Dry Eye occurs when there is an imbalance of tears that leads to inflammation of the ocular surface that builds on itself over time, causing irritation, discomfort, blurred vision, FB sensation etc. One might think the stimulus is not having enough watery tears, but in reality 86% of DED has an MGD component. Even if you have Sjogrens syndrome and think you won't benefit from any of our new interventional dry eye treatments, you could be very wrong. I’ll explain more in today’s video.
This is eye school with me, Dr. D where I teach you about products and treatments related to dry eye syndrome and eye beauty. I’m an eye doctor that treats patients with dry eye and I pay special attention to makeup and skincare, I even have an esthetician that I work closely with in my practice. I’m obsessed with helping you achieve beautiful, comfortable healthy eyes.
Meibomian glands: what are they and how do they work?
Meibomian glands are sebaceous glands located all along both your upper and lower eyelids. They play an important role in producing and protecting your tears.
There is a beautiful drawing of mine in the video that shows the meibomian glands. You can see that they are located in both the upper and lower lids, and that they are long vertically oriented glands. Their openings are located along what many call the “water line” or the edge of the eyelid.
Although many of us believe that our tears come from one place- the lacrimal gland and that they’re fairly simple - just “water” - that could not be further from the truth. In reality, your tears are produced from the goblet cells on the conjunctiva, the lacrimal gland as well as the meibomian glands and there's other accessory glands that produce tears as well.
Each and every time you blink, those little glands are gently compressed, releasing oil into your tears. It’s this oil that protects the tears and prevents evaporation. Have you ever gone outside on a windy day, and felt your eyes burn and water immediately? That’s often the sign of a poor oily layer of your tears. Because the tears lack the top layer of oil, the watery part evaporates quickly in the wind and causes symptoms.
In the video I shared a diagram of the layers of a healthy tear film illustrating those layers I described and how the lipid layer is the very top layer, protecting and sealing the others to your eye and preventing dryness.
What causes MGD?
So your next question might be "what causes Meibomian Gland Dysfunction?" Well there are a myriad of things: demodex, bacterial infections or bacterial overpopulation of the lid margin like occurs in blepharitis, rosacea, environment (computer use, lack of blinking leads to a stagnation of the glands and then thickening), hormonal changes, retinol use, use of cosmetics and glues and other anti-aging things around the eyes, like bakuchiol for example, allergic conjunctivitis, autoimmune disease, inflammation of the cornea or conjunctiva, high cholesterol could even be a cause, so there are many causes for Meibomian Gland Dysfunction. Even preservatives can cause it.
So why do I claim that Dry Eye Disease IS Meibomian Gland Dysfunction? Clinically, Meibomian Gland Dysfunction is super prevalent, and even my patients with Sjogrens syndrome or other autoimmune disease, which you might think would cause a purely aqueous deficient situation, do indeed have Meibomian Gland Dysfunction present.
In one study, 224 subjects with Dry Eye Disease were examined using an objective severity scale, 159 were classified into 1 of 3 categories:
79 were classified with only Meibomian Gland Dysfunction
whereas only 23 were classified as purely aqueous deficient
and 57 showed evidence of both Meibomian Gland Dysfunction and aqueous deficiency
Overall, 86% of these qualified Dry Eye Disease patients demonstrated signs of Meibomian Gland Dysfunction.
This is why I say it’s much more common to have Meibomian Gland Dysfunction than not, and even if you’ve been diagnosed with Sjogrens, the newer interventional dry eye treatments may still be helpful to you.
Here is a case study of Meibomian Gland Dysfunction causing Dry Eye Disease
I have shared one of my clinical cases for you in the video. This is a gentleman that I've seen over the course of several years many, many times. This is a 72 year old caucasian gentleman with an extensive history of psoriasis and rosacea. When we take a look at his meibomian gland atrophy. His initial dry eye score was severe and tear break up time was instant. In the video you can watch me performing intense pulsed light, TearCare,and you'll see him sitting under our photobiomodulation device as well.
I also show you the oil expressing from his glands, you can see how thick and yellow and in some areas there is no oil coming out at all and that's representative of atrophic glands. In his case, it was his ocular rosacea and psoriasis that lead to Meibomian Gland Dysfunction, probably with additional factors as well. In this case, Meibomian Gland Dysfunction has caused a tear imbalance leading to dry eye but the initial cause was Meibomian Gland Dysfunction. This caused a tear imbalance that led to dry eye but the initial cause was Meibomian Gland Dysfunction and if you don't control the inflammation and clear the obstruction, you'll get nowhere in a case like this.
Let me know in the comments below if you’ve been diagnosed with Meibomian Gland Dysfunction and what has helped your condition.
That’s it for today's lesson, class is dismissed. I’ll see you next time!