Atrophied meibomian glands / finasteride

[finasterized]

This is all very scary to me. I have been suffering from eye irritation for the last 8 years, and despite seeing doctors about it three times, only today did I discover on my own the profound connection between a drug I've been taking since 1998 (finasteride) and the meibomian gland. I was told that I had blockages and instructed to express them through massage and warm compresses. I confess tht I have not sufficiently given this a try, but after reading all I have about finasteride today and then gland atrophy here I have little doubt that my meibomian glands have atrophied. It has been nine years!

I was also never told that I have dry eye syndrome, despite its perfect match to my symptoms.

It is especially worrisome that this all is such new ground to doctors. Whom do I see for treatment and diagnosis? I don't want to go in there knowing more about it than the doc.

My eyelids are constantly dark and irritated, I often experience stinging, I remove stringy discharge from my eyes every morning in the shower, and things are greatly exascerbated by crying (which I do often, unfortunately).

I would like to attempt to express my glands at home to test for atrophy. Any advice?

Thanks!

[Rebecca Petris]

Dear finasterized,

Welcome to DEZ. I'm sorry to hear about this. I hope you don't mind, I've separated this to its own thread because I think it will get seen more this way (and should!)

It is especially worrisome that this all is such new ground to doctors. Whom do I see for treatment and diagnosis? I don't want to go in there knowing more about it than the doc.

I wish I knew someone to refer you to around here but I have just recently moved back to the Seattle area myself. If you get the right sort of doc it's okay to know more than him/her as long as you can get them to do the right things anyway (like press real hard on those glands....)

I would like to attempt to express my glands at home to test for atrophy. Any advice?

You could get a copy of Dr. Latkany's book "The Dry Eye Remedy" as it's got some diagrams and has instructions. It sounds very likely though that you really need your glands expressed by a doctor.

I'm working on a directory of dry eye doctors but it will be a little while. Meantime hopefully someone here has a local suggestion for you.

[finasterized]

Wow, great to get such a substantial response so quickly. I was up very late reading about all this after spending years frustrated and constantly thinking about it. It is relieving to finally understand what's at play in my case, but depressing to realise that there's basically no cure (specially if the glands have atrophied), nor (correct me if I'm wrong) anything truly effective at managing the symptoms.

Because my case is certainly antiandrogen-induced, I had a burst of hope reading about research into "Androgen Tears," but it was quickly dashed here on this board: First when I read that Allergan's trials had been completed without plans to go live, and secondly when I read of meibomian gland atrophy after the problem persists long enough.

I'm pretty anxious to determine if atrophy has happened in my case. How not? I distinctly remember wondering about my eye irritation back in 1999 when I was 23. I blamed contact lenses (they certainly didn't help), and quit wearing them but continued using finasteride under the understanding that its only side effects were sexual (and none of which I had). The drug had been in use since the early 70s to treat enlarged prostate etc., so it's a wonder to me they never caught this. I was told by doctors who looked at my eyes no longer than 10 seconds that I had meibomitis and should massage them after using warm compresses. Honestly, I cannot/could not see anything remarkable on my own examinations, and I have since then (six years ago!) failed to take their instructions seriously, imagining that no keratinized oil blockage (such as a blackhead) would be removed by mere heat and massage. I asked about expression and was told that it was no longer done.

Alas, it seems there was no blockage but rather a dysfunction of the glands in the presence of antiandrogens. THAT is what I seek now to determine, if only I can find a doctor who knows about this, or at least knows about the role of meibomian lipids in tear film stability.

[Rebecca Petris]

It is relieving to finally understand what's at play in my case, but depressing to realise that there's basically no cure (specially if the glands have atrophied), nor (correct me if I'm wrong) anything truly effective at managing the symptoms.

Based on my understanding of your posts there is no reason to deprive yourself of hope in this way. If they are ALL 100% atrophied, yes, you're in a pickle but this is quite rare. Furthermore, if they do have some function - or can be coaxed & coached back into partial function through proper care, they CAN be effectively managed. The primary direct treatments for this are heat & expression; Omega 3s; and oral antibiotics. Which one, two, or three of these things is chosen depends on the case and on the doctor. Personaly, I rely almost exclusively on lid care though I also take Omega 3s (salmon and flaxseed oil). - Of course, additional treatments are needed when as a result of the MGD you're very very dry.

I had a burst of hope reading about research into "Androgen Tears," but it was quickly dashed here on this board: First when I read that Allergan's trials had been completed without plans to go live, and secondly when I read of meibomian gland atrophy after the problem persists long enough.

Again, don't give up too soon on this. First of all, you can get the same product that Allergan had on trials compounded at Leiter's pharmacy in San Jose. See leiterrx.com, call Chuck Leiter and ask about DHEA drops (and search this board on that topic). Second, there are two more hormone therapies that have just entered clinical trials and one of them is specifically for men. Please have a look at at our clinical trial roster for information about things like this (www.dryeyezone, then click on News, then Clinical Trials). I also post updates on my blog at dryeyedigest.blogspot.com.

I'm pretty anxious to determine if atrophy has happened in my case. How not?

There is a test for this called meibography. It's actually pretty simple to perform, but the majority of doctors are probably not well aware of it or experienced with it. I first learned about it from a research optometrist in SoCal, Dr. Paugh. Personally if I were wanting to get a definitive answer about my current state, I'd go see someone like Dr. Paugh rather than try hit & miss near home. Others include Dr. Pflugfelder, a world leader in dry eye research at Baylor in Houston (if memory serves I think he's the one that came up with that test) and Dr. Tseng in Miami. Many members here have been to one or both of those latter two.

Meantime, if you know your MGs are a mess, why not just get started with a good lid care regimen and see how it goes? Your progress or lack thereof would also give you more to talk about with the doctor when you find an expert.

By the way, we're going to have a Puget Sound area support group meeting later on this year.

[finasterized]

Thanks a lot for this encouraging and informative post! It raises some questions that I will post when I return from work.

[charmee]

Hang in there

Hi, What a horrible thing you're going through. That's really tough. I think there's hope, though.

It seems to me that if you have some blocked glands, then you've still got at least some glands working. If they're working even a little now they'll start flowing much better with therapy, so there's hope. A lot of hope. The therapies for MGD really do help. Your glands can improve.

There's no cure, it's true. But you've already been living with this horror for years with things just gettting worse. Things can finally start getting better now.

Is there an alternative to finasteride, or do you have to continue taking it? I really hope there's an alternative.

I share your frustration with the doctors who let things get this bad. I too kept going to doctors who had no idea while things just kept getting worse. It's a crying shame.

Oh, and try not to cry! Sometimes it takes my eyes 2 days to recover from a cry.

I sure hope you find a good doctor and get a good treatment plan started righted away. Welcome to the group. You are not alone.

Charmee

[bassfan]

finasterized - are you out there? I sent you a PM a few weeks ago, never heard back!!!

[finasterized]

Rebecca, Bassfan & Charmee-

I really have to apologize for flaking out on this thread I started. Your responses were all very substantial and helpful, not only as it concerns practical information.

I'm heading to the library today to check out a book on gland expression. I'll post back with my results. Of course, my fear remains that there is no blockage, but rather atrophy...

[sazy123]

If you dont think your MGs are blocked, it could be the case that they are just underfunctioing 'not producing enough oil' . Doesnt necesarliy mean they are atrophied. I dont know what the cause for my MGD is. But i think it could be that they are not producing enough oil as i dont seem to have blockage or wrong consitency that im aware of, becuase when i have face pain all my eye glands seem to work fine. So luckily i know they are not atrophied. If you havent had the pleasure of bieing in this situation where something makes them feel normal then i guess you wouldnt know. But my point is that just becuase they are not blocked doesnt mean they are atropied.

[finasterized]

sazy- i don;t really follow you. what sort of situation enables you to tell that your MGs are indeed functioning?

[sazy123]

Well i dont know if my prob is MG's or Mucin layer. But i when i have face pain my M glands seem to work coz i dont have any dry eye. So ive heard in the past that the glands could be not 'producing enough oil' like the lacrimal gland doesnt produce enough tears, rather than being blocked. I could be wrong though.

[brd888]

Yeah if quality or quantity of meibum is poor the tears will break quickly.
It is impossible to see your meibum output unless it is the toothpasty stuff (apparently).