Meibomian gland loss, how much do Dr’s know?

[Topher3]

I understand the common literature on meibomian gland atrophy and loss. And I too believe that it’s true. However I was wondering after seeing a comment on a post on here about how some doctors aren’t too sure that gland loss is as cement fact as most believe. Have they performed meibographies on cadavers and then conducted an analysis of the body? Have doctors seen meibomian gland loss in the flesh? I’m curious, are meibographies as much hard evidence as we need to be certain?

[deep_dry_eye]

You bring up great questions! Unfortunately, I don't have any answer to you. I also suspect nobody knows for sure. Unfortunately, dry eye disease does not get a lot of scientific or medical research funding.

[Milo007]

I understand the common literature on meibomian gland atrophy and loss. And I too believe that it’s true. However I was wondering after seeing a comment on a post on here about how some doctors aren’t too sure that gland loss is as cement fact as most believe. Have they performed meibographies on cadavers and then conducted an analysis of the body? Have doctors seen meibomian gland loss in the flesh? I’m curious, are meibographies as much hard evidence as we need to be certain?

Hello Topher3

Good question. I think the point is if meibography doesn't detect the presence of glands (dark empty areas) then it is pretty obvious that there has been a structural change in the glands (provided the instrument used is of very high precision and quality like the lipiview/lipiscan or keratograph 5M and the meibography was done properly).

Now the second consideration is that if meibography doesn't detect the presence of glands in some areas of the tarsus then it's again not the case that some remnant or altered form of the glands are not present there. This is because we have clear evidence of gland regrowth as recorded by meibography. So the "blank" portions in a meibography (where glands are supposed to be present) is most probably some morphologically altered condition of the atrophied acini that isn't "imaged" by the meibography (technical limitation) but they are very much there. Only some lucky people have witnessed gland regrowth where the structural existence of the atrophied glands were restored to normal.

What caused the regrowth?

Probably the activation of some chemical pathway that acted as a trigger for the stem cells to initiate gland regrowth. We all know stem cells have the ability to regrow tissues and meibomian glands do host stem cells.

So there's definitely a chance of something being present even though meibography does not image the atrophied portions of the glands.

Hopefully we will have better instruments in future with greater precision that can image the structural modification of the atrophied portions of the glands.

[Topher3]

Hello Topher3

Good question. I think the point is if meibography doesn't detect the presence of glands (dark empty areas) then it is pretty obvious that there has been a structural change in the glands (provided the instrument used is of very high precision and quality like the lipiview/lipiscan or keratograph 5M and the meibography was done properly).

Now the second consideration is that if meibography doesn't detect the presence of glands in some areas of the tarsus then it's again not the case that some remnant or altered form of the glands are not present there. This is because we have clear evidence of gland regrowth as recorded by meibography. So the "blank" portions in a meibography (where glands are supposed to be present) is most probably some morphologically altered condition of the atrophied acini that isn't "imaged" by the meibography (technical limitation) but they are very much there. Only some lucky people have witnessed gland regrowth where the structural existence of the atrophied glands were restored to normal.

What caused the regrowth?

Probably the activation of some chemical pathway that acted as a trigger for the stem cells to initiate gland regrowth. We all know stem cells have the ability to regrow tissues and meibomian glands do host stem cells.

So there's definitely a chance of something being present even though meibography does not image the atrophied portions of the glands.

Hopefully we will have better instruments in future with greater precision that can image the structural modification of the atrophied portions of the glands.

Yes I do agree with you that if there’s nothing visible that obviously nothings there or it would be like the surrounding tissue. Yes it’s very interesting, I wonder what caused that gland regrowtth, I too have read about gland regrowth in some miraculous cases, however I don’t know how “truthful their discoveries are”.You are correct glands do contain stem cells. I personally believe that they will discover a gland regrowth cure whilst trying to cure baldness. As the hair follicle dies when the sebaceous gland dies. That’s just my thoughts on how they’ll find the cure as I feel they’re not really working on meibomian gland regrowth as much as curing baldness.

[Milo007]

I personally believe that they will discover a gland regrowth cure whilst trying to cure baldness. As the hair follicle dies when the sebaceous gland dies. That’s just my thoughts on how they’ll find the cure as I feel they’re not really working on meibomian gland regrowth as much as curing baldness.

OMG!!! You took the words out of my mouth!

I always had this analogy in my mind as the hair follicles shrink and go dormant much like meibomian glands do. The hair follicles do miniaturize and lose functionality. But they are always there as you can make them regrow sometimes using minoxidil or 5-alpha reductase inhibitors.

The technology behind reviving hair follicles and meibomian glands would be quite similar in approach I believe. They might involve the stimulation of stem cells or may involve activation of some chemical pathway or genes to roll the regeneration process.

Whatever might be the case I believe tissue regeneration technology is the future of most of the currently irreversible cases of tissue damage. I am definitely looking forward to the baldness cure by the way (big grin).

[Milo007]

Unfortunately, dry eye disease does not get a lot of scientific or medical research funding.

Really can't understand why!

This problem is going to hit 90% of the population within the next 10 years. If no cure is found this will be a massive epidemic.

[deep_dry_eye]

Really can't understand why!

This problem is going to hit 90% of the population within the next 10 years. If no cure is found this will be a massive epidemic.

Politicians do what keeps them elected. Its much splashier to say we're going to give money to XYZ (i.e., build a wall) then to put it into basic scientific research. What little money that does trickle down to basic health and scientific research is usually allocated to other diseases things, such as cancer.

[Milo007]

Politicians do what keeps them elected. Its much splashier to say we're going to give money to XYZ (i.e., build a wall) then to put it into basic scientific research. What little money that does trickle down to basic health and scientific research is usually allocated to other diseases things, such as cancer.

I pray politicians start getting dry eyes (evil grin)...

[quattroboy]

As the hair follicle dies when the sebaceous gland dies.

I know this is a slight subject detour but my understanding is hair follicles don't die. They can go dormant because of testosterone.

Many men who are in remission for testicular cancer, take drugs to reduce testosterone levels, a side effect being their hair starts to recover.

In fact I read something 10 years ago where men in the US where taking these drugs to restore hair growth. The problem being these drugs are not mean't to be taking long term.

[Milo007]

I know this is a slight subject detour but my understanding is hair follicles don't die. They can go dormant because of testosterone.

Many men who are in remission for testicular cancer, take drugs to reduce testosterone levels, a side effect being their hair starts to recover.

Slight correction here...It's not the effect of testosterone but dihydrotestosterone that affects the follicles. DHT sensitive follicles shrink under the effect of DHT in bloodstream and switch to a quasi-permanent state of dormancy. So gene expression plays the most important role in MPB whereas hormones are just part of the execution process.

[Topher3]

Really can't understand why!

This problem is going to hit 90% of the population within the next 10 years. If no cure is found this will be a massive epidemic.

I agree, with this young generation, and the screen time they have, dry eyes is going to be a HUGE problem. Barely anyone knows what dry eyes are and it flies under the radar really badly. In a decade there is going to be an absolute **** storm.

[Topher3]

I know this is a slight subject detour but my understanding is hair follicles don't die. They can go dormant because of testosterone.

Many men who are in remission for testicular cancer, take drugs to reduce testosterone levels, a side effect being their hair starts to recover.

In fact I read something 10 years ago where men in the US where taking these drugs to restore hair growth. The problem being these drugs are not mean't to be taking long term.

I guess so. But technically the whole structure and system that is needed to create more hair has withered away and is not there anymore so technically it’s kinda dead.

[Guest]

Well, I think it’s a good analogy but doesn’t offer me much hope personally. Here’s why...we know that hair loss, follicle loss, is hornonal and genetic. I’m sure there are other factors but these seem to be huge. Ok, so assume we identify the same causes in mgd. How then do you tackle the genetic component? As far as I know, you can use a 5 aloha reductase drug and if the issue is dht, you’ll regrow hair. What if it’s not. What if it’s peogramned genetic cell death? How do we stop that? What if the issue is protein synthesis? How do we tackle that? We’re 20 years off that imho. I hope I’m not being a downer, I’m just trying to be realistic from my point of view having gone through this hell. I still believe that the causes of the disease are too vast to get it nailed down any time soon.

Let me hivr you a little sonetning ive been working on. You all know I have floppy eyelid. Lately I’ve been trying to understand why am I not the typical floppy eyelid patient? I am thin, not fat at all, work out regularly, eat well, relatively young (I’m 38 and onset is usually 40+) and I didn’t have any outward signs of sleep apnea (never snored til this last year). So I cannot understand how this is happening to a guy that ate really good, kept his health in check (blood work every six months with adjustments accordingly).

so let’s speculate. Again, this isn’t certain, but I’m going to be seeing some doctors to do genetic testing and determine if I’m correct or not....I believe I have a soft tissue disorder. Possibly Ehlers danlos syndrome. Why do I think that? Well, my family history for one. My mother lost all of her teeth by age 11. She had these pockets in her gums that would get infected and NOTHING would stop the gum disease. So I’m going to have her tested also. Because that sounds like periodontal EDS. So my aunt, my moms sister, he eyelashes point into her eye all the time. I told my mom that happened to me and she said. Your aunt Mary has this too. I’m now seeing a pattern. Then recently, my moms brother got diagnosed with diverticulitis. That happens when a sac forms in the gut and bulges out. Then that pocket gets inflamed and holds food there. You could perforate your gut this way. So, my mom had lax gum, my aunt had lax lids and my uncle had lax intestines and I have lax lids, lax throat/palette and intestines. I’m starting to get bad gut issues. I’m sure all the pills im taking aren’t helping but I genuinely believe I’m seeing a pattern here, a genetic defect in collagen.

So I ask you, how do we fix our genetics? If I’m correct and this is an issue with the way my body is structured. I’m not seeing a solution aside from surgery. I genuinely hope we find a solution but again, I don’t even think we’re sniffing around these ideas yet. Until we look at the person as a whole, it’s going to be hard to get to the bottom of these disease processes.

even my doctor doesn’t understand the disease in that detail. And he’s awesome, he changed my life. But I guess even if I’m right, treatment doesn’t change. So I think people don’t look down paths that won’t alter our behavior. However, going down that path may lead to a new discovery about how to treat the disease. But you can’t do research on something that has no possible monetary gain. So when will this happen? I’m hoping soon. I’m hoping doctors start trying to heal the root cause of out problems. We have to get then thinking that way to begin the research however.

[Topher3]

Dowork123 Yeah, I don’t see how I have atrophied glands, sure I did some gaming but there’s people out there who do it 12+ hours a day with no problems. Sure I’ve eaten bad foods occasionally but I’m in the healthy bmi. Sure I’ve taken anti depressants for a couple years however there’s people who take em all their life and don’t have gland loss. I got my lipiview done and I’m not a partial blinker. I do believe there has to be a genetic component there’s no way I can develop this when I there’s people at way more extremes than me and have no problems. It’s the only answer, genetics.

also I have a question with your allergies I have them too, have your glands had damage done to them from allergies? Or are your oil glands fairly fine? Because I feel as if the allergies may have somehow made them misfunction properly. Idk tho.

[Guest]

Dowork123 Yeah, I don’t see how I have atrophied glands, sure I did some gaming but there’s people out there who do it 12+ hours a day with no problems. Sure I’ve eaten bad foods occasionally but I’m in the healthy bmi. Sure I’ve taken anti depressants for a couple years however there’s people who take em all their life and don’t have gland loss. I got my lipiview done and I’m not a partial blinker. I do believe there has to be a genetic component there’s no way I can develop this when I there’s people at way more extremes than me and have no problems. It’s the only answer, genetics.

also I have a question with your allergies I have them too, have your glands had damage done to them from allergies? Or are your oil glands fairly fine? Because I feel as if the allergies may have somehow made them misfunction properly. Idk tho.

My oil glands are 97% perfect. Just two glands in the lower lid barely started truncating. So no, the allergies and floppy lid haven’t caused damage yet. I know this has been going on for at least 10 years too.