The Patient's Guide to Dry Eye Syndrome: Meibomian Gland Dysfunction8:52 PM
One of the most common types of dry eye I see is a direct result of clogging of the tear glands that line the upper and lower eyelids. This type of dry eye is more common in younger patients and men than other etiologies. If you are having dryness and also experiencing:
- itching, redness, or irritation along your lash line
- small white/yellow bumps along your lid
- recurrent styes
- thick, hazy tear film intermittently between blinks
- suffer from rosacea
|Clogged Meibomian Glands: also called impacted or inspissated glands, or posterior blepharitis|
- Warm compresses (typically with a warm washcloth) for 2-5 minutes with gentle massage along the lid and lash line
- eyelid cleansers like: Ocusoft Foaming Eyelid Cleanser, or Sterilid lid scrubs
- Pulsed treatment with prescription drops like Azasite or Besivance to improve gland secretion (I typically dose twice daily for 2 weeks and then once daily for 2 weeks to see improvements)
- Oral Doxycycline (especially effective with rosacea or acne component). I typically dose 20 mg of Doxy Hyclate twice daily for 2 weeks, then once daily for two weeks. 50 mg generic doxy with the same dosage is another common prescription. Note: Doxy can cause rashes and severe sunburns!
- For severe disease some doctors are using new techniques like meibomian gland probing or the Lipiflow device
|OCUSOFT FOAMING LID CLEANSER: I love this stuff and prescribe it quite frequently! Much better than the old baby shampoo treatment|
- Your doctor may measure something called the "Tear Break Up Time" when discussing dryness. Remember, poor gland secretion causes the tears to evaporate quickly. If your tears are evaporating off the surface of your eye (or "breaking up") before 10 seconds, then you have clinically significant dry eye.
- Your doctor may apply pressure to your eyelids to see if your meibomian glands are properly secreting. The gland should secrete every time you blink, so there should be a noticeable, clear secretion when the doctor presses against your lids. With MGD, the secretion may be a thick, white color like toothpaste. Sometimes the gland is so clogged, no secretion at all comes out! If that is the case, your glands may be sclerosed closed, typically causing very severe dryness
- If you have meibomian gland dysfunction, you may have a lot of depositing and haziness with your contact lenses. Newer, more oxygen permeable contact lenses are made with a material called Silicone Hydrogel that in most patients improves comfort, in addition to being healthier for the eye. Biofinity and Air Optix Aqua are two examples of lenses in this category. Silicone hydrogel is good for dryness in that it is hydrophobic, so should theoretically draw less water from the eye. However, this also means that it attracts lipids, so clogged gland secretions stick to the material like glue. If you are having these issues, you may have to be refit into an older hydrogel material like Proclear for comfort. Dailies are a great solution because the lenses won't have enough time to deposit before you throw them away!