Dry eye is one of the most common problems we see in the office and can be the cause for a variety of symptoms including discomfort, irritation, itching, redness, foreign body sensation, reflex tearing (yes, dryness of the surface of the eye can actually cause you to produce tears that spill out of the eye), and even blurred vision and pain. These are symptoms that almost everyone has experienced at one time or another. Oftentimes when I talk about dry eye symptoms and how to treat these problems, patients ask – “Why is this happening?”
There are many potential causes of dry eye, but today I will discuss one of the most common: meibomian gland dysfunction.
What is meibomian gland dysfunction?
The meibomian glands are specialized oil glands of the skin that are arranged rows along the edge of each eyelid (there are between 20 and 40 glands within each of our upper and lower lids). The openings of these glands are located very near to the edge of the eyelid and the eyelashes. Each of these tiny meibomian glands produces an oily substance that exits at the opening of the gland and becomes a part of the tear film. In a normal patient, a smooth, even layer of tears coats the surface of the eye at all times, and the oils from the meibomian glands form a very thin layer on the surface of this tear film. Similar to the function of a pool cover floating on the surface of a pool, this oily layer protects the tears and prevents them from evaporating (see diagram). In this way, the oil layer that comes from these important glands helps the tears to work better. On the other hand, anything that causes dysfunction of the meibomian glands can lead to loss of this oil layer and abnormal evaporation of the patient’s tears – which leads to burning, stinging, pain, and blurred vision.
What can cause meibomian gland dysfunction?
Sometimes it is hard for patients to believe that something so small as tiny oil glands can impact one’s comfort or even one’s vision, but severe meibomian gland dysfunction can do just that. Meibomian gland function can be affected by advancing age, diet, changes in weather and environment, hormonal changes, diet, smoking, alcohol consumption, skin diseases such as rosacea and other systemic diseases – most patients who suffer from dry eye symptoms (the myriad of which are listed above) have some degree of meibomian gland dysfunction. Therefore, in addition to treating dry eye patients with prescription drops (like Restasis or Xiidra to increase tear production) and tear supplementation with artificial tears, treating the concomitant problem of poorly functioning oil glands can greatly improve a patient’s symptoms.
How do we treat meibomian gland dysfunction?
The foundation of treatment for meibomian gland dysfunction and associated dry eyes is to use frequent artificial tears for any symptoms and to perform a routine method of cleaning the skin (and thereby the openings of the meibomian glands) along the edges of the eyelids. This involves a 3 step process:
1) Apply a warm washcloth, warm compress, or hot pack over closed eyelids for at least 5 minutes
– One option is to stand in the shower with a hot washcloth over the closed eyelids, continually reheating the cloth with the hot running water
– Some patients prefer to use re-heatable masks (available for purchase in our optical shop) which can maintain heat for an even longer period over closed eyelids
This step helps to open up the pores in the skin and the openings of the meibomian glands.
2) Immediately after the hot compress, close your eyes gently and clean the skin along the edges of the eyelids with soap, baby shampoo, or a facial cleanser.
– Baby shampoo works well, as it is a gentle, tear-free soap
– A foaming tea-tree oil cleanser (available for purchase in our office)
This step helps to clean out any oils or debris that cause plugging of the openings of the meibomian glands.
3) Rinse away the soap and debris with water and apply a lubricating eye drop to both eyes
We tell patients with dry eye symptoms that this 3 step process should be a part of their daily routine – like brushing your teeth. Performing eyelid cleaning in this manner 1-2 times per day can greatly improve dry eye symptoms.
What if drops and eyelid cleaning are not enough? What if I don’t have time to do these things or if I am interested in other treatments?
In addition to using artificial tears and performing eyelid cleaning, other treatments such as oral omega 3 and flaxseed oil supplementation and oral prescription medications are available to improve meibomian gland function.
One particularly promising option for patients with dry eye symptoms is a new in-office treatment called Lipiflow. The Lipiflow machine is connected to a disposable pad that heats the eyelid to a temperature of 108 degrees Fahrenheit (warm but not uncomfortable!) and massages the lid to clean and unplug the meibomian glands over a 12-minute treatment. If performing daily eyelid cleaning is like brushing one’s teeth, have a Lipiflow treatment is analogous to having your teeth polished and cleaned in the dentist’s office. Many of our patients have said that Lipiflow treatment is actually a very pleasant, almost spa-like experience and the results have been excellent.
Patients who are interested in Lipiflow must first be evaluated as candidates in an Advanced Dry Eye Evaluation. We have a number of days designated for these evaluations at our Creve Coeur office each month. If you think you have dry eye, meibomian gland dysfunction, or would like to schedule an Advanced Dry Eye Evaluation, you can contact our office at (314) 567-7771.
As always, if you have any questions about this topic or any other topic pertaining to eye care, please feel free to email me, Dr. Geoffrey Hill, at firstname.lastname@example.org