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jsr 10-25-2004 07:32 PM

Meibomian gland dysfunction
Hey all,

I am 23 years old and was recently diagnosed with meibomian gland dysfunction (posterior blepharitis). I have been suffering since this past january and it has been hell. I had been wearing contacts for years, and for the past two years my eyes were really dry and sometimes my vision got blurry, but I just used rewetting drops because my routine opthalmologist never told me that I had anything. When it got bad this year, I was initially diagnosed with mild GPC from my contact use (which I do have), but I went from doctor to doctor, and basically got prescribed all sorts of anti-histamines, anti-inflammatories, as well as steroids with no luck, except elevated pressure in my eyes! I decided I needed to see the best.

I am a first year medical student in baltimore and have been desperate to control this problem so that I can study - I went and saw a specialist at hopkins who diagnosed blepharitis, and she put me on erythmocyin, doxycycline and told me to do the usual warm compresses. I have been on this treatment for about a month and I am very worried because I still have seen no improvement. My eyes are blurry, they burn, get extremely tired easily, feel gritty and sandy, and I have extreme light sensitivity. I have been using thera tears, wash my eyes a few times a day with a warm cloth, massage them, clean them with baby shampoo, but they just seem to be very temporary relievers of my symptoms.

I do not know what to do - I am afraid that this situation is not going to get any better and that I am going to have to deal with this awful situation forever (I know it is chronic, but isnt acute management supposed to put it into "remission"?) I am willing to be diligent and do all that I need to do, but I feel sort of hopeless right now - i just bought some ocusoft lid scrubs and am going to try that as well. It worries me even more because I am going into a profession in which i will be reading a lot and I heard that stress can exacerbate it (great!) will i ever be able to wear contacts again? - i dont even feel like i can see as well in glasses. does it take longer for the medication to work? is there hope for me?

Thanks in advance for all the comments - I have read everything on this site already but I didnt feel like there was that much addressing this condition


Montgumski 10-25-2004 09:00 PM

Your eyes can get better, it just takes time.
First of all, relax. I know its a serious problem because I have it too, but your not helping your health anybody by worrying.

Now, about the meibomian gland dysfunction, what did your doctor say was the cause? It's very important to know the cause, some people here have acne rosacea, sebhorreic dermatitis, adverse drug reactions from accutane, the list goes on. You need to tailor your treatment to whatever you think caused it.

Another thing you should know is your surrounding facial skin and the health of your skin can contribute significantly to your eye comfort or discomfort.

I had bad sebhorriec dermatitis and once I treated that my eyes got better.

ajneedhams 10-26-2004 09:28 AM

Re: Meibomian gland dysfunction

I totally know how helpless you feel. I have the ocular rosacea form of MGD. I have been on the doxy for 6 wks and I keep hoping to see some long term improvement. Oh, I will have 1 or 2 good days, but then the burning and stinging, scratchy feeling returns. My Dr wants me to take the doxy for 6 months (at least)

I really can identify how you feel. I wore contacts happily for 20 yrs (I'm 35) and then one day, I got pink eye from my daughter, and I never have been the same. It led me to believe that the infection caused my dry eyes, but the Drs seem to think it only exacerbated an underlying condition. I don't quite get it and I am beginning to think these Drs know very little. Even though I have some meibomian gland dysfunction, I know that I also have lacrimal dysfunction as well. Were you tested with a Schirmer's test for baseline tearing etc? my eyes don't water much with this condition.

Keep up with the warm compresses and the lid massages. There are some newer things on the horizon. One (in which I haven't yet tried) is the eye drop "Soothe" which is available to order over the counter from any pharmacy and is available on the shelf at any Medicine Shoppe Pharmacy right now. I haven't yet tried it but it is a lipid replacement that is supposed to last 8 hrs. I hope it is better than Refresh Endura because that stuff stings my eyes. I'm guessing it is the castor oil component. Also there is a new RX drug called Diquefosil (sp?) that is coming out soon that may be able to help a lot of our related suffering. Keep hope.

Good luck and pop in and let us know how you're progress goes.


CSLewis 10-26-2004 02:15 PM

Re: Meibomian gland dysfunction
Hi - I have MGD, too. I first got it about 2 years ago. I'm in my 30's and never had any eye problems before all this happened. My ophth. thinks it may be related to rosacea, but I don't appear to have any skin problems, so he's not sure what caused it(?). And I don't wear contacts, so that's definitely not the source of my eye problems. I wish I knew what it was that set everything off.

It took me almost a whole year to get this condition under control. It was my worst nightmare! I didn't get any sleep because my eyes were just burning all the time and felt like they had sand in them. My ophth. told me that the healing process would be very slow and not to expect any great improvement for a long time. Wow - was he ever right. But now my eyes are fine and the meibomian glands have regained their function. I have been symptom-free for about a year now. So there is definitely hope for people with MGD to live normal lives, once the symptoms are brought under control. I attribute my recovery to warm compresses, preservative-free artificial tears, doxycycline, and a good, caring doctor. I've stayed away from things like steroids, punctal plugs, NSAIDS, etc. I tried changing my diet for a while there, too, but I didn't notice any real link - except for drinking lots of water, which does in fact seem to help.


ajneedhams 10-26-2004 04:07 PM

Re: Meibomian gland dysfunction
In my quest for info on ocular rosacea- I had gone back in the archive boards and found many of your posts. It is so unbelievably good to hear that you are now doing so well after all this time. My story and symptoms sounded very similar to yours and my onset of ocular rosacea came on at a very stressful time in my life as well. I there is a link. I assume you are off the Doxy now. That is great.


jsr 10-26-2004 04:35 PM

Re: Meibomian gland dysfunction
thank you everybody for the quick responses

mont - sorry i sounded like i was having a panic attack - I guess it came out a little stronger in writing! - its just very frustrating when i need to constantly study and my eyes hurt so much - for about a week, i came home to my apt and would take 3 hour naps - so i prob was depressed as well from this condition, but even when i wake up my from the naps and in the morning, my eyes are tired.

I dont know exactly the cause - the doc i saw kind of took care of me fast and then threw me out (but she didnt make me pay for some reason :) ) - she was actually really great, but I will ask her more questions when i do my follow up - I know that I have the meibomian gland dysfunction, but Im assuming that it came about as a result of repeated infections - i was a contact wearer and I got GPC earlier this year - after my eyes had been dry for a while - i dont know if i had GPC or MGD first (GPC was just diagnosed earlier), but I also used to as a kid get pink eye often (maybe once a year) and also styes - I took good care of my eyes, but I guess i was just prone to infeciton for some reason, even though i have no other medical conditions and have been in good shape my whole life. But maybe its another cause - rosacea? I dont know - I am light skinned, get flushed easily on my nose and cheeks, but i've never had any skin problems on my face (acne, etc)

I would say that my biggest problem is blurriness and dry eyes/very tired eyes(burning)- i just got my prescription changed, but neither this prescription (even though i read 20/20 in the office) nor the last one seemed to be drastically different in terms of improving this blurriness - its almost like a fishbowl effect when i look out or a distortion - Im hoping that the blepharitis is the main cause of this blurriness as my eyes are not being coated properly, but I also havent seen to many people complain about this and I dont know if the routine treatment is going to really attack this.

I will try all of the recommendations that everyone has posted here - thanks ajneedhams and CSLewis as well!


calibug 10-26-2004 06:53 PM

Re: Meibomian gland dysfunction

Sorry to hear about the MGD. I have it too. You should really check into a link with rosacea. If you have some redness on your face, you could be developing it. I started with the eye symptoms and never had any skin problems of the sort. After about a year or so of the eye symptoms, I started to develop the skin problems.

If rosacea is the cause, you should treat the skin and possibly the eye symptoms will calm down. I am doing better after months of doxcycline. I'm not 100 percent normal and my eyes flare up but I do have a lot more good days. You've got to keep up the warm (not hot) compresses and the cleaning as well. I think this stuff takes a long time to get under control.

Jen - are you still taking the doxycycline?? Did you have visible blood vessels on your eyelids? I have a pink rim around the edges of the eyelids esp. on top. Looks like pink eye liner.

Good luck, Jeff....if you are interested there are some pretty good posts on the dry eye please help thread...even about MGD.


purple2067 10-26-2004 07:29 PM

Re: Meibomian gland dysfunction
jsr - you are in Baltimore? Go see Dr. Terrence O'Brien at John's Hopkins Wilmer Eye Institute, Greenspring Station on Falls Road in Lutherville. He's one of the best corneal and dry eye specialists in the world. I am in New York, and every doctor that I saw or spoke to here told me to get down to Maryland to see him. I love him. He is trying to get me into a study for Diquafosol that he will be running soon. Tell him Elyse sent you. He'll know exactly who you are talking about. :)

jsr 10-26-2004 07:39 PM

Re: Meibomian gland dysfunction
hey purple!

thanks so much for the advice - when I scheduled my first appointment, they set me up with Esen Akpek and said she was the best for what I was complaining about - have you ever heard of her? She is really good, but maybe I should make an appointment with him...

thanks again


jsr 10-27-2004 05:47 PM

Re: Meibomian gland dysfunction
just curious, has anyone else had very distorted/blurry vision as their main problem with posterior blepharitis, alongside a general malaise feeling? I hope I am not blurry for years



jdn5764 10-28-2004 02:30 AM

Re: Meibomian gland dysfunction
I've had so called "blepharitis" for two years now, vision is very bad in right eye, so much so the pupil no longer dilates, everything is blurred and dark and eyelid droops. constant swelling feeling in eyelid 24 hours per day.

Two years on I still haven't got used to the blurred dark vision in my right eye, I don't think I ever will and am at the stage now where I don't think my life will ever be as it was due to this.

Montgumski 10-28-2004 03:24 AM

jsr, blurry vision is quite common, I would imagine
Since the tear film quality is poor, the tear film does not spread evenly. Even though the tear film is very thin, it does have some effect in the way the eye refracts light. Also, if your a long time dry eye sufferer, dry spots could have developed on your cornea and are therefore causing more refractive errors known as higher order aberrations. Higher order aberrations cannot usually be corrected by glasses, the only thing that I know of that does a good job of taking care of these higher order aberrations is lasik or lasek eye surgery.

And, if your like me, that is where the problem lies. Laser eye surgery will take care of the higher order abberrations but it can also make dry eyes worse. It's a catch 22.

Another thing worth noting with higher order aberrations is that they can reduce your visual acuity. A reduction in visual acuity can tire your eyes quickly causing eye teaming problems, which is just another way of describing eyestrain. A lot of people dont know this, but eyestrain can cause symptoms of attention deficit disorder.

lulu04 10-28-2004 09:05 AM

Re: Meibomian gland dysfunction
To CSLewis: Jen2003, is that you? If so, I'm glad to see you're still checking in! :)

I had asked you many questions, way back when, regarding posterior blepharitis/MGD; at the time, my doctors couldn't figure out what was wrong with my (always red) eyes. My fourth doctor finally diagnosed me with MGD, and I am now on Doxy (100mg per day, controlled release). It's only been 3 weeks, but there are some hours (not days, yet) when my eyes feel somewhat normal.

Are you still taking the Doxy? If not, how long were you on it?

Thanks again; your posts were very helpful to me in finally reaching a diagnosis!

purple2067 10-28-2004 08:40 PM

Re: Meibomian gland dysfunction
JSR, I see that you are in Baltimore. You might want to go see Dr. Terry O'Brien. He's one of the country's leading dry eye specialists. He's my doctor. He's the chief of the cornea service at John's Hopkins' Wilmer Eye Institute. He's absolutely wonderful. If anybody can tell you what is wrong, and help you, he can. He is at the Wilmer Laser Vision Center at Greenspring Station, Falls Road, Lutherville, MD. I live in NY and continue to see my local doctor. But about 3 or 4 times a year I make the trip down to Maryland to see Dr. O'Brien, and my local doctor communicates with him about me throughout the year. He has some very good ideas.

CSLewis 10-29-2004 11:53 AM

Re: Meibomian gland dysfunction
Hi lulu (et al) - yea, it's me (Jen2003). I haven't been checking the boards for a while so I forgot my password, etc. Also, I was banned as Jen2003 because I let my old email account lapse and wasn't checking it - so don't let that happen to you! :)

I'm glad to hear you finally got a proper diagnosis. That really sucks when you don't know what's wrong. And you definitely need to give the doxy more time before you start noticing any real improvement. I have been off and on the doxy (50mg/day) for the last year now. I went for a month without taking it, then back on for a few months, then off again for a couple months, and so on. My doctor is weaning me off of it so I'll finally be done with it in December - yeah!!! I actually was going to stop taking it altogether a while back, but that was against my doctor's advice. I wasn't experiencing any side effects from it, so he convinced me to keep taking it for a little while longer, since he can still see signs of inflammation (although I'm not experiencing any symptoms). I see my doctor every four months and will probably have to do so for the rest of my life. :( But if that's what's going to keep me symptom-free, that's okay by me! I have excellent insurance through my employment so my doctor visits are fully covered. Phew! And I really like my doctor - very caring and supportive. One of the most important things he did for me was to relieve my anxiety. His reassurance that I would eventually get better did wonders for my recovery.

It's good to hear that you are actually starting to experience some moments of relief, albeit they are brief. But that's a GREAT sign! You may have turned the corner. That's what happened to me. I noticed I was having to use the artificial tears less and less, and I was actually able to sleep through the whole night without that burning sensation. My progress was VERY slow. I'd say that it took a good 5 months, from the time I started doxycycline, to get to the point where I was no longer dependent on artificial tears and I was starting to feel "normal" again. I just couldn't believe it when I was finally able to make it through a WHOLE day without having to use the tears! That was a huge breakthrough for me. But even now, although I am symptom-free at this point, there isn't a day (or maybe even an hour!) that goes by that I don't think about what has happened to me and my eyes. It is the most terrible thing I've ever had to deal with, so I don't take it for granted that I've made it to this point. Back when this all first started to happen to me, I never thought I'd see this day. So hang in there and try your hardest to stay positive. A good attitude and patience will go a long way. :)


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