Dry Eye & MGD

The tear film consists of three layers on the outer surface of the eye and is largely responsible for everyday visual comfort. When the tear film is compromised, or destabilized, the eye surface becomes easily irritated and may become red, watery, scratchy feeling and generally uncomfortable. The top oily layer of the tear film is the protective coating on the eye surface that keeps the middle watery layer intact. When oil production is inhibited, the watery layer of the eye surface is left exposed. This is the root cause for the majority of those with Dry Eye.

What are the Symptoms?

The symptoms of dry eye include:

  • A gritty, scratchy feeling
  • Burning sensation
  • Watering eyes particularly when exposed to the wind or in the car.
  • Variability in the quality of vision
  • Ghosting or double vision
  • Tiredness sensation especially towards the end of the day
  • Inability to tolerate contact lenses

What is Dry Eye & MGD?

The tear film is a complex structure of mucin, tears and oil that protects the surface of the eyes. When the tear film is compromised, it results in a variety of symptoms, most of which have been associated with Dry Eye and MGD (Meibomian Gland Dysfunction). Understanding the tear film is key to seeing the clear differences between tear deficiency issues and MGD, especially since MGD is more common and has greater long term impact on Dry Eye symptoms.

Mucin Layer

The mucin (mucous) layer at the bottom of the tear film provides a “sticky” foundation and acts as a barrier to the eye surface.

Aqueous Layer

The aqueous layer is the “juicy” center that is comprised of tears produced by the lacrimal glands.

Lipid Layer

Finally, the top “oily” lipid layer of the tear film is made up of lipids or oils produced from the meibomian glands. When MGD is present, our glands do not consistently produce the oil necessary for a stable tear film and the aqueous layer will evaporate.

What are the Causes?

THE UNDERLYING CAUSE OF DRY EYE SYMPTOMS

Dry Eye is generally caused by an imbalance in the tear film that acts as a shield on the surface of our eyes. There are two primary contributors to tear film imbalance. The first is decreased tear production. In recent years, we have learned that true reduced tear production is rare. What we know now is that the problem almost always originates with blockage of the tiny Meibomian Glands in our eyelids. These glands produce essential oils that form the top layer of the tear film and are the core protective element that is essential to long-term visual comfort.

When the Meibomian glands are blocked or the glands have been compromised, the eye becomes exposed. This leads to dry eye signs and symptoms. This is known as MGD or Meibomian Gland Dysfunction. MGD is easy to diagnose and manage. The treatment of MGD is essential for the long term management of dry eye.

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  • Rheumatoid Arthritis, Sjogren’s syndrome, thyroid disease and lupus
  • Medicines such as beta-blockers, antihistamines, diuretics and anxiety medications
  • Refractive surgery such as LASIK surgery
  • Various prescription and non-prescription medications
  • Swollen, red irritated eye lids, commonly referred to as Blepharitis
  • Out-turning of the eye lids (ectropion) and in-turning of the eye lids (entropion)
  • Contact lens use for long periods of time

What is the Diagnosis?

MEIBOMIAN GLAND DYSFUNCTION (MGD)

The cause of Dry Eye has not been easily diagnosed in the past, due to the fact that most doctors have focused on a lack of tear production. Much research has been performed on Dry Eye causes in the past 20 years, and it is now known that, in most patients who present Dry Eye symptoms, tear production is not the primary problem. In fact, tear deficiency as a cause of Dry Eye is quite rare. For the overwhelming majority of patients with Dry Eye symptoms, blocked glands (Meibomian glands) in the eyelids are the root cause of Dry Eye Symptoms. There is an insufficient production of essential oils to protect the tear film, leaving the eye exposed and causing Dry Eye symptoms. Detecting MGD at its earliest stages is imperative to ensure long-term tear film health and avoid Dry Eye symptoms. Today, there are various tests that can be performed during your eye exam to assess Meibomian gland function and structure. Assessing Meibomian gland function and structure is essential to help determine an appropriate course of action.

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EVALUATING GLAND FUNCTION AND TEAR FILM HEALTH

When checking gland function, the goal is to evaluate if the Meibomian glands are secreting the right amount of oil and if the oil is of the right consistency. An assessment of gland function requires that a small amount of controlled pressure be placed over the eyelids to observe what comes out of the glands. This pressure can be applied with the help of an instrument or a doctor can lightly use their thumb or finger. The pressure is very gentle and should not cause any discomfort. The pressure is applied while you are seated at the slit lamp, so the doctor can view the gland secretions under magnification.

A PICTURE TELLS THE STORY OF MEIBOMIAN GLAND STRUCTURE

Evaluating the structure of the Meibomian glands is essential to understand how to manage your Meibomian glands over the long term. The best way to image the glands is using breakthrough imaging technology or Dynamic Meibomian Imaging® (DMI). DMI is a picture that is taken of your eyelids that shows you and your ophthalmologist:

  • The appearance of the glands that you do have
  • The presence of gland loss or structural changes over all

When MGD is present and not treated, the glands can begin to atrophy, much like what happens to muscles if they are not used. Gland loss can present a serious long-term problem, as there is no way to restore gland function when the glands are no longer present.

What Treatments are available?

Long term effective treatment for Dry Eye symptoms has eluded many who have come to rely on short term relief from drops, various at-home symptom relief remedies or other prescribed medications. For many, managing symptoms is a frustrating process. The key to effective Dry Eye treatment is to understand the underlying cause of the symptoms.

Dry Eye is generally caused by an imbalance in the tear film that acts as a shield on the surface of our eyes. There are two primary contributors to tear film imbalance. The first is decreased tear production. In recent years, we have learned that true reduced tear production is rare. What we know now is that the problem almost always originates with blockage of the tiny Meibomian Glands in our eyelids. These glands produce essential oils that form the top layer of the tear film and are the core protective element that is essential to long-term visual comfort.

When the Meibomian glands are blocked or the glands have been compromised, the eye becomes exposed. This leads to dry eye signs and symptoms. This is known as MGD or Meibomian Gland Dysfunction. MGD is easy to diagnose and manage. The treatment of MGD is essential for the long term management of dry eye.

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