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    Old 01-27-2004, 10:49 AM   #1
    jenn062
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    meibomian gland dysfunction

    Hi,

    I have very dry eyes, I had them for almost two years now. I been to so many eye docs I lost count, and had so many different diagnoses. Most of the docs say it it an eyelid problem, but I read were people with meibomitis have most symptoms in the morning, my symptoms are all day long. I am wondering if anyone has been diagnosed with MGD? and if they can tell me the symptoms ? I am so tired of getting this run around from these docs, they act like its normal to spend most of your day with goggles on. my eyes are never comfortable, the summer months are a little better but not much. Any info would be much appreciated!!

    Thanks Jenn

     
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    Old 01-27-2004, 06:48 PM   #2
    rianny
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    Re: meibomian gland dysfunction

    People without dry eye symptoms will never understand what it's like.

    I got this from Google:

    The Dry Eye Problem
    There are two main ways that people get dry
    eye – increased tear evaporation and decreased
    tear production.
    The root cause for “evaporative” dry eye
    is a condition called “meibomitis,” an inflammation
    of the meibomian oil glands in the
    eyelid. This inflammation of the meibomian
    glands chews away at the surface of the eye
    while the eyes are closed during sleep, causing
    the sandy-gritty eye irritation these
    patients experience when they first open
    their eyes in the morning. While various lid
    scrubs have been marketed for this condition,
    both doctors and patients are equally
    dissatisfied with their effectiveness. To
    date, there has not been an effective overthe-
    counter treatment for meibomitis.
    The oil normally produced by the meibomian
    glands in the eyelid coats the tear film
    acting like a biological plastic wrap to retard
    evaporation, keeping the eye moist. Meibomitis
    leads to evaporative dry eye by causing meibomian
    gland dysfunction – oil production by the glands
    decreases and the oils that are produced become
    thicker. With the reduction of the quantity and quality
    of the oil layer, evaporation increases and these patients
    develop dry eye. Doctors have not had any treatment
    available to treat meibomian gland dysfunction.
    The second main way people get dry eye is by
    decreased aqueous tear production. Aqueous tear production
    decreases due to any condition that decreases the
    function of the lacrimal glands, or any condition that
    decreases corneal sensation (just as irritated eyes tear
    more, numb eyes tear less). The top 4 causes of decreased
    tear secretion are rheumatoid arthritis, diabetes, long-term
    contact lens wear, and LASIK eye surgery. While there
    have been a multitude of artificial tears, gels, and ointments,
    there have been no treatments that actually
    increase lacrimal gland function.


    So, basically MGD can affect your eyes for all day long since tears keep evaporating. Have you tried antibiotics like tetracycline or doxycycline? I'm on tetracycline and Omega 3...but not expecting much.

    Also, there is an eyedrop called Restasis, which may increase the amount of tears produced. I read it is quite effective. I wish I could try it, but it seems like it is not available in Canada yet. Life is a nightmare with this stupid disease....*sigh*

     
    Old 01-28-2004, 05:05 AM   #3
    jenn062
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    Re: meibomian gland dysfunction

    Hi

    Thanks for your reply, it seems you know more about this, then some of my docs. I am on Doxycycline 50 mg a day, but I am not sure if thats enough, also I take flaxseed oil 2x aday and I been on Restasis since it came out in April it might of helped a little but I still get alot of symptoms, story of my life. I got upper plugs in and my eyes get real watery, but the symptoms are still there, but without plugs they are dry, sandy gritty. This has been a two year nightmare, and what makes it worst is I don't know anyone else with dry eyes, well not like mine. People think you put lubricating drops in and your eyes should feel great,WRONG. I can't really do much, and when I go shopping my eyes get so irritated they run down my face, thats an attractive look . The FDA is approving a new eyedrop for dry eyes, hopefully this month, but it will probly be a year before it is available. You mention you were taking antibiotics, what dose are you taking ?

    Thanks again, Jenn

     
    Old 01-28-2004, 11:05 PM   #4
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    Re: meibomian gland dysfunction

    Well, I wish I could even try Restasis. It is not available in Canada now.
    I sent an email to Allergan, and they said currently there is no plan to make it available in Canada.

    I'm on 750mg/day of tetracycline. Doses for doxycycline must be different from tetracycline, but I think I was on 100mg/day when I was taking doxycycline. Treatment with Doxycycline did not help me much because I did not take it long enough (only for 1.5 month). Maybe it should have worked if I take longer. I read that it takes at least 2-3 months to be effective.

    I searched for dose of doxycycline used to treat ocular rosacea, and it was 50-100mg/1-2times/day. I think it should be similar to that.

     
    Old 01-29-2004, 04:35 AM   #5
    jenn062
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    Re: meibomian gland dysfunction

    Hi,
    That too bad about Restasis, I wonder why they don,t make it in Canada, what part of Canada do you live, can,t you see a doc in the u.s and get a rx for it? I don't know how that would work? but it is probly worth looking in to.well I hope you get some soon.

    Thanks , Jenn

     
    Old 01-29-2004, 04:18 PM   #6
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    Re: meibomian gland dysfunction

    Jenn, sounds like you are still having more than your share of problems. I was in hopes you had found a solution by now.

    Like you, I am still battling blepharitis, better but not gone. The Occu-Soft EyeLid Scrub started irritaing my eyes and I had to quit using it on Q-Tip to cleanse inner edge of eyelids. I now use Refresh Plus to moisten Q-Tip and cleanse inner edge of eyelids then use the Occu-Soft on cotton pad to cleanse outside of eyes.

    I too wonder when it will all end and we will be comfortable again.

    Hang in there, surely there is hope for us.

     
    Old 01-30-2004, 06:47 AM   #7
    jenn062
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    Re: meibomian gland dysfunction

    Hi, How long have you had blepharitis? I think at one time I did, but now it is meibomian gland dysfunction. lucky me, I hoping all the warm compresses will work, but most times they make my eyes feel dry & itchy.

    Thanks again Jenn

     
    Old 01-30-2004, 04:08 PM   #8
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    Re: meibomian gland dysfunction

    I live in BC, and Seattle is pretty close from where I'm living. However, even if I can get to an opthamologist in states, I won't have any chance to get the price of Restasis with healthcare, will I?

     
    Old 01-31-2004, 12:20 AM   #9
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    Re: meibomian gland dysfunction

    Hi Rianny and Jenn062,

    I'm very new to this board (I just found it tonight!) but not to Dry Eye Syndrome (DES). I've had mine for over 12 years (dry eyes that is...I've had my eyes for 35! ). You'll notice in future posts I have a good sense of humor, you gotta with this problem not to mention I'm male and it's pretty hard to find other males to talk with about this, but not that they would anyway. Not too many things out there that are more intimate than the eyes and with guys, well...were just not generally into this type of thing. Don't blame us, it's the fault of that doggone "Y" chromosome!

    After doing some reading among the various posts here I felt I might have some significant input to offer those suffering.

    In regards to your concern Rianny about your inability to obtain Restasis in Canada you might try locating a pharmacy that can and more importantly will consider compounding cyclosporine 0.05% drops if you haven't already. This is the generic name for the above. I used this (prescribed by my HMO ophthalmologist) a good year before it's FDA approval. We (my MD and I) used a pharmacy in Northern California to produce it for me. I knew about this medication before my HMO MD, (not uncommon for me as I find I know more about current research than the overwhelming majority of ophthalmologists I meet). It (mine) came in a multi-dose, 10ml vial as opposed to the single use droppers of Restasis and it must be refrigerated. It's not as convenient, but it's the same medicine. I was also one of its test subjects in it's clinical trial. I've also participated in Inspire's INS365-mucin agonist solution and Allergan's topical androgen therapy trial, both to treat qualitative DES (versus quantitative that cyclosporine is aimed at). I have both types unfortunately (well, at least I'm well rounded).

    In regards to your question Jenn062 about what is Meibomian Gland Dysfunction (MGD). It is inflammation of the Meibomian glands, also known as "meibomitis" as stated in the article found by Rianny. The two primary causes are either infection or an immune mediated response. Examples: Staphylococcal infection (a bacteria found on the ocular surface, eyelids, skin etc.) or Sjogrens, a systemic autoimmune disorder. These are just two examples, there are many more. Either one affects the meibomian glands ability to properly produce the oils necessary to retain a stable tear film, thus helping to create an evaporative dry eye state. Simply creating more tears either through lacrimal gland stimulation as in reflex tearing from sticking a finger or foreign object in your eye (uuuuhhmm...not recommended!) or taking oral medications i.e. cholinergic muscarinics probably won't provide significant relief as the tear surface will still quickly evaporate (and in addition you have tears running down your face....oh what fun!!). The symptoms are very similar to quantitative dry eye (poor functioning lacrimal glands), with gritty, burning, foreign-body (f/b) sensation, photosensitivity etc. The only way to know for sure if you have MGD is to have your ophthamologist do a complete eye exam including measuring your tear Break Up Time (BUT) using one of the currently available methods and rose bengal or fluorescein staining using the slit lamp along with the Schirmers test. These are pretty common tests though and I would think any competent ophthalmologist would be utilizing these methods in his/her evaluation of you already.

    Personally I think qualitative DES is more problematic as you can at least make yourself tear more if you have quantitative dry eye. (I also use Pilocarpine a muscarinic medication used primarily for Sjogren's patients that causes increased salivation and lacrimation, prescribed experimentally by my personal non-HMO ophthalmologist). With meibomitis, simply lacrimating more does little to help and your symptoms never really get significant relief. (How do I spell relief? I never open my eyes!!). Hope this helps, wheeew!.

    -eek!

    My quote of the week: "I'm not crazy...just ask the voices."

    Last edited by eek!; 02-02-2004 at 07:21 PM. Reason: misspelling

     
    Old 01-31-2004, 11:15 AM   #10
    jenn062
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    Re: meibomian gland dysfunction

    Hi, eek!

    How did the ins365 work for you? I been waiting for that to get approved by the FDA, but they put a hold on it, so it won't be an other year before its available!!

    I seen many opthalmologist and they really can,t tell me which tear componant is lacking, I had that schirmers test done and that came out about 15 in each eye, but then again with plugs in and a piece of paper stuck in your eye what do they think gonna happen. I had the rose bengal test done and the suface of my eye only showed a couple of dry spots, and my tear break up time was I think every 3 or 4 seconds that is why I am pretty sure it is an oil problem, and a couple of the eye docs did say they didn't see any oil coming out and that I did have some Inflammation of the eyelids, well that all depends on which doc I see, they all have a different opion, I even had a couple of them say it looks like you have a healthy comfortable eye I ask them if they wanted to trade? my eyes are never comfortable.

    Also how did the topical androgens work out? I heard they are suppose help the meibomian glands function again.

    Thanks for the info. Jenn

    Last edited by jenn062; 01-31-2004 at 11:18 AM.

     
    Old 01-31-2004, 02:58 PM   #11
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    Re: meibomian gland dysfunction

    Hi Jenn,

    Wow, you Schirmered 15mm, that's actually pretty good, of course you probably already know that, but I see your tear break up time (TBUT) was only 3-4 sec , not so good. I'm curious to know if this test was done with or without topical anesthesia as the Schirmer done without will obviously irritate the ocular surface more and may even stimulate more reflex tearing. I regularly Schirmer, with anesthesia, 0-2mm with upper punctal plugs and lower permanent punctal occlusion and my TBUT is similar to yours of 4-5 sec.

    The Inspire study, I felt, made no noticeable difference to my symptoms, but then again it's a double-blind, placebo controlled study and neither my supervising MD or myself new if I even received the medication or control. I had, if I remember right a 1 in 4 chance of getting the medication in a significant dose. I may have received the lowest dose which might not be enough for relief.

    The androgen study seemed to help a little, but it to was similar in outline as the INS 365 trial and I do not know if I received the drug and/or what dose. It seemed to help though. It wasn't a "oh wow!" experience but it appeared to me to make a little difference (who knows, maybe I got the placebo!!). I feel my primary problem, even with the low Schirmer results, is qualitative DES and I am placing a great deal of hope on the androgen studies. This is got to work!, I keep telling myself, it just makes sense. I just wish the FDA approval process were a little quicker.

    I very much enjoyed your comment you wrote about asking your doctor if he/she would like to trade eyes! I'm not sure if it's a good idea to antagonize your treating physician but I grinned reading it and can certainly appreciate the feelings. My HMO ophthalmologist in frustration told me to move to Seattle (I live in San Diego, CA) which I found insulting, but later I thought about it and am uncertain if he was being sarcastic (he has a tendency to be) or serious (or maybe both!). Anyway, that's old history and I'm too positive a person to dwell on trivial matters (Am I referring to him or his statement?...You decide ). I've got too many more important things to deal with, uhmmm..let's see, like my health!

    I not sure how much you know about MGD and anatomy/physiology and chemistry of the human body but androgens are in the steroid class of medications. If your Schirmer results are consistently above 10mm and your TBUT is consistently below 10sec then your DES certainly qualifies itself a consideration of MGD (barring any other results from a thorough exam, I obviously do not know your results of other tests done so take this info for what it is, as they say in the rules "my opinion only"). If you have qualitative DES secondary to MGD, and from what I've read you may very well (but I'm not a MD ), you might try and ask your ophthalmologist if he/she is willing to try a one-time trial of current topical steriods already available on the market. There are a few and they posses significant potential side effects of increased ocular pressure (IOP) and glaucoma and cataracts. Any good MD should know this already though and keep you on it for a limited time only, (Important: regardless of a favorable symtom outcome). I've been placed on experimental topical steriods with some noticeable relief by a non-HMO ophthalmologist and was placed on loteprednol etabonate 0.5% ophthalmic suspension for one week. It along with good hydration (more accurately, preventing dehydration), a good nights sleep, pilocarpine 5mg orally and the androgen study have made the most difference (not at the same time).

    Interestingly enough, getting a good nights rest of at least 8 hours has made the most difference to me (insert head scratch here)?? The pilocarpine helps tremendously to make me lacrimate more (approx 10mm now, a five-fold increase) but these are not quality tears and I still suffer from chronic ocular discomfort. With your Schirmers of 15mm I really do not think you would be a good candidate for this medication and the price....ooouch!!! My HMO doesn't cover experimental medications and it costs me about $200 (from the U.S.) for a month.

    Well as you and others may tell, I have a tendency to be long winded but I consider myself an intelligent individual and I think accurate and up-to-date information is not only important, but absolutely necessary, so blah, blah, blah, blah, blah and blah!!

    eek!

    P.S. I'll have more info for you later, (if you enjoy hearing me blab!) but for now I have errands to run. I actually have a life outside my DES, (although sometimes I have my doubts). Sorry, don't wish to end in a downer, so have a great day everybody!!

    Last edited by eek!; 02-01-2004 at 01:03 PM. Reason: misspelling

     
    Old 01-31-2004, 04:11 PM   #12
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    Re: meibomian gland dysfunction

    Hi eek,
    Thanks for all the info, it seems like you know something about this.
    I know the FDA really drag their feet on things, the topical androgens won,t be available for 1 and half, it might as well be 10 years when you are in pain.
    Well anywho I got an appointment with a Dr. Gilbard in Boston Monday, he invented Thera tears I already paid his years salary, with all the drops I use, that don't work , hopefully he knows his stuff,but then again I'm still hoping for a magic drop!lol
    I have tried the topical steriods, it seem to really bother my eyes but everything does.

    Well have a good one. Thanks, Jenn

     
    Old 02-02-2004, 01:31 AM   #13
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    Re: meibomian gland dysfunction

    Hi there,

    I have read all your posts and wanted to add my experience with dry eyes to this discussion. I developed severe dry eyes seemingly overnight in April 2002 and have been very uncomfortable since. I have seen many opthamologists, some of which had no idea what the problem was. Thankfully my current eye specialist does and has gone some ways toward helping me. Just to give you an idea, I have scored ZERO on nearly all of my schirmers tests and have felt at times that I wanted to rip the eyelids off my face. My tear break up times were 6 seconds.

    I have been on Tetrex, minomycin and doxycycline which was the most beneficial ( 100mg a day). I took antibiotics for about 18 months and only recently stopped due to stomach/digestive problems. I started on restasis in December 2003 and have had some relief so far. My eye doctor says that my blepharitis and eye inflammation has reduced somewhat. By the way, restasis is still an unregistered and unapproved drug for sale in Australia and my eye doctor had to write to the Australian government with my schirmer results to get approval to have it imported into the country AND I had to buy 6 months worth in advance! Also, he has to justify importing the drugs into the country by doing a schirmer test every 6 months to prove that it is helping!!!

    My eye doctor told me that the meibomian gland dysfuntion is caused by " the male hormone cell receptors not working properly". Does anyone know what the hell this means? I have searched the internet with no luck.

    I also use warm compresses and clean my eyes twice a day with diluted baby shampoo. I use eye gel during the day and ointment at night when sleeping and am just coping with this awful problem.

    I was also put on Plaquenil and prednisone for short periods to see whether that would help. It didn't. I have been tested a number of times for sjogrens and other autoimmune diseases with negative outomes.

    I hope that some of the newer creams and medication they have on the market help all of us.
    Christine

     
    Old 02-02-2004, 03:26 PM   #14
    jenn062
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    Re: meibomian gland dysfunction

    HI Christine,

    Thanks for the reply, the male hormone cell your doctor was talking about, I believe are androgens but i am not really sure

    They are doing a phase 3 study on topical androgens now .but it probly won't be available for another year or so, I don,t know what takes them so long.
    So you were taking 100 mg of doxycycline, my doc only prescribed me 50 mg , and how long does it take to work?

    Thanks, Jenn

     
    Old 02-02-2004, 07:10 PM   #15
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    Re: meibomian gland dysfunction

    Hi Jenn,

    How did your MD visit turn out? That's great your close enough to see a "doc" of this caliber! (I'm quite envious ) I tried his Thera Tears and they didn't do much for me either unfortunately. At least this is a MD whose really focused on our condition. Great news for you! I recently found a new eye drop by Allergan that works the best for me (which is not so great, but better than anything else). It's name is Refresh Endura. This is a truly unique, new formula. It contains castor oil and is designed to help all three components of the tear film. I've included a short excerpt from Steven Wilson, MD who I believe is a staff member of the University of Washington, School of Medicine in Seattle, WA.

    Refresh Endura is a preservative-free emulsion with ingredients which treat all three layers of the tear film. In addition to an aqueous component, Refresh Endura contains a demulcent that enhances the mucin layer of the tears along with a lipid component, castor oil. It too seems to provide long-lasting relief.
    “The surprising efficacy observed in the vehicle arm was one of the factors which delayed approval of Restasis. Although it had no benefit in improving measures of the underlying inflammation, the study results revealed the vehicle itself was quite effective in improving comfort,” Dr Wilson explained.


    He's correct in my book. During the Restasis clinical trial, we (the patients) were given the actual medicine during the first few weeks, which helped reasonably well and then we were switched to the "other drops" which no one involved was made aware of whom got what.

    The problem Allergan faced was the first medicine with the cyclosporine, also had this new vehicle that the medicine was dissolved within. The drug study soon revealed castor oil, in itself, had therapeutic qualities and they (Allergan) couldn't decide if the relief patients were getting was from the oil or the cyclosporine! Ooops! The result? They had to repeat this phase of the clinical trial over. I believe the castor oil helps more with qualitative dry eye i.e. meibomitis type sypmtoms. The important question we all want to know of course is; "How much does it help?". Well, for me it helps a little, enough that I will continue with it. This is saying a lot from me, as I have found no relief with any other Refresh product or any other otc eye drop. Give it a try and let me know if it helps!

    Wish you all my best,

    Kee

    Last edited by eek!; 02-02-2004 at 07:27 PM.

     
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