September 25, 2011
Atrophy of Meibomian glands
I bought a magnifying glass with light and can barely see more than 2-3 open glands. I've got a specialist appointment next week, so I'm preparing for the possibility that my glands have died.This is a research blog post – collecting relevant information on this subject from the internet.
Can you see MG with the naked eye?
"The ducts of the meibomian glands open to the surface of the eyelid at the junction between the anterior and posterior aspect of the lid. I don't think that you can visualize them with the naked eye, unless perhaps they become stenosed with a concretion of hardened sebum. Sometimes the glands themselves can be seen with the slitlamp by pulling the eyelid down and looking at the conjunctival side. The glands can then sometimes be visualized as yellow streaks if they are filled with yellow sebum. Transilluination of the eyelid with a light source is also possible." [Source]
In brief, they ought to be visible with a magnifying glass but not with the naked eye.
How many glands are normally fully productive?
"only kids have a full row of fully productive MGs." (Source)
"At any given time n the "normal" eye as amny as half of your meibomian glands will not be secreting oil." (Source)
Why would one's meibomian glands die?
"chronic inflammation can lead to growth of new blood vessels and scarring (as seen in macular degeneration)" [Source]
"medications such as retinoic acid (Accutane®) can obliterate meibomian glands and contribute to meibomian gland dysfunction." [Source]
"My doctor — M. Reza Dana — informed me that accutane caused my M glands to atrophy." [Source]
How does one know that one's glands are dying?
"With meibography (transillumination of the meibomian glands) an opthalmologist can tell the difference."Source)
Subjective clinical approaches for the evaluation of MGD include biomicroscopy of the lid margins in terms of telangiectasia and overall lid margin injection (dilated blood vessels at the surface of the skin or mucous membrane) or lid margin keratinization; evaluation of capping or plugging of the meibomian gland orifices and evaluation of the expressibility and quality of the meibum from the glands; and in vivo analysis of the meibomian glands themselves (atrophy or loss) through meibography. The latter technique captures images of the lids illuminated by near infrared or infrared light, allowing visualization of the glands. To date, this method has been assessed subjectively by a clinician or reader, but may lend itself to more objective methods of computerized image analysis.17–19 Some secondary, subjective, clinician-assessed approaches include corneal and conjunctival staining (due to excessive evaporation and subsequent desiccation), Schirmer or phenol red testing (again, due to excessive evaporation and subsequent aqueous tear loss), and measures of tear film stability, such as noninvasive and invasive tear film breakup times. [Source]
Here is a selective quote from one online source (http://medweb.bham.ac.uk/http/depts/path/Teaching/FOUNDAT/CHRONINF/chronic.html):
Chronic inflammation is an inflammatory response of prolonged duration – weeks, months, or even indefinitely – whose extended time course is provoked by persistance of the causative stimulus to inflammation in the tissue. The inflammatory process inevitably causes tissue damage and is accompanied by simultaneous attempts at healing and repair. The exact nature, extent and time course of chronic inflammation is variable, and depends on a balance between the causative agent and the attempts of the body to remove it.
On healing and repair:
Dead cellular material and debris are removed by phagocytosis (mainly by macrophages) and the tissue is left with its original architecture intact.
Lost tissue is replaced by proliferation of cells of the same type, which reconstruct the normal architecture.
Lost tissue is replaced by a fibrous scar which is produced from granulation tissue…..Fibroblasts migrate into the damaged area along with the capillaries to form a loose connective tissue framework. This delicate fibrovascular tissue is granulation tissue.
So, the result of chronic inflammation can be that the original tissue is replaced by another type of tissue by fibroblasts. This "secondary healing" can result in the loss or diminishment of the original normal function. [Source]
This person has no visible MGs (see detailed case study here)
Is this reversible?
According to two of the top German dry experts, both gland atrophy and gland dropout are reversible. One of them told me that meibomian glands are [some technical term I forgot] glands and are therefore capable of renewing themselves. This makes sense to me as I have frequently read about people who experienced strong symptomatic relieve after years of suffering. The one expert above also told me he has patients who have the disease for 20+ years and are doing equally well or better than let's say 15 years ago (due to advances in treatment). (Source)
Lipid based eye drops: Systane Balance
More permanent remedies
Blocked MG being probed by a doctor. See details here.
Dr. Maskin developed instrument prototypes to test his theory and used these investigational designs (with proper informed consent) on some of his MGD patients. His findings were a breakthrough in the understanding and management of MGD, he says.
First, he found that he could easily enter the MG and, with the probing technique, immediately and dramatically relieve symptoms. Secondly, he found through probing that the conventional understanding of MGD was "incomplete at best.