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MEIBOMIAN GLAND DYSFUNCTION (MGD):

MEIBOMIAN GLAND DYSFUNCTION (MGD):

If your eyes are bothering you, it is very important to have a thorough eye examination to properly diagnose the cause(s). If you have more than one condition (e.g. dry eye, allergies, meibomian gland dysfunction (MGD), contact lens related issues, conjunctival chalasis, demodex, other) it is imperative that each is identified. This is because treating only one condition will be met with limited success. Your eyes will be their healthiest when all issues adversely affecting them are properly identified and treated.

Meibomian Gland Dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian glands most often associated with blepharitis*, meibomitis**, ocular rosacea***, environmental allergies, autoimmune conditions, and/or demodex**** (see definitions below). Meibomian glands are oil producing glands in the eyelid margins of both your upper and lower eyelids. These glands produce the oil which comprises the outermost layer of your tears. This oily layer protects your tears from evaporating. When these oils are reduced, the evaporation of your tears from the surface of your eyes is increased and your eyes become drier much more quickly, especially when you are reading a computer screen, cell phone, tablet, document, watching T.V., driving, etc..

Since MGD often results from blepharitis, meibomitis, ocular rosacea, and/or demodex, it is very important to determine whether or not you have any of these conditions. It is also important to know that, if not properly diagnosed and treated, these conditions are chronic and progressive. These conditions adversely affect your eyes causing irreparable damage in two very important ways: first, by causing irritation and inflammation of your eyes and eyelids leading to damage of your tear producing glands, and second, by causing blockage, structural damage and loss of your oil secreting meibomian glands.

Blepharitis, meibomitis and ocular rosacea are very closely related and have a lot of overlap with regard to their causes, symptoms and treatment. They all cause damage to your meibomian glands secondary to the accumulation of debris and a biofilm***** on your eyelids that blocks the openings of the meibomian glands thereby obstructing oil flow, along with a thickening of the glands’ contents. If left untreated, meibomian gland blockage, and the thickening of the glands’ contents, cause in increased pressure resulting in structural damage and eventual loss, or death, of your glands. Once lost, Meibomian glands do not have the ability to regenerate.

ROUTINE SCREENING AND EVALUATION ARE ESSENTIAL FOR THE EARLY DETECTION AND INTERVENTION OF MGD TO PREVENT PERMANENT MEIBOMIAN GLAND LOSS.

SYMPTOMS OF MGD:

  • Dry eye
  • Burning
  • Irritation
  • Stinging
  • Itching
  • Red ("bloodshot") eyes
  • Gritty feeling
  • Foreign body sensation (as if a grain of sand or an eyelash is in your eye)
  • Blurred vision
  • Light sensitivity
  • Tearing
  • Red, swollen, or thickened eyelids
  • Dilated small blood vessels on the eyelid margins and/or overlying the white of the eye
  • "Dandruff" in your eyelashes
  • Contact lens intolerance
  • Styes, chalazia and/or cellulitis involving your eyelid(s)
  • Corneal erosions, infiltrates and ulcers resulting in scarring and, potentially, loss of vision


HOW TO DIAGNOSE AND EVALUATE MGD:

The diagnosis of MGD is made by taking a thorough history and examining your eyes with a biomicroscope.. Special attention is paid to evaluating your Meibomian gland orifices (openings), eyelashes, eyelids and eyelid margins. Gentle digital pressure is applied to assess the quality and quantity of the oils secreted by your glands which reflects the functioning of your Meibomian glands.

The gold standard to directly evaluate your meibomian glands structurally is to image them using advanced technology known as LipiScan. LipiScan is a meibographer which captures images of your meibomian glands. Using this state-of-the-art technology your meibomian glands can be viewed to assess and quantify them structurally.

LipiScan Logo
LipiScan Dynamic Meibomian Imager
Gland Comparison

Almost complete loss of meibomian glands in the eyelid

Once your Meibomian glands have been evaluated, and depending upon the degree to which Meibomian gland dysfunction is an issue for you, Dr. Muller will discuss your treatment options. Dr. Muller's recommendations can range from homeopathic/natural treatments, to treatments involving medications and mechanical cleansing. Below please find a broader explanation of the array of treatments available.

HOLISTIC TREATMENT:

Lid Hygiene:

Warmth applied to your eyelids immediately prior to cleaning, or “shampooing”, your eyelashes, a minimum of two times each day, i.e. in the morning and in the evening.

LID CLEANSING IS ANALOGOUS TO BRUSHING YOUR TEETH

Most of us know that brushing our teeth prevents the accumulation of plaque, and the development of cavities and gum disease. Another part of your daily hygiene should be taking a minute to clean your eyelids and eyelashes. Cleaning your eyelids removes debris that can build up over time causing obstruction and loss of your meibomian glands. This obstruction and loss of your glands leads to MGD and dry eye. Prevention of MGD using early detection and intervention are essential to the long term health and comfort of your eyes.

Products that you can use include: simply soap and water, or diluted baby shampoo, or OCuSOFT hypochlorous spray and eyelid wipes, other. For the application of warmth you could use a Bruder Moist Heat Eye Compress, or simply a warm wash cloth.



LID HYGIENE USING OCuSOFT

Preservative Free Artificial Tears:

One drop instilled in each eye 4-8 times each day, depending upon need.

Some artificial tear options include: OCuSOFT Retaine MGD, NanoTears MXP Forte, NanoTears TF, Systane Ultra, TheraTears, Refresh Optive Advanced, Soothe, GenTeal Lubricant Eye Drops for Mild to Moderate Dry Eye.

Omega-3 fatty acid supplements, in addition to a diet rich in Omega 3s:

Omega-3 supplements should be purified and from re-esterified triglyceride EPA and DHA.

https://prnomegahealth.com/products/dry-eye-omega-benefits/
https://www.healio.com/ophthalmology/cornea-external-disease/news/print/ocular-surgery-news/%7B4c7547a8-5f21-480f-a839-46a9a347f4ec%7D/re-esterified-omega-3-supplements-improve-ocular-surface-signs-symptoms
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975557/
https://www.nwvision.org/eye-care-services/dry-eye-treatment/omega-3-supplements-for-dry-eyes/

Prescription Medications:

Depending upon the severity of your meibomian gland dysfunction (MGD) the following medications may be prescribed by Dr. Muller:

  • Antibiotic ointment at bedtime
  • Azasite drops massaged into your lashes at bedtime
  • Antibiotics by mouth (doxycycline, tetracycline, minocycline, etc.)
  • Restasis and/or Xiidra
  • Alrex or Lotemax drops
  • Other

Mechanical Treatments:

Blepharoexfoliation: Golf Club Spud Scaling procedure

Using a hand held instrument known as a golf club spud, Dr. Muller gently cleans and exfoliates your eyelids removing keratin, debris and the biofilm***** plugging, or blocking, the openings to your Meibomian glands. This procedure enhances the health of your Meibomian glands and helps with dry eye symptoms.

After the procedure, the patient is instructed on how to maintain the benefits of the procedure by keeping their eyelids clean. The procedure is typically repeated at intervals which vary based on each patient’s individual needs.

https://www.ncbi.nlm.nih.gov/pubmed/24145633
https://www.youtube.com/watch?v=j57ffQ4Olao

MicroBlepharoexfoliation (MBE) using BlephEx

BlephEx™ is a comfortable in-office procedure performed by Dr. Muller using a revolutionary new patented medical device which employs a high speed rotating micro sponge along with a medical grade eyelid cleanser to deep clean and exfoliate your eyelids and eyelashes, removing dandruff, scurf, debris and the biofilm***** plugging, or blocking, the openings to your Meibomian glands. This procedure enhances the health of your eyes, eyelids and Meibomian glands and helps with dry eye symptoms.

A numbing drop is placed in each eye prior to treatment. The procedure lasts about 6 -8 minutes and is soothing. Most patients simply report a tickling sensation.

After the procedure, the patient is instructed on how to maintain the benefits of the procedure by keeping their eyelids clean. The procedure is typically repeated at intervals which vary based on each patient’s individual needs.

In-office treatment provides targeted approach to blepharitis


Microblepharoexfoliation efficacious in reducing meibomian gland disease


BlephEx News Story


BLEPHEX TREATMENT FOR BLEPHARITIS, MGD AND DRY EYE


iLux:

iLux is a handheld medical device which gently and comfortably heats your eyelids to a safe, therapeutic temperature which softens the contents of your meibomian glands. Once the contents are softened, manual pressure is applied to your eyelids to unblock, clean out, and evacuate your glands. iLux treatments can be customized to optimize your results by applying more compressions combined with a longer heating time in the areas where you need it the most.


iLUX treatment for Dry Eye and Meibomian Gland Dysfunction


LipiFlow:

 LipiFlow: is the “gold standard” for treating Meibomian gland dysfunction. This is because it is the most effective at unblocking and cleaning out your Meibomian glands. LipiFlow is an FDA-cleared electronic device that removes meibomian gland blockages and restores gland function. Through advances in the application of Vectored Thermal Pulsation (VTP) technology, the LipiFlow treatment utilizes a patented algorithm of heat applied comfortably to your eyelids, followed by massage, to remove the obstructions and evacuate the contents of your glands. This deep cleaning allows the meibomian glands to resume proper production and flow of oils. The entire treatment takes approximately 12 minutes, is comfortable and is extremely effective. (Dry Eye and MGD)


LIPIFLOW TREATMENT FOR DRY EYE

MEIBOMIAN GLAND DYSFUNCTION (MGD)

Meibomian Gland Probing:

Meibomian gland probing is a safe and effective technique for treating obstructive meibomian gland dysfunction. The procedure is performed in our office using a compounded surgical grade topical anesthesia applied to the eyelids. Probing is performed through the natural gland openings, or orifices, physically unclogging the openings and the ducts of the Meibomian glands. Meibomian gland probing mechanically clears the orifices and the ducts from blockage by thickened meibum, cellular debri, and fixed fibrotic obstructions thus allowing the oils to flow freely again. Having the oils flowing freely again improves the health of the surface of the eyes, and the Meibomian glands, which alleviates eye and eyelid discomfort. Dr. Muller typically combines the use of various anti-inflammatory medications and antibiotic drops to optimize your results.
Additionally, Meibomian gland probing has been reported to be associated with regeneration of missing, or atrophied, Meibomian glands. Probing may promote glandular regrowth/regeneration in part by mechanically re- establishing a patent orifice/duct system.

https://www.tandfonline.com/doi/abs/10.1080/09273948.2018.1522357?journalCode=ioii20
https://www.healio.com/optometry/cornea-external-disease/news/online/%7B486d86a2-6785-4ae6-af12-6c2eb262d8a6%7D/study-shows-efficacy-of-meibomian-gland-probing
https://bjo.bmj.com/content/102/1/59

*Blepharitis:
Blepharitis is a condition where there is inflammation of the eyelids around the area of the eyelashes and the meibomian glands. You can have a seborrheic component (often with "dandruff" in your eyelashes) and/or a bacterial (staphylococcal) component sometimes causing styes or chalazia.

**Meibomitis:
Meibomitis refers to the inflammation and dysfunction of the meibomian glands in the eyelid margins. When the meibomian glands are healthy, the oil they produce has the consistency of olive oil, which is the desired quality. When the glands are inflamed the oils they produce are thicker, like toothpaste, which is of poor quality and are less effective at lubricating the eyes. Additionally, when the meibomian glands are inflamed and the oily secretions thicken, the glands become clogged. When the glands become clogged, they become damaged and often close off ("drop out") and die, ceasing to produce any oil at all. If this condition is allowed to progress, you will ultimately have significant problems with dry, red, irritated and inflamed eyes. This increases your risk for recurrent infections involving your eyes and eyelids, scarring of the surface of your eyes, decreased vision and significant discomfort.

***Ocular Rosacea:
Ocular rosacea is characterized by inflammation of the eyelids. It is often the first sign of rosacea of the face (which involves the nose, cheeks, forehead and chin). People with rosacea tend to blush or flush easily. People with rosacea also have a much higher incidence of Demodex infestation.

****Demodex:
Demodex mites are little bugs that can infest your eyelashes, eyelash follicles and eyebrows. These mites are nocturnal, coming out of your eyelash follicles at night to eat, mate and lay their eggs. Their life cycle is typically 2 to 3 weeks. If your eyelashes are infested with Demodex you may experience redness or irritation of your eyelids, dandruff in your eyelashes, and occasional itching, while some people experience no symptoms at all. Demodex infestation causes damage to your meibomian glands, making it important to quickly diagnose and treat the infestation.
Read more…

*****Biofilm:
A biofilm is a slimy, sticky film of bacteria that coats the surface of the eyelids. A biofilm is composed of a well-hydrated matrix of bacteria and their glycocalyx, a sugary coating that allows cells to adhere to and communicate with each other. The eyelid margin—with its moisture, nutrients and warmth—is the perfect environment to cultivate a thriving bacterial biofilm.