Dry Eyes, Blepharitis, & Meibomian Gland Dysfunction

Illustration of Layer of the Cornea of the eye.

Dry eyes are a very common but potentially debilitating condition. There are many causes of dry eye but by far and away the most common cause is Meibomian Gland Dysfunction. 

Healthy tears are vital to your eyes functioning correctly. Your tears are a very important part of your eyes, immunity, cleaning system and optical pathway.

When your eyes are dry you may experience:

  • Painful, sore gritty eyes

  • Blurred vision

  • Recurrent corneal infections or erosions

  • Persistent eye “fatigue”

  • A pressure feeling behind the eyes

  • “Watering” eyes

What is Meibomian Gland Dysfunction?

Meibomian Gland Dysfunction (MGD) is sometimes also called blepharitis. Generically, it refers to inflammation of the eyelids and is by far the most common cause of dry eyes. It can lead to red, flaky skin on the eyelids and sore, red, gritty eyes. Often patients will feel as though their eyes are stuck together in the morning due to the sticky deposits on their lids and lashes. Blepharitis leads to dry eyes by reducing the quality of your tears and leading to dry patches on the surface of your eye. 

Each eyelid contains a row of meibomian glands. Their job is to secrete the very important oil layer of the tears. In MGD, the secretions from the meibomian glands become thick and viscous so not enough is secreted in the tear film. This creates an imbalanced and unhealthy tear film that is ineffective in moisturising the eyes and leads to dryness, blurred vision, redness and pain.

There are three important layers in our tears. They must all be present in balanced quantities for our tears to effectively moisturise the eyes. The innermost layer that sits against the cornea is the mucin layer. Next is the aqueous layer. This is made of water and is secreted by the lacrimal gland. It is very rare for this gland to function abnormally. 

The layer of tears that is deficient in MGD is the outermost layer. This layer is made of oil, which is secreted by the meibomian glands. The meibomian glands are located in the upper and lower eyelids. Treatment of your meibomian gland dysfunction will help to restore all of the layers of the tear film to a normal healthy state so that you can return to having comfortable eyes again. 

Dry Eye Treatments

Intense Pulsed Light “IPL”

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IPL stimulates the meibomian glands to create a healthier and thicker oil layer for the tears. This leads to a significant reduction in dryness and an improvement in redness, pain and vision.

The treatment is repeated after 2 weeks, 1 month and then monthly until symptoms have resolved. Sometimes a “top-up” treatment may be required a few months later. The treatment is painless and no needles or injections are required. Four or 5 gentle applications of the laser are applied to each lower eyelid, you will feel a “warmth” on the cheeks and lids. Your eyes will be covered with a pair of goggles to protect them from the bright light. Afterwards, a drop of local anaesthetic will be instilled into your eyes. This will allow a firm squeezing of your eyelids to express some meibomian gland fluid out of your meibomian glands. 

You must NOT wear make-up or sunscreen to your appointment when having IPL but you may put it on after the treatment. 

LIPIFLOW

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Lipiflow is a treatment that is performed in the clinic at the Queensland Eye Institute. The procedure takes approximately 15 minutes and you will be able to drive to and from your appointment. The treatment warms the lipid in your meibomian glands and performs a pulsed and directed massage to the glands to unblock them. It effect takes up to 8 weeks to help your symptoms. Some people need the treatment annually but most have a beneficial effect for years. A treatment costs $700 for both eyes. Unfortunately there is no private health or medicare rebate. See a video of how Lipiflow works at the bottom of this page.

Testosterone Eye Drops

These are particularly beneficial for women with Meibomian Gland Dysfunction. They are used twice a day for at least 6 months. Many women stop the drops after 6 months but then use them again intermittently for a few months if their symptoms return. The drops are specially compounded so are not available at a regular chemist.  

Omega-3 capsules

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Taking a high dose of Omega-3 oils (such as fish oil) significantly helps MGD and other dry eye conditions. There are two important benefits. The essential fatty acids in Omega-3 capsules are important in producing potent anti-inflammatory prostaglandins. This anti-inflammatory effect reduces the inflammation that occurs in blepharitis and other dry eye conditions.  The high dose of Omega-3 fatty acids also improves the health of the oil secreted by the meibomian glands. This leads to a healthier and more effective tear film and more comfortable eyes.

Dry Eyes Make Eyes Dryer

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When your eyes are dry, the tears become too salty. This high salt concentration can damage some of the cells that help to produce tears, thus making your eyes drier.  It is important to use lubricating drops to reduce the salt concentration and break this cycle so that your eyes can have a chance to recover and return to a healthy comfortable state. 

Drink more water

Remember that if you are dehydrated, your eyes will be as well. So make sure you drink plenty of water and avoid excessive tea and coffee.                          

Control your environment

The environment around you plays a very important role in dry eye treatment. Wind, fans, cold air-conditioning and warm heating all have a drying effect, which means that you will have excessive evaporation of your tears. Increasing the relative humidity and protecting your eyes from the direct flow of air will reduce the evaporation of your tears.