How can I improve my meibomian gland function?
Patients who have meibomian gland dysfunction have to try to improve the meibomian gland function by home eye care regimes and adjunctive treatments here at Clinica London. In my last blog post, I briefly mentioned eyelid hygiene and home maintenance plus diet and Omega supplements, that the patient could regularly do at home. In this blog, I want to talk more about what we offer patients here in the clinic to help them manage their meibomian gland dysfunction (MGD) and hence improve the function of the oily Meibomian glands in their eyelids.
There are several areas that we can help
First of all, I can prescribe Lymecycline tablets for two and four months initially, one tablet a day. I consider whether there may be Dermadex mites and if present, recommend Azithromycin drops and tablets for one to two weeks.
In the clinic:
- We can do MiBo Thermoflo here at Clinica London, which is where the nurse does a half hour session of heating the eyelids and then massaging and expressing the unhealthy oil.
- We do BlephEx treatment which is a lid margin curettage done lightly with a rapidly spinning sponge and some cleaning foam to remove the biofilm from the lid margin, crusts from the lash roots and lift off Meibomian gland orifice plugs.
Taking each one of these, in turn, Lymecycline tablets act in an anti-inflammatory way, as well as having antibacterial action. They are best used for at least two months because they do not start to work for about two months. Some patients find four months is enough, but several find that they have to continue for eight months and then after stopping for a few months, then have another course. Fortunately, the side effects of Lymecycline are few but in a very small number of patients include mild nausea, headache and skin reactions.
MiBo Thermoflo is well tolerated. A small amount of gel is put on the surface of the eyelids and using a warm metal probe, which does not hurt. The eyelid temperature is heated to that which will help it to have more fluid oil and then the eyelid oil is expressed with massage. This helps to empty the eyelid glands of the stagnant thick oil, after which new oil can be produced, which together with the other modalities, will gradually improve.
BlephEx is a treatment where a fast spinning soft sponge is used with some cleaning foam under local anaesthetic to scrub away the biofilm at the lash roots and along the lid margin. The biofilm causes a local build up of inflammation, and if that inflammatory material can be removed and together with the patient’s home care, this helps to keep the openings of the meibomian glands open and the oil to drain.
Regaining normal function to the meibomian glands takes a concerted effort by the patient at home and with the assistance of the nursing staff and doctors at Clinica London.
In addition to Omega 3, the oils used for salads and light cooking should be olive oil. One patient said to me today that she did not like cooking with olive oil because when it got too hot, it changed and was not good for you. So I explained to her that when you cook with olive oil, you can only cook very quickly at a not too high heat, for instance, to stir fry vegetables. You cannot do anything that is terribly hot or prolonged because it has a low temperature before it starts to give off smoke. Olive oil is delicious and extremely good for your health and your eyelids.
The combination of good eyelid hygiene maintenance regime and diet can go a long way to helping regain the function of the eyelids and the meibomian glands.