Dry eye syndrome produces a burning feeling in the eye with a lot of itching, grittiness, redness and puffiness, increased sensitivity to light, blurry vision, and other discomforts. The condition starts from a variety of factors such as infections, other auto-immune disorders, prolonged use of contact lenses, gland dysfunctions, and even medications taken for other diseases. Regardless of where the condition springs from, the underlying effect is that there is less quantity of tears produced and the composition of tears becomes so unstable that it vaporises more rapidly.
Meibomian gland dysfunction is a very common predisposing factor to dry eye, being found in as many as three quarters of all three out of four dry eye patients. The meibomian glands supply the oily secretions that go into the outer layer of the tear film, making the tears stable and less vulnerable to evaporation. There are about 30-40 meibomian glands in the upper lid and 20-25 in the lower lid. The glands may experience abnormal lipid production, many times due to bacterial infections of the eyelids (such as blepharitis), skin conditions (such as rosacea), or side effects of drugs.
MGD is a complex disease. There are two generic manifestations, meibomian seborrhoea and meibomitis. Meibomian seborrhoea is indicated by excessive lipid secretions or easily expressed secretions. In this condition, the meibomian secretions are produced in excess amounts, and its chemistry can be harmful to the cornea. Meibomitis refers to a swelling of the glands due to bacteria, usually staphylococcus, and may be accompanied by seborrhoea or rosacea. In this condition, the secretions are too viscous and can cause clogging in the orifices of the meibomian glands. Meibomitis swiftly develops into swelling and inflammation along with long-lasting eyelid tenderness. Meibomitis is also called obstructive MGD.
It is not easy to treat obstructive MGD. The usual approach is to apply warm compresses followed by gland expression. A recently developed approach for cleaning the meibomian glands holds some promise. The fundamental idea involved is to use a probe attached to a narrow, hollow and flexible stainless steel tube (called cannula) to explore the ducts branching out from the meibomian glands. Many probe sizes can be used, from 2mm to 6mm, depending on which size is best able to produce relief.
The doctor implants the probe into a meibomian channel until it hits the obstruction symptomatic of obstructive MGD. When this occurs, the physician may use the probe/cannula to get rid of the secretions or to supply some anaesthetic and try to eliminate the obstruction. Sometimes only the blocked canals are cleared. In other instances all channels are cleaned as a preventative measure. The surgical procedure may last only 5 minutes or for as long as 30 minutes, depending on the extent of blockage and the patient’s tolerance.
After the clogged up canals are decongested, the flow of meibomian secretions is restored and the related dry eye symptoms may soon disappear. Eyelid massage and gland expression are effective methods for cleaning blockages in the meibomian ducts. But for the more rigid obstructions, MGD probing more effective method.
Relief from dry eye and MGD symptoms can last for one month or even up to 18 months after the probing procedure. After the procedure is performed, you are advised to continue eyelid scrubs and heat compresses. These will discourage the build-up of more gland obstructions.
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