Dr. Bazan, MGD Question

[Rojzen]

metaplasia; retinoic acid as gland nutrient

Sazy123: The technical assistant who took my call, at Dr. Gilwit's, was not terribly knowledgeable of the possibilities, and so all she conveyed was that if meibomians are sealed over by metaplasia, Dr. Gilwit would not be likely to have success using his device for a gland expression procedure. We did not discuss gland atrophy from causes other than metaplastic overgrowth of the gland openings.

My two cents are this: That, in fact, I would not take, as final, any MG diagnosis that purports to attribute dysfunction to clogging, as opposed to swollen capillaries, or vice versa, because I don't believe that diagnostics are far enough along to ensure accuracy in this. Yes, if meibum can be expressed, this probably means there is no complete blockage of at least some glands, either via solidified waxes or swollen or overgrown tissue, but beyond that, pinning down the pathology more exactly would strike me as impossible.

HENCE, I say, go for any procedure that is safe that may somehow open and activate gland passages, i.e., press for Dr. Gilwit's treatment by making your case directly to Dr. Gilwit, and not accepting as final any diagnosis that purports to limit possibilities.

I must add here that Dr. Tseng's retinoic acid therapy is partly premised on the effect of highly concentrated vitamin A not only as a peeling agent, but also as a nutrient that can favorably affect the way gland tissue functions. He explained this to me once, and I believe this concept is elucidated in some of his not-too-recent publications.

[lgreene]

Dr. Gilwit

Just wanted to mention that I saw Dr. Gilwit a few times a few years ago, and I found him VERY strange. My parents are also treated by him, and he has done some peculiar things. While I credit him with starting me on Restasis (which no longer does much for me), his treatment of my dry eyes aside from that came down to once manually (with a Q-tip) expressing my meibomian glands (pressing twice on the top of the lid and twice on the bottom of each eye) and charging me $250 for doing so (in addition to the consultation fee), without giving me any information on the possibility of doing this myself. I never went back to him after that. If he can be helpful, that's great, but I have found him to be less than professional (and very eccentric), and ridiculously expensive.

[sazy123]

Hi Lgreen, thats not good. Lets hope the MG expression technique was more than that because its hardly ground breaking and to charge $250 for it

The treatment hasnt been fully explained.

Thanks rozen,

As far as i know my glands do not express any thing when pressed.. I have badly inflamed inner eyelid margins (some areas not as bad as others, top lids arent to bad). When pressed i cant see any liquid of any sort come out. This either means the inflammation has decreased the glands ability to produce of oil (by 'turning off' the process of oil production), or that the inflammation is obstructing the oil, i think it is the former, since if it were the case that inflammation is causing obstruction preventing oil from getting to the eye- there would be a sign of blockage- which there isnt.

Its literally just inflammation under, around and in some areas completely covering the MG orifices (right eye next to punctum).

My glands do still work, because when the inflammation decreases due to illness, they flow nicely.

Dr Tseng's retinoic acid therapy would i presume to for blocked glands cause not inflamed cause?

[Rojzen]

retinoic acid for multiple causes of obstruction

I think, Sazy, that Dr. Tseng's intention for the topical retinoic acid covered multiple possible causes of meibomian gland obstruction. For sure, the retinoic acid has been used, by him, as an attempt to produce a sort of chemical peel-off of skin tissue that, over time, may over-grow gland openings. In addition, though, I'm pretty sure that Dr. Tseng has used retinoic acid as a way of treating other factors in the whole process of a gland becoming obstructed.

I also recall that Dr. Tseng once wrote, some years ago, about retinoic acid being a possible treatment for recurrent corneal erosions, btw.

While I don't know how retinoic acid might alter the consistency of meibum, to make it flow better, or reduce glandular inflammation, I recall Dr. Tseng telling me that this concentrated form of Vitamin A could potentially restore function to diseased glandular tissue. The mechanism of that is something I don't recall. Possibly some of Dr. Tseng's older writings may cover this.

All this said, I had real trouble seeing how slathering petrolatum on my lid margins every day could possibly help to open them. I have a hunch that some of the makeup removers we use can actually contribute to or cause MGD, because many of these have petrolatum and other oily components. This is simply to say that perhaps the potential of retinoic acid has yet to be tested, assuming it has not yet become available in a medium other than gooey ointment.