Dr. Bazan, MGD Question

[Meebo]

I was diagosed with MGD due to rosacea, hence ocular rosacea. Since I do not show symptoms of a typical blepharitis patient, I would assume my exact diagnosis would be Non-Inflammatory MGD, or meibomitis, due to ocular rosacea. I am not aqueous deficient and my major symtom would be waking up with dryish eyes. Tear kick in after I get out of bed and get ready for shower. Taking lovaza omega 3's, barleans flax, and multi vits.

At this time it seems that my glands are not closed, but possible in between open and stenosed. I get some clear stuff after a warm compress and some self-expression. My biggest concern is atrophy, mainly because many publications refer to Non-Inflammatory MGD as Atrophic MGD.

I am not sure if you have heard of them, but Dr. Tseng and Dr. Gilwit are two professionals that come to mind, consistently standing by the fact that they are gaining ground on how to solve the meibomian mystery. Dr. Tseng is doing more and more research on the demodex mite and vitmain A applications, and Dr. Gilwit has a patented gland expression procedure that no one on the board quite knows about.

Are there any solid conclusions you are aware of in regard to Non-Inflammatory MGD and how one could go about improving the functionality of their glands? I can visually see my glands open; if I need to unclog them, I will do what it takes to unclog them. They apparently arent working since my TBUT is 3 seconds, so I'll do whatever I have to make them work normally.

I always said i was up for a challenge; I guess MGD heard me.

[jlg_uk]

I myself like others here, am concerned about my meibomian glands in that I'm keen to avoid any/further permanent damage to them - atrophy/dropout. I'm hoping that compresses/manual expression largely to totally achieve this.

How do you see the state of your glands? I have a 12X mirror, but find it hard to get a good view of them.

The tear film is a complex thing that is not fully understood. I hope that the increasing focus this area is starting to receive will yield significant benefits for all who suffer in the not too distant future.

[sazy123]

Meebo-

Are you sure you dont have inflammation? Because usually in ocular rosacea you have inflammation. Which is causing MGD.

If your glands are not blocked i would assume the cause to be inflamation.

My glands are not blocked in the slightest! but i have inflamed inner eyelids - which i didnt think of as abnormal to begin with. Related to ocular rocasea.

Have you tried progesterone cream?

[Meebo]

I myself like others here, am concerned about my meibomian glands in that I'm keen to avoid any/further permanent damage to them - atrophy/dropout. I'm hoping that compresses/manual expression largely to totally achieve this.

How do you see the state of your glands? I have a 12X mirror, but find it hard to get a good view of them.

The tear film is a complex thing that is not fully understood. I hope that the increasing focus this area is starting to receive will yield significant benefits for all who suffer in the not too distant future.

I simply look at them in the mirror. I read that if you get a good look at them they show show a little bit of oil at each gland. Steosed means that u may not see the oil, but the gland orifice opens whern you go to express them. This happens, but they are not expressing much lipid. Closed is apparent, meaning the gland doesnt even open when you go to express it. I do not believe that c;osed necessarily means drop-out has occured. I would imagine steosed means that the glands are clogged to the point where it is difficult to get oil out of them.

My goal is go get these glands in as much of a better working condition as possible. I am researching and seeking professional medical advice every way i can get it.

[Meebo]

Meebo-

Are you sure you dont have inflammation? Because usually in ocular rosacea you have inflammation. Which is causing MGD.

If your glands are not blocked i would assume the cause to be inflamation.

My glands are not blocked in the slightest! but i have inflamed inner eyelids - which i didnt think of as abnormal to begin with. Related to ocular rocasea.

Have you tried progesterone cream?

I guess you are correct and I am wrong about having non-inflammatory MGD. I do have inflammation on the cornea, but I do not believe my eyelids are inflamed, hence the reason I was calling it non-inflammatory. Maybe there is infammation but very mild to the point where you cannot really tell. So most likely I have MGD due to inflammation. Thank you for this clarifcation. When I think inflammation I think blepharitis, and I do not have any symptoms, except for MGD.

I have been reading about progesterone...what were your beginning symtoms and test results? (TBUT) Have you used the cream or have you been trying other methods to alleviate symptoms?

[Justin]

"waking up with dryish eyes" Go back to basics. Make sure no air is blowing on your eyes at night. Make sure there are no allergens in your bed. Do your lid care and use ATs before bed. And use tranquileyes or tape to make sure your eyes are completely closed. Talk with your doc about using Azasite before bed.

The flushed and dilated blood vessels can obstruct the MGs. Do you know what your triggers are? Are you wearing sunglasses?

Dr. Tseng - should be coming out with a demodex treatment very soon (a cream I belive). Dr. Gilwit - sent me a weird email about his instrument that gave me no info whatsoever about it! I asked for more info, so we will see. It is to be used by a doc in office, but the Mastrota Meibomian Paddle is also excellant for aiding in expression.

"Are there any solid conclusions you are aware of in regard to Non-Inflammatory MGD and how one could go about improving the functionality of their glands?" There is a lot of overlap between glands that are obstructed, and glands that produce bad meibum. If ocular rosacea is the underlying cause, its most important to controll that and keep the MGs free flowing. So this would require you to manage the inflammatory component of the ocular rosacea. Rosacea is a jumble of confusion, from diagnosis to treatment. I am not aware of "solid" conclusions, other than identifying and controlling the things that can make it worse.

[sazy123]

"waking up with dryish eyes" Go back to basics. Make sure no air is blowing on your eyes at night. Make sure there are no allergens in your bed. Do your lid care and use ATs before bed. And use tranquileyes or tape to make sure your eyes are completely closed. Talk with your doc about using Azasite before bed.

The flushed and dilated blood vessels can obstruct the MGs. Do you know what your triggers are? Are you wearing sunglasses?

Dr. Tseng - should be coming out with a demodex treatment very soon (a cream I belive). Dr. Gilwit - sent me a weird email about his instrument that gave me no info whatsoever about it! I asked for more info, so we will see. It is to be used by a doc in office, but the Mastrota Meibomian Paddle is also excellant for aiding in expression.

"Are there any solid conclusions you are aware of in regard to Non-Inflammatory MGD and how one could go about improving the functionality of their glands?" There is a lot of overlap between glands that are obstructed, and glands that produce bad meibum. If ocular rosacea is the underlying cause, its most important to controll that and keep the MGs free flowing. So this would require you to manage the inflammatory component of the ocular rosacea. Rosacea is a jumble of confusion, from diagnosis to treatment. I am not aware of "solid" conclusions, other than identifying and controlling the things that can make it worse.

This is my problem- 99% sure, but there isnt anything that makes them flushed etc, they are just permanently like this. I think they got to a stage, beyond flushing. Like in facial rosacea when the face blood vessels dilate and the face becomes permanently red. The vascular inflamation goes away when im ill however and it doesnt obstruct the glands anymore- the glands flow freely. It is so annoying because there isnt anything that can be done about this. If it was facial rosacea, IPL would be the course of action.

Would Dr. Gilwit expression instrument work if blood vessels are obstructing the MG's? i assume it would only benefit those who have actual blocked/toothpaste type glands?- those that you can see are blocked. Mine arent blocked.

[Meebo]

"waking up with dryish eyes" Go back to basics. Make sure no air is blowing on your eyes at night. Make sure there are no allergens in your bed. Do your lid care and use ATs before bed. And use tranquileyes or tape to make sure your eyes are completely closed. Talk with your doc about using Azasite before bed.

The flushed and dilated blood vessels can obstruct the MGs. Do you know what your triggers are? Are you wearing sunglasses?

Dr. Tseng - should be coming out with a demodex treatment very soon (a cream I belive). Dr. Gilwit - sent me a weird email about his instrument that gave me no info whatsoever about it! I asked for more info, so we will see. It is to be used by a doc in office, but the Mastrota Meibomian Paddle is also excellant for aiding in expression.

"Are there any solid conclusions you are aware of in regard to Non-Inflammatory MGD and how one could go about improving the functionality of their glands?" There is a lot of overlap between glands that are obstructed, and glands that produce bad meibum. If ocular rosacea is the underlying cause, its most important to controll that and keep the MGs free flowing. So this would require you to manage the inflammatory component of the ocular rosacea. Rosacea is a jumble of confusion, from diagnosis to treatment. I am not aware of "solid" conclusions, other than identifying and controlling the things that can make it worse.

Seems like this hits the nail on the head. I need to control the rosacea, as, I actually DO have infllammation, and it is from the rosacea.

I am going to most likely pursue laser treatment of the facial component and angular artery and ask about azasite and possibly moxy to get these puppies flowing some oil. If you hear anything from Dr. Gilwit let me know. Apparently the procedure is still a secret to many. Thanks for the feedback!

[sazy123]

Seems like this hits the nail on the head. I need to control the rosacea, as, I actually DO have infllammation, and it is from the rosacea.

I am going to most likely pursue laser treatment of the facial component and angular artery and ask about azasite and possibly moxy to get these puppies flowing some oil. If you hear anything from Dr. Gilwit let me know. Apparently the procedure is still a secret to many. Thanks for the feedback!

Yes please let us know, i am going to pursue laser treatment of the face as well, so let me know how you get on etc!

[Meebo]

Yes please let us know, i am going to pursue laser treatment of the face as well, so let me know how you get on etc!

I have contacted Dr. Toyos' office but have not gotten a reply. Hang in there.

[Philipp_from_Germany]

@ Sazy and Meebo

Check out this IPL patent:

http://www.freepatentsonline.com/y2007/0191821.html

"The present invention can also permanently treat blepharitis by eliminating the vascular engorgement and abnormal pilosebaceous structures of the eyelid margins. It can be used for removal of misdirected eyelashes to resolve trichiasis."

They also quote Toyos' findings...

[Meebo]

Check out this IPL patent:

http://www.freepatentsonline.com/y2007/0191821.html

"The present invention can also permanently treat blepharitis by eliminating the vascular engorgement and abnormal pilosebaceous structures of the eyelid margins. It can be used for removal of misdirected eyelashes to resolve trichiasis."

They also quote Toyos' findings...

Very interesting. Unfortunately, I have not heard back from Dr. Toyos.

[sazy123]

Very interesting. Unfortunately, I have not heard back from Dr. Toyos.

When did you email him? i was going to email him but i didnt hear anything in the past either. It annoys me, it doesnt take much just to email back.

I wonder if you can contact him by ringing his clinic?

Thanks phillip! this sounds very interesting, actually the kind of thing i think would benefit me.

[Rojzen]

Dr. Gilwit's office declined to treat my atrophied glands

Meebo: As you can see, many at DEZ have actually pursued Dr. Gilwit's therapy. I continue to be intrigued by it, but when I called his office, last year, to attempt to schedule a consultation, his technical assistant told me not to bother to come down, after I disclosed that I had received a diagnosis of atrophied (rather than inflamed/clogged) MGs.

When I was a patient of Dr. Tseng's, he treated my atrophied MGs with topical retinoic acid. We continued with this for about 2 years, and it did not ultimately peel away the metaplastic/overgrown tissue sealing my MGs. The same therapy had worked miracles in other patients, I am told. I remain intrigued with this therapy, but look forward to its being refined in several ways. My retinoic acid was in ointment form, heavy with petrolatum, which is severely damaging to the tear film. Possibly in another medium, it would work differently.

While you are exploring these directions, please look carefully at Dakrina, which includes Vitamin A (for benefits to goblet cells), and at Dwelle. Despite my completely overgrown/atrophied meibomians, I function well and comfortably with Dwelle. (See reports of my remission from disabling dry eye via Dwelle, in other posts.)

[sazy123]

Meebo: As you can see, many at DEZ have actually pursued Dr. Gilwit's therapy. I continue to be intrigued by it, but when I called his office, last year, to attempt to schedule a consultation, his technical assistant told me not to bother to come down, after I disclosed that I had received a diagnosis of atrophied (rather than inflamed/clogged) MGs.

When I was a patient of Dr. Tseng's, he treated my atrophied MGs with topical retinoic acid. We continued with this for about 2 years, and it did not ultimately peel away the metaplastic/overgrown tissue sealing my MGs. The same therapy had worked miracles in other patients, I am told. I remain intrigued with this therapy, but look forward to its being refined in several ways. My retinoic acid was in ointment form, heavy with petrolatum, which is severely damaging to the tear film. Possibly in another medium, it would work differently.

While you are exploring these directions, please look carefully at Dakrina, which includes Vitamin A (for benefits to goblet cells), and at Dwelle. Despite my completely overgrown/atrophied meibomians, I function well and comfortably with Dwelle. (See reports of my remission from disabling dry eye via Dwelle, in other posts.)

Hi rozen,

Did they imply his treatment would work for inflamed- but Non clogged and Non atrophied glands?

I was wondering since mine are not blocked by toothpaste consistency, but blocked by inflammation and blood vessel engorgement from ocular rosacea.

Im guessing its an unplugging procedure- which removes paste etc thats created a blockage (having same function as compresses- which dont do much for me)?.. did you get an idea of what it actually is?

thats great that dwele has helped you so much, it stung really bad.. which i think was due to the inflammed inner eyelid sensitive to the ingredients..
Thanks