Diagnosis and Treatment
The meibomian glands produce the protective
oil that makes up the outermost lipid layer of the tear film. This
creates a barrier for our tears and helps prevent tear evaporation. If
the meibomian glands are underfunctioning or obstructed this can lead to
chronic dry eye and ocular surface inflammation.
Meibomian Gland Dysfunction (MGD) is a condition where the glands in
your eyelids cannot produce the necessary quality and/or quantity of
protective oils (meibum) to keep your eyes healthy and moist.
Evaporative Dry Eye is the secondary condition that results from not
having enough lipids in the tear film to protect the eye.
Symptoms of MGD include:
- Grittiness
- Tearing
- Burning
- Redness
- Discharge worse in the mornings
- Tired, Puffy Eyes
- Blurry Vision
How is MGD diagnosed?
MGD is diagnosed by evaluating the function of the meibomian glands under magnification and special imaging of the glands. Our doctors use LipiScan™ to
assess the structure of your meibomian glands. With this new
technology, the cause of dry eye can be identified with high accuracy.
Consequently, your eye doctor can now prescribe the most appropriate
treatment possible to alleviate your painful dry eye symptoms.
How does LipiScan work?
Using dynamic surface illumination and adaptive transillumination technologies, LipiScan™
quickly generates a multidimensional view of the meibomian glands that
is clear and easy for your doctor to analyze for structural changes.
Long-term effects of untreated MGD
Structural changes to the glands are irreversible.
If left untreated, reduced function of obstructed glands
leads to permanent structural changes to the glands including twisting,
truncation and atrophy. Once a gland has atrophied completely, function
is lost permanently, which leads to chronic discomfort and potentially
sight-threatening damage to the ocular surface.
Treatment for MGD:
Lipiflow® Treatment (in-office treatment)
LipiFlow®, by Johnson & Johnson, is a
12 minute in-office medical device that uses optimal heat application
and gentle pulsing massage to effectively unblock and improve the
function of the meibomian glands after just a single treatment. LipiFlow
is the only device that can heat the meibomian glands from both the
inside and outer surface of the eyelids effectively clearing meibomian
gland blockages. Your doctor will determine if the LipiFlow® System is
an appropriate treatment option for you based on a complete exam of your
eye health, including evaluation for blocked glands and associated dry
eye symptoms.
For more information on the Lipiflow procedure click the link below:
Lipiflow® Treatment
Additional Treatments for MGD:
Manual Lid Margin Resurfacing & Meibomian Gland Expression by your doctor
This is an in-office technique used by
your eye doctor to gently debride the lid margin of any solid material
that may be blocking the gland openings, followed by targeted pressure
to expel stagnant oil from clogged meibomian glands. The procedure is
painless and can improve meibomian gland function in mild cases. This
procedure is recommended in conjunction with Lipiflow for more severe
cases.
Warm compress therapy
Moist heat is a simple home remedy that
can be applied multiple times a day and at your convenience in the
comfort of your own home. Like flossing, you must be consistent for this
treatment to be effective.
We recommend the Bruder Moist Heat Eye Compresses.
Simply microwave the mask for 20-25
seconds and apply to the eyes for a minimum of 10 minutes, 1-2x daily or
as recommended by your eye doctor.
Eyelid hygiene
Overgrowth of bacteria surrounding the
eyes and lash follicles can contribute to inflammation of the eyelid
margin and subsequent meibomian gland dysfunction. Daily eyelid hygiene
can help to prevent irritation, infection and recurrent styes. Talk to
your doctor about which eyelid cleansing products are appropriate for
your condition.
Topical prescription medications
Prescription eye drops may be prescribed
by your doctor to calm down inflammation associated with MGD and dry
eye. These drops often work synergistically with other treatments and/or
can help improve the outcome of Lipiflow treatment.
Over-the-counter lubricating eye drops
To help restore an insufficient tear
film, you may need to use OTC artificial tear drops. Ask your doctor
which brand is recommended for your condition.
Nutritional Supplements
Several studies have shown that increasing dietary
intake of Omega-3 fatty acids (when taken in the correct form and
dosage) can improve dry eye symptoms as well as reduce inflammation.
Therapeutic dosing for dry eye treatment is 2000 mg daily of two specific
omega-3s (DHA & EPA combined) found in fish oil.
Foods naturally rich in Omega-3 fatty acids:
Fatty fish including Salmon, Mackerel, Sardines and Anchovies (preferably wild caught)
Plant based sources include Flax Seeds, Chia Seeds, Hemp Seeds, Walnuts, Pecans
Brands of Supplements we recommend:
Nordic Naturals ProOmega 2000
EPA 1125 mg & DHA 875 mg per 2 softgels
PRN Omega Eye /De (Dry Eye)
EPA 1680 mg & DHA 560 mg per 4 softgels
Vitamin D3 - 25 mcg (1000 IU) per 4 softgels)
PRN DE Dry Eye Omega Liquid with vitamin D3
EPA 1680 mg & DHA 560 mg per teaspoon
Vitamin D3 - 25 mcg (1000 IU) per teaspoon
Resources:
1 Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution
of aqueous deficient and evaporative dry eye in a clinic based patient
cohort: a retrospective study. Cornea. 2012; 31(5):472-478