Tmei1.pnghe meibomian glands are small fat secreting glands located between your eyelashes and eyeballs. They are arranged vertically within the eyelid and are located with 30-40 in the upper lid and 20-30 in the lower lid. This oil produced (which there number over 100 types) helps to stop the water in the tears from evaporating, so helping to prevent dry eyes. The force of eyelid closure allows expression of the oils on the lid margin. As meibum interacts with the tear film, it reduces surface tension and enhances the tears by spreading them evenly, creating a smooth refractive surface and maintaining a consistent quality of vision.

Meibomian gland dysfunction is associated with dry eye in 86% of patients who suffer symptoms of dry eyes

In a patient with Meibomian Gland Dysfunction (MGD), the oils become thicker than normal and can lead to blockage of the narrow duct. Although oil production continues the quality of the oils is changed and reduced. Vision is affected because there is too much or too little oil in the tear film. This imbalance causes tear film instability, reduced tear film break-up time (TBUT) and evaporative dry eye, infections and potential cyst formation, e.g. Chalazion/styes.

Nearly 40% of routine eye care patients and 50% of contact lens wearers are affected with Meibominaitis or Meibomian Gland Dysfunction. In the early stages, patients are often asymptomatic, but if left unmanaged, MGD will either cause or exacerbate dry eye-like symptoms. Dryness, burning, itching, stickiness, foreign body sensation, watering, photophobia and intermittent blurred vision are frequently seen in cases of MGD.

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Diagnosis

Until now the main way of investigating Mebominaitis was clinical observation by your Ophthalmologists. However, 2 recent advances in diagnosis have helped in better understanding dry eye syndrome.

 

Lipiview

LipiView®- This technology allows the doctor to evaluate the lipid (oil) layer on your eye. Here's how it works: LipiView® takes extremely detailed images of your eye's tear film.

The procedure is non-invasive, can be performed in our office, and takes less than five minutes. If you've ever had a comprehensive eye exam, LipiView® will feel similar. The tear film can be clearly seen as an array of colors that are reflectedlipi.jpg when a light source is directed towards the front surface of the eye. Readings are instantly calculated and displayed on the LipiView® monitor.

Typically, our physician will perform a Meibomian gland evaluation.

LipiView® is an imaging device that is intended for use by a physician in adult patients to capture images of the tear film. The following conditions may affect the assessment of a patient's tear film using the LipiView®: Use of ophthalmic drops such as artificial tear lubricants, ointments, and medications. Patients should not use oil-based ophthalmic drops (e.g., Soothe®, Restasis®) for at least 12 hours prior to LipiView® assessment. Patients should not use ointments for at least 24 hours prior to LipiView® use. Patients should wait at least 4 hours after the instillation of all other ophthalmic drops prior to LipiView® use.

Soft or rigid contact lens wear. Patients should remove contact lenses at least 4 hours prior to device use. Use of oil-based facial cosmetics around the eye.

Eye rubbing.

Recent swimming in a chlorinated pool. Patients should not swim for at least 12 hours prior to LipiView® use.

Any ocular surface condition that affects the stability of the tear film. These conditions include disease, dystrophy, trauma, scarring, surgery, or abnormality.

 

Meibomian Gland Evaluator

gland.jpgThe Meibomian Gland Evaluator is designed to expert the same pressure as closing the eyelids to assess the functioning and blockage of the glands, through the slit lamp. It simulates the force applied to MG by a normal blink Gentle and consistent pressure is applied to the outer skin of the lower eyelid while visualizing the secretions from the meibomian gland orifices. The pressure applied to the eyelid when using the device is between 0.8 g/mm² and 1.2 g/mm² (0.3 PSI)

 

Treatment Options

In MGD patients, the reduction of symptoms is important, and the prevention of permanent damage that can affect the eye's ability to maintain a balanced environment is paramount. Education is an important parameter and the new Lipiview and Meibomian Gland Evaluator act as diagnostic and education tools. MGD is a chronic condition and requires a regular, if not daily, lid hygiene regimen.

  1. Dietary supplements like Omega 3 and Flaxseed oil are recommended as they have been proven to reduce symptoms of dry eyes. They are recommended by the Dry Eye Workshop (DEWS).
  2. Warm compresses. A study out of Oxford University found that heating the eyelids significantly increased meibomian oil production. This warms the meibum, allowing it to flow more freely, and helps soften lash debris.
  3. LipiFlow® is intended for the application of localized heat and pressure in adult patients with Meibomian Gland Dysfunction (MGD), also known as evaporative dry eye or lipid deficient dry eye. Unlike traditional treatments (e.g., warm compresses, wetting drops and ointments) that address dry eye symptoms, LipiFlow treats the root cause, the obstructed Meibomian glands. If left untreated, dry eye can lead to further ocular deterioration and additional problems. The goal of unblocking the glands is to allow them to resume their natural production of lipids required for a healthy tear film.
  4. Lid scrubs. These help to remove oil, bacteria and debris, as well as to stimulate the meibomian glands. Baby shampoo or mild soap have historically been. OcuSoft (OcuSoft) and SteriLid (Advanced Vision Research) are bactericidal products available commercially. These products may be less irritating to the conjunctiva than shampoo or soap. Lid scrubs may be prescribed at different steps within the lid hygiene regimen.
  5. Massage. Lid massage can dramatically improve symptoms by helping re-establish tear film stability. Research has demonstrated that, after gland expression, the tear film return to normal, and in some cases, super-normal levels. The Lipiflow Treatment allows this to be undertaken in a controlled manner to unblock the gland surface and express all abnormal oils by the using the gentle compressor system.
  6. Tetracycline. For ongoing management, tetracyclines are effective and useful. They reduce bacterial lipase production, reducing free fatty acids, which in turn lessens inflammation and symptoms of irritation.

If you have been affected by any of the symptoms mentioned above, please don't hesitate to give us a call.

We have a team of experts on stand-by who are ready to take your call at our Manchester (0161 907 2685) Clinic or our Blackpool (01253 308 031) Clinic.