Meibomian gland disease and blepharitis are an overlap disease and I will begin to explain
to you as follows – the lid of the eye is divided up into two sections, one in the front
and one at the back. The one in the front is where the eyelashes come out – when you
get deposits on the eyelashes, that is known as anterior blepharitis, that usually
comes from infection and other deposits. When this is the case, often the bacteria leak
into the eye and cause an uncomfortable feeling and a foreign body sensation, as well as burning
and itching. This is something which can be easily treated. Now with regards to the back
of the lid which is where the meibomian glands lie, this is where you get meibomian gland
disease, sometimes known as posterior blepharitis.
Posterior blepharitis was the common name but as we began to understand the disease
process, we understand that this has become a condition which is really more typified
by a dysfunction in the meibomian glands as a result of very poor oil layer production.
When the oil gets produced as you will see in the associated photograph which you are
going to see in a moment, the oils become blocked and inspissated and the gland begins
to produce less good quality oils. Type 1 are good quality oils and type 2 are poor
quality oils. The glands begin to produce poor quality oils – the poor quality of
the oils, there is an insufficient oil layer over the cornea. The tear lake is made up
of a water layer, a mucin layer, as well as an oil layer. The oil layer prevents evaporation.
With an insufficient oil layer, the eye begins to evaporate and as a result will lead to
a dry eye disease known as evaporative dry eye.
The symptoms of meibomian gland disease also known as posterior blepharitis include numerous
symptoms, some of which are burning of the eye, fatigue, foreign body sensation, a feeling
of a dry eye and many other symptoms, sometimes such as intermittent blurring of vision and
difficulty at falling asleep at nighttime due to the foreign body sensation that one may be feeling.
Well as we spoke about anterior blepharitis being deposits on the lids, that
can easily be dealt with by yourself. The best thing for you to do is to take a commercially
available lid wipe and clean your lids. We used to treat patients using diluted baby
shampoo, but now we know that it upsets the tear film layer and makes it unstable, even
worsening the disease, so please avoid baby shampoo as best as possible. With regards
to the posterior disease known as Meibomian gland disease, hot compresses are really the
the mainstay of treatment. Hot compresses increase the heat to the lid, melting the oils and allowing
the opportunity for you with using digital pressure to get rid of all the oils from the
lids. Make sure after you've used the heat on the eye to put digital pressure onto the
lids – at the top and then at the bottom. If you fail to do so, you would just have
heated up the eyes, melted the oils and it will just re-solidify and not come out. Which
are the best bags to use? Well, there are very many bags available commercially, pop
into your local optometrist and he or she should be able to help you out.
First of all, you need to see if the diagnosis is accurate because it can be allergic diseases
associated with the problem or there can be another pathology as well which can be easily
missed and sometimes mistaken for meibomian gland disease. In reality, we also have to
see if there is coexisting disease, often blepharitis or meibomian gland disease coexist
with other forms of dry eye such as the water layer insufficiency as well as many other
inflammatory and effects of processes, this you need to get treated in order to improve
the condition of the eye. You will also need to see if there's coexistent damage to the
cornea and to treat that. If there is damage to the cornea, this will often result in a
very uncomfortable eye and also an increased risk of infection. We need to treat this coexisting
damage to make certain that it heals adequately and in order to prevent infection and to also
give you a much more comfortable eye. Meibomian gland disease is sometimes associated
with rosacea and only a specialist ophthalmologist can actually treat this for you.
When you come to see an ophthalmologist, he or she will give you special treatment of the associated
diseases such as the rosacea. He may put you onto some tablets such as doxycycline to treat
that problem. In addition, he will give special attention to the cornea and will advise you
on the use of the most appropriate artificial tears. The ophthalmologist will also give
you special attention to the inflammatory changes that are occurring in the dry eye
disease. When there are evaporative changes, the tears become hyperosmolar which means
there's a high concentration of salts and this leads to damage to the cornea and causes
inflammatory changes. The ophthalmologist will be able to give you particular care to
reduce the inflammatory changes in the eye using drops such as steroid drops
and this will definitely modify the long-term outcome of your disease, if it is appropriate
for you. The ophthalmologist may also choose to add omega-3 to your regime. Omega-3 is
very good for changing the consistency of the oil as well as reducing inflammatory changes
around the eye. The next part of the treatment is probably
the mainstay of the treatment and that is emptying of the meibomian glands. If you look
back at this photograph, you will see that if the gland is blocked, the oils will not
be getting out and the best thing for us to do is actually to melt the oils and allow
the oil to come out. Now there are various mechanisms by which this can be done in the
office but the best of which I believe is LipiFlow. The reason why I think LipiFlow
is the gold standard in this day and age is because LipiFlow gives heat to the eye, it
protects the cornea and therefore no heat damage can occur in the cornea itself. The
heat is given specifically to the lid from the back of the lid. The reason for this is
that the heat can then directly go into the lid, into the meibomian glands which are located
at the back, bypassing all the tissue from the front and then simultaneously LipiFlow,
which is computer-controlled will begin to give simultaneous pressure to the eye and
extrude all the oils during the same process. We are not waiting for an extrusion process
after the oils have melted, we are doing it at exactly the same time. In this way, we
are giving a complete kick start to the whole process. Once the glands are completely emptied,
they are able to recover again and begin to produce normal oils and hopefully they will
give you a significant improvement in your quality of life and in your dry eye symptoms.
Unfortunately, we don't really fully understand the disease process and even though we can
give you effective treatments, unfortunately the disease can come back, however, you should
understand that if you've treated it in the first place, you're going to prevent yourself
long-term damage. LipiFlow or similar treatments will prevent long-term atrophy which will
occur if you don't treat it in the first place. If you do not treat it, there will be ongoing
damage and the glands will just atrophy away. LipiFlow treatment or the similar will certainly
hold that process and even though the disease may come back, the final outcome will be much
improved with significantly reduced atrophy in the long term.