?

[Milo007]

Recently, among doctors, there's been a new unpublished theory -- based on anecdotal evidence without solid proof. The theory is that MGD sufferers, a subset of the patients, dont actually have dead glands despite what meibography (i.e., LipiView) shows. But rather, the "dark areas" of the glands are "dormant", i.e., the tissue is not dead , but just not active. The theory is that, if we can somehow control inflammation and give the glands the right environment, they can be recovered and made active again (produce good quality oils again).

The intuition is backed by many drs who see patients with "dark" (dormant, or previously thought dead glands), but somehow able to recover and secret oil. Some treatments that *may* help include IPL, Xiidra, and Restasis. The theory is that these treatments can reduce inflammation, and create an environment for the glands/tissue to recover.

deep_dry_eye

It's a very optimistic news for all of us. Can you share the links to the original sources of information?

If scientists could somehow figure out the way to wake up the glands from dormancy it's practically a cure to MGD!

[Milo007]

This is my docs theory. He is very skeptical about the claims made about gland dropout. Just because the image doesn't show them doesn't mean they're not there.

He found one study where lippview was done a group of juveniles where nearly 50% showed gland dropout, but none had symptoms! He found both facts very hard to believe.

Reckons it's the power of marketing over common sense.

I read somewhere that a scientist from Germany said in an interview that both gland atrophy and drop out are reversible because they contain stem cells and have the ability to regenerate. The question is how to stimulate the glands to kick start the regeneration process. I am hopeful a cure will come up very soon based on this possibility.

[deep_dry_eye]

deep_dry_eye

It's a very optimistic news for all of us. Can you share the links to the original sources of information?

If scientists could somehow figure out the way to wake up the glands from dormancy it's practically a cure to MGD!

I have no published source, as I mentioned this is anecdotal evidence without solid proof that would not pass statistical rigour and peer review. This is via chatting with various doctors and researchers.

[Meibum Ian]

You are right. But I am doubtful if the authorities who checks the emails would convey the query to the doctors at all. Most clinics instead ask for booking another appointment with the doctor to clarify any queries. Some doctors are too professional to pass on any information via email or telephone. I have experienced this myself but emailing the clinic is definitely worth a try. Nothing to lose!

For the clinic in question, it's possible to email the optometrists directly. Lipiview images etc should be on file.

[Fenix]

I’m interested in the probiotic theory, what kind of probiotics are you taking if I may ask. I could really do with something helping my internal gut flora. I believe I could possibly benefit from probiotics. Thanks

I'm taking a strong formula (10 billions, 10 different type of cells) and I have started feeling a bit better after 1.5/2 days.
Now I want to try to switch to home made milk kefir as daily source of probiotics.
Please, even if probiotics are a supplement, ask your doctor how long you can take it.

EDIT:
these are some interesting articles on probiotics and dry eye:
https://www.toyosclinic.com/eye-news...sacea-and-acne
http://www.optometry.org.au/blog-new...-help-dry-eye/
https://www.eyeworld.org/article-per...-on-probiotics
http://internationalprobiotics.org/d...-one-solution/
https://www.eventscribe.com/2018/FOC...&rnd=0.6331789
https://www.ncbi.nlm.nih.gov/pubmed/28676009

[Alix]

I’m interested in the probiotic theory, what kind of probiotics are you taking if I may ask. I could really do with something helping my internal gut flora. I believe I could possibly benefit from probiotics. Thanks

Hi I’m taking this - the “original” one in the green box.
I don’t know too much about probiotics I just picked up this one at the health store on the basis that the capsules do not need to be refrigerated.

https://probio7.com/about-probio-7/

I would give it a go, you can always stop taking them if you have an adverse reaction, so far I haven’t had any.

[Alix]

I don't think getting dependent on it is an issue.

Also, the effects all along for me with cyclosporine drops (Restasis, 0.05%) were subtle and a slow build up. So I think cyclosporine drops are best used at least 6 months before deciding anything... preferably a year. It takes 4-6 weeks for it to kick in, then it takes time after that for your eyes to start recovering from the inflammation (that is now being suppressed by the cyclosporine drops). If one's eyes are bad enough, I don't think a quick recovery/major improvement over a couple of months is likely.

When Restasis first came out standard advice was that it takes 1 month to work. Now I commonly see articles where docs say to try it at least 6 months, which mirrors my own experience with using it because at 1 month the effect was tiny compared to the effect months later.

How long did you take Restatis for? I am sorry I probably wasn't being very clear but what I meant by being afraid of getting dependent on Ikervis was that say in 6 months time it does start working, I would then have to take it for an indefinite (infinite?) time for my eyes just for my eyes to feel normal, and since I have to pay full price for this, this is financially unviable for me.

[Topher3]

I'm taking a strong formula (10 billions, 10 different type of cells) and I have started feeling a bit better after 1.5/2 days.
Now I want to try to switch to home made milk kefir as daily source of probiotics.
Please, even if probiotics are a supplement, ask your doctor how long you can take it.

EDIT:
these are some interesting articles on probiotics and dry eye:
https://www.toyosclinic.com/eye-news...sacea-and-acne
http://www.optometry.org.au/blog-new...-help-dry-eye/
https://www.eyeworld.org/article-per...-on-probiotics
http://internationalprobiotics.org/d...-one-solution/
https://www.eventscribe.com/2018/FOC...&rnd=0.6331789
https://www.ncbi.nlm.nih.gov/pubmed/28676009

Why do I have to ask a doctor? Doctors have been nothing but an absolute joke to me over the years. Can’t eveyone take pro biotics? I thought it was kind of like a supplement, doctors and I do not get along.

[Guest]

How long did you take Restatis for?

I've been on Restasis since the fall of 2009. I believe my eye issue is likely to be long-term, therefore I expect to have to use Restasis long-term as well, unfortunately (well, unless something better comes along)

... what I meant by being afraid of getting dependent on Ikervis was that say in 6 months time it does start working, I would then have to take it for an indefinite (infinite?) time for my eyes just for my eyes to feel normal, and since I have to pay full price for this, this is financially unviable for me.

Are the Ikervis vials re-sealable? I wonder if one could cut costs by using each vial until it's empty? For example, I get WAY more than 2 drops out of each Restasis vial... and this makes the med way more affordable. It royally sucks that treating this condition gets so expensive. :-(

Might be worth starting a separate thread to see if other Ikervis users have any tips for making it more affordable.

[deep_dry_eye]

I've been on Restasis since the fall of 2009. I believe my eye issue is likely to be long-term, therefore I expect to have to use Restasis long-term as well, unfortunately (well, unless something better comes along)



Are the Ikervis vials re-sealable? I wonder if one could cut costs by using each vial until it's empty? For example, I get WAY more than 2 drops out of each Restasis vial... and this makes the med way more affordable. It royally sucks that treating this condition gets so expensive. :-(

Might be worth starting a separate thread to see if other Ikervis users have any tips for making it more affordable.

I personally find Xiidra to be way more effective than Restasis. However, I am on both Restasis and Xiidra, the two combined can help reduce inflammation. You might want to give this a try.

[Alix]

Are the Ikervis vials re-sealable? I wonder if one could cut costs by using each vial until it's empty? For example, I get WAY more than 2 drops out of each Restasis vial... and this makes the med way more affordable. It royally sucks that treating this condition gets so expensive. :-(

Might be worth starting a separate thread to see if other Ikervis users have any tips for making it more affordable.

Hi, no they are not resealable, but there is enough in one vial to use twice so I used to put in one drop into each eye at night, wrap the vial in clingfilm, keep it in the fridge, and then use the rest in the morning. Still, 120 pounds for 30 vials, multiplied by 12, then potentially by years all adds up. Alternatively I could get them on the NHS which would only cost me 8 pounds a month but I do not meet the criteria, my signs are not serious enough. I've been told no way 3 times by different doctors and there is no point asking again, my signs haven't deteriorated since the last time I was at the hospital.

[Guest]

Hi, no they are not resealable, but there is enough in one vial to use twice so I used to put in one drop into each eye at night, wrap the vial in clingfilm, keep it in the fridge, and then use the rest in the morning. Still, 120 pounds for 30 vials, multiplied by 12, then potentially by years all adds up.

Ouch - that's expensive!

Alternatively I could get them on the NHS which would only cost me 8 pounds a month but I do not meet the criteria, my signs are not serious enough. I've been told no way 3 times by different doctors and there is no point asking again, my signs haven't deteriorated since the last time I was at the hospital.

I wonder if there's any chance that your doctors are misinformed?

https://www.moorfields.nhs.uk/sites/...ril%202017.pdf

"NICE state that ciclosporin (Ikervis) is recommended as a possible treatment for people with dry eye disease that has not improved despite treatment with artificial tears."

^^ that fits your situation, correct?

"Ciclosporin eye preparation may be started in patients with the indicated diseases who have been found to be dependent on topical steroid to keep them free from sight-threatening ocular surface inflammation and/or free from severe and debilitating symptoms. No special tests or results are required before initiating treatment"

^^ So it would seem to me that if you have debilitating symptoms when you're not on steroid drops, you should qualify for Ikervis, no? If your doctor is saying your signs need to be worse, with all due respect, that would seem to contradict what the NHS's own guideline suggests.

"Ciclosporin eye preparations may be recommended as a treatment option after first-line agents (e.g. ocular lubricants / steroids) have failed or are not tolerated for... Dry Eye Disease (DED)/ Keratoconjunctivitis Sicca (KCS)"

^^ There should be zero problem meeting that criteria.

Argh... bureaucracy can be crazy. Boggles my mind that they won't cover this med for you. :-(

[Alix]

Ouch - that's expensive!



I wonder if there's any chance that your doctors are misinformed?

https://www.moorfields.nhs.uk/sites/...ril%202017.pdf

"NICE state that ciclosporin (Ikervis) is recommended as a possible treatment for people with dry eye disease that has not improved despite treatment with artificial tears."

^^ that fits your situation, correct?

"Ciclosporin eye preparation may be started in patients with the indicated diseases who have been found to be dependent on topical steroid to keep them free from sight-threatening ocular surface inflammation and/or free from severe and debilitating symptoms. No special tests or results are required before initiating treatment"

^^ So it would seem to me that if you have debilitating symptoms when you're not on steroid drops, you should qualify for Ikervis, no? If your doctor is saying your signs need to be worse, with all due respect, that would seem to contradict what the NHS's own guideline suggests.

"Ciclosporin eye preparations may be recommended as a treatment option after first-line agents (e.g. ocular lubricants / steroids) have failed or are not tolerated for... Dry Eye Disease (DED)/ Keratoconjunctivitis Sicca (KCS)"

^^ There should be zero problem meeting that criteria.

Argh... bureaucracy can be crazy. Boggles my mind that they won't cover this med for you. :-(

Hi thank you for looking into it, I really appreciate it but it is lost cause. I don't tick any of the boxes, haven't had Lasik, don't have Sjogrens, keratitis etc. I "just" have dry eyes from long term contact lens use/partial blinking. They say that whatever symptoms I have, they can only treat the signs and in my case they are not "bad" eg. Schirmers test is 10.

It really doesn't matter any more, even though I didn't use it for long enough, Ikervis was not what I was expecting anyway. Perhaps I just had my hopes up too high.

I'm now just waiting for my appointment at the hospital to get a second opinion about my conjunctival chalasis and then possibly get surgery.
In the meantime, I'll carry on with scleral lens fittings (not going too well) and start using Blephasteam.

[Guest]

Alix Well, I hope things get better... with any luck the Blephasteam and/or sclerals will be a good solution for you. Fingers crossed!

[Guest]

My eyes have been painfully dry since chemo three years ago are used to Joe at night and regular traps in the daytime. At night it is terrible I can’t open my eyes, like shards of glass. Krill oil has lessened dryness. Is there anything else out there for nighttime?