MGD (Dry Eye) Treatment Guide – How to Treat Meibomian Gland Dysfunction

so one of the major causes of dry eye syndrome and 
dry eye symptoms it has to do with the thickening   and blockage of oil glands within the eyelids 
which we call meibomian gland dysfunction or   mgd for short this is where the normally smooth 
and liquid oils within the meibomian glands   stop producing properly and instead form a waxy   harder substance which can go rancid 
leading to inflammation of the eyelid   and increased tear film evaporation and this has 
been found to affect over 80 percent of everybody   with dry eye syndrome which is exactly why 
meibomian gland dysfunction treatment is such   a major focus for so many dry eye specialists but 
what are the most current and effective treatments   for mgd whether you are looking for advanced 
treatments through your eye care provider or   looking for at home therapies that's what 
we're covering today so let's take a look this video is brought to you by the makers of 
tier restore the dry eye warm compress uniquely   designed to permit the use of your eyesight 
throughout the eyelid treatment which makes it   easy for me to complete my morning warm compress 
routine while staying productive thank you to   tear restore for helping us keep making dry eye 
education possible hello and welcome this is dr   allen here from the dr eye health show helping you 
learn all about the eyes vision and finding the   best vision products if you are new here to the 
channel and you suffer from dry eyes then consider   hitting the subscribe button down below so that 
you don't miss any of our future content on dry   eye syndrome also this video is part of a full 
dry eye series where we go over different types   of dry eye syndrome so you can figure out what you 
have as well as the different treatment options   available whether it be something done at home or 
if it's through your eye care provider if you want   to check out videos in that full series i'll put 
that link in the description below so you can find   it easily now it comes to treatment for meibomian 
gland dysfunction the first one that i like to   discuss is that of doing eyelid warm compresses 
now on this channel we've talked about eyelid   warm compresses many times before but i think it 
deserves mentioning again because so many of our   patients as an eye doctor a lot of people will 
tell them to do this and then they just fail to   really do it or incorporate it into their normal 
daily routine unfortunately with meibomian gland   dysfunction this is typically a chronic condition 
and is something that you need to keep doing and   managing over time but the whole point of doing 
an eyelid worm compress is to supply heat to the   meibomian glands any solidified now waxy oils 
can then be melted down into a liquid and then   that liquid can hopefully be expressed from these 
oil glands and then your eyelid is able to reduce   the inflammatory load because it doesn't have that 
rancid oil still stuck in the glands and that will   hopefully allow your body to make new oils so that 
your tears don't evaporate as quickly it also acts   as a protective function because if the oils 
have remained wax in those glands for too long   the gland can eventually atrophy and die off and 
unfortunately if that happens there really isn't   any way that we know at the time in this video to 
get them to grow back now there are many different   types of worm compresses on the market that you 
can choose from there are ones that you activate   through a sodium acetate chemical reaction such as 
the tier restore there's ones that you put in the   microwave and there's ones that you plug in into a 
computer or into through a usb into a wall socket   and then electronically heat up the oil glands 
with whichever method that you choose or that your   doctor recommends the important thing is that you 
do them on a regular basis at least once or twice   a day for at least 10 to 20 minutes at a time 
clinical studies and from clinical experience   that is the appropriate amount to be using to get 
a clinical benefit where we start to see improved   function of the oil glands after completing warm 
compresses many eye doctors will recommend doing   some form of eyelid massage when i was just in 
school maybe five six years ago then at that   time my professors would just recommend doing a 
little gentle digital massage with your finger   the downside of doing that is if you push too hard 
you could be putting unnecessary pressure on the   globe of the eye and that could increase risk for 
things like glaucoma if you're someone who's at   risk for it that is why now there's a lot of new 
devices that are coming out including one that   i featured previously on this channel called the 
new lids device which creates kind of a mechanical   activating motion that agitates the oil glands and 
allows them to encourage that oil gland those oils   to open up and release there's also other devices 
and warm compresses coming out that use vibration   to try and achieve the same effect now if you're 
somebody with a more severe form of meibomian   gland dysfunction the oil glands can become 
capped off in the form of eyelid scaling this   is where the eyelids themselves start to have 
the appearance of chapped lips in the winter   where there's dead epithelial skin cells that 
are not covering the oil glands and prevent the   glands from even releasing their contents in 
that situation your doctor may recommend doing   an eyelid debridement with a small tool in the 
clinic and then they could even recommend doing   meibomian gland probing where a small almost 
needle-like tool is used to puncture the oil   glands to allow them to open up then your doctor 
may even do manual meibomian gland expression this   is using a small forceps in the clinic to pinch 
the individual glands to really express all of   its contents i do encourage you do not attempt 
to do this at home it is something that must be   done by an eye care professional now let's shift 
over and talk about some advanced technologies for   meibomian gland dysfunction treatment that may be 
available for you at your local eye care provider   or eye clinic the first one i like to talk about 
and probably because it's been out the longest   is that of lipiflow now lipiflow is a mechanical 
device that either your eye doctor or a technician   can apply to your eyelids and then what it does 
is apply heat to both sides of the eyelid so it's   not just like doing a warm compress where you're 
trying to get heat through the skin it applies   heat to both sides of the eyelid at the same time 
and then it has a pumping action that encourages   those glands to continually express any of those 
oils out of the glands and since lipiflow has been   out for quite some time there are a lot of studies 
that do show good clinical support for benefits   of getting the lipiflow done it even shows some 
clinical benefit lasting up to three years after   a single treatment however i do also want to 
mention that a lot of people will have severe   forms of meibomian gland dysfunction and may need 
multiple treatments with something like lipiflow   to have really the desired effect now very similar 
to the lipiflow is a device called the ilux   the ilux again applies heat to the eyelids but 
it does this through supplying infrared and a   lime light to this top surface of the eyelid but 
it makes sure that it applies heat throughout the   entire lid because it also has a sensor reading 
that goes underneath the eyelid so it can tell   that it's fully heated up the lids but then 
the device also has a mechanical pumping action   which again helps express the oils from the eyelid 
now as far as the difference between lipiflow and   ilux the lip flow is something where your doctor 
can set it up and then they can just hit the start   button and it'll run on its own ilux is something 
that has to be done mechanically and manually so   your eye doctor or your doctor's assistant will 
have to perform that procedure on your eyelid   and as far as the ultimate clinical result between 
those two at least one study has shown them to be   equally equivalent at treating meibomian gland 
dysfunction one additional technology i want to   mention is that of tearcare some eye clinics will 
offer tear care as a way to add additional heat to   those eyelids within the clinic but this device 
does not have the mechanical pumping action so   instead your doctor may offer a meibomian gland 
expression done in the clinic again using some   sort of mechanical forceps now just to speak on my 
personal experience i've had both the lipiflow and   the ilux done i find them to be very comfortable 
and have good results as far as having a something   like tear care or manual expression i've never 
really had that done but i've done it for patients   and they seem to respond well to it as well the 
one other cool technology that many eye clinics   are now starting to offer is something that is 
technically not fda approved for the treatment   of dry eye or meibomian gland dysfunction at this 
current time i say that because i believe they are   applying for fda approval at this current 
moment and it's something that we'll talk   about in a future video hopefully when that comes 
out otherwise this is something called ipl intense   pulsed light this originally was developed 
for dermatologists to treat things like ocular   rosacea and just rosacea of the skin in general 
but they have since found that it has this kind   of this side effect extra benefit of reducing the 
inflammatory load on the eyelids and heating up   these oil glands and helping remove telangiectasia 
which is the growth of abnormal blood vessels   on the eyelids too now the treatment with ipl is 
a little bit more involved they do have to have   a handheld device put onto the lids and it 
requires several treatments at least usually four   treatments to have a benefit but i would not be 
surprised if you go to see a dry eye specialist in   your area and they discuss with you the advantages 
of something such as the ipl treatment but be sure   to stay tuned to the channel because hopefully 
we'll have some cool videos coming out soon   on the ipl so now that we've discussed some new 
technologies in the eye clinics that are available   for helping meibomian gland dysfunction now let's 
move over and talk about some of the different eye   drops medications that are available as well as 
oral medications or supplements that your dog eye   doctor could recommend for you now two medications 
that are available in the form of an eye drop for   treating meibomian gland dysfunction one of those 
is something called cyclosporine a that's the   generic name otherwise they're brand names such as 
Restasis or a new form called Cequa are available   these are eye drops used twice a day and have 
long since been used mainly for different forms   of dry eye disease but there are studies that 
do show that there is some clinical benefit for   meibomian gland dysfunction through using these 
eye drops some of the biggest downsides for using   a medication such as Restasis or Cequa is often 
time the cost the prices for these medications   can get quite costly and they often take several 
months to start seeing a clinical benefit however   with that being said i have many patients who 
are on or using these medications and they have   excellent responses so again something to talk 
with your iq provider about another topical eye   drop that can be used to help with meibomian gland 
dysfunction is that of topical Azasite now topical   Azasite is often used as an antibiotic usually 
prescribed for just a seven day course however   eye doctors have been shown in studies that if 
you're using it for a longer treatment period   they can have benefits for the meibomian glands 
in the eyelid however oftentimes just like topical   cyclosporine these medications can sometimes be 
rather expensive so it's important to again talk   with your eye care provider and work with your 
insurance to see what's going to be best for you   now is very similar functioning to 
Azasite that this medication helps   reduce inflammation in these oil glands there's 
also the use of taking oral doxycycline now oral   doxycycline is again an antibiotic that's often 
prescribed for many different forms of infection   however usually at a lower clinical dose that 
doesn't necessarily have the same side effects   as a full antibiotic dose of doxycycline has 
also been shown to change the function of these   oil glands in your skin and consequently can help 
improve things like rosacea as well as these oil   glands functioning of the meibomian glands but in 
comparison to the topical azosite, doxycycline has   been out for a long time and so usually it's much 
more affordable the biggest downside is that oral   doxycycline may have more side effects than using 
something like the topical azasite now another   possible treatment for meibomian gland dysfunction 
is that i'm taking supplements for omega 3s now   omega-3 fatty acids has been an interest of study 
in medicine in many different subjects of medicine   whether it be cardiology neurology dermatology 
and then of course eye care for quite some time   and in the dry eye space there is a lot of 
conflicting evidence now while there is some   debate of omega 3 for its benefits for dry eye and 
even meibomian gland dysfunction i'm mentioning it   here because i think it is something that some 
doctors will recommend for you but i think it's   really important that before taking any supplement 
whether it be something like flaxseed oil or fish   oil anything like that best talk to your eye care 
provider so they can go over your medications and   health history to make sure it is something 
best for you or if it's something that they   even recommend but either way eating a diet that 
has more omega-3s and less omega-6s is healthy for   the body and recommended no matter what dry eye or 
not so now where are you at with meibomian gland   dysfunction do you have a really severe case have 
you had any of these treatments mentioned such as   a lipiflow ilux maybe ipl treatments have you been 
taking omega 3 supplements have you been put on   medications like Restasis are you doing warm 
compresses every single day let us know in   the comments what you have tried what has helped 
for you and overall kind of where you're at with   your whole dry eye experience or if you need help 
finding a dry eye specialist in your area again   drop comments in the section below i'll include 
extra links in the video description to help you   find a dry eye specialist otherwise thank you so 
much for watching if this video helped you out   hit the like button for us share this with friends 
and family anyone you know that is struggling with   dry eye syndrome either way thanks so much for 
watching again this is Dr.

Allen here from doctor   eye health keep an eye on it and we'll talk to you
soon.

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