Having now seen thousands of LipiScan’s in the last year, I have come to realize there are some key things that destroy Meibomian Glands.
It is very sad to see this happen. It is a travesty when this happens to a 7-year-old, like the one I saw a couple of weeks ago. She had no history of any diseases. Her only crime was that she spent 4-5 hours a day playing video games, looking at her mom’s iphone, or staring at the computer/laptop per day (approximately) for years. Now she has corneal scarring and a decrease in vision that will take either a lot of steroids (which raises her risk of early cataracts and glaucoma) or laser surgery which her insurance may or may not cover.
Above you can see the glands disappearing on the right side of the lower lid in this 11 year old boy who spends 3 hrs a day on an electronic device.
1. Computer Use. This is not a joke. It is serious. Many people decrease their blink rate which leads to a decreased “milking of the meibomian glands” which then causes the glands to dry up. And it does not look like they come back once scarred.
2. Video Games: I must add this as a separate entry since Video Games are likely even more addictive than just regular computer use, which is bad for the glands in patients who do not blink or look away often (which is almost 100% of the kids I have observed, including my own kids).
Each month, I am seeing more and more kids
3. Rosacea: Rosacea is an inflammatory condition of the skin and eyelids which can cause scar tissue of the nose, face and meibomian glands. These patients appear to attract Demodex mites more than the average patient to their face and lids which appear to clog the gland orifice in the form of blepharitis which leads to the down-regulation of oil production (ie, the process that happens when you stop milking a cow), and the death of the glands. Rosacea can happen in any race/nationality and it is still unclear if it is purely a European gene or mutation.
4. Sjögren’s Syndrome: Sjögren’s Syndrome is an autoimmune condition that affects the whole body. Symptoms include extensive dryness of eyes and mouth, arthritis, profound fatigue, chronic pain, major organ involvement, neuropathies and lymphomas in some patients. The inflammation in Sjögren’s Syndrome decimates the Meibomian Glands. It has gotten to the point that if I see a patient with little to no Meibomian Glands left, I ask them again if they have any joint aches (anything at all) and/or dry mouth at all. Recently I saw a young lady in her early 30’s with almost no meibomian glands left and terrible dry eyes. She did not note any arthritis or dry mouth on her initial screening with our tech. When I asked her again to tell me if she had any pain anywhere in her body. She said, “well, maybe my hands hurt a bit from time to time.” We did an SJO test which was clearly positive to Sjogren’s syndrome. We were lucky to diagnose her condition early. Most patients have a lag time of 5-7 years before Sjogren’s is diagnosed.
5. Chalazion/Stye Removal: Styes are the acute closure of a gland that leads to a bump on the eyelid. A Chalazion has been there for more than a few days and scar tissue may be starting to form. If you do not put warm/hot compresses on the clogged gland right away, it is possible that the stye will turn into a chalazion which will not resolve and will need an excision. Once we excise the chalazion, that gland that was clogged or glands that were clogged, likely never work again normally. This is still unpublished data based on the LipiScans that I have seen before and after chalazion removal. I recommend trying to cannulate the gland first with a probe and steroid injection in patients who want to save the gland. The problem is that insurance does not cover this and it costs about $400-500 which is crazy! Thus most patients prefer to do an excision as it is covered by insurance.
6. Accutane or Isotretinoin: this is a powerful drug used in the treatment of acne. It changes the oil secretion of the sebaceous glands of the face. Unfortunately, it appears to also damage the function of the meibomian glands and lead to devastating dry eyes in some patients. This week, two separate patients in their 20’s contacted me about my early research on stem cell injections into the meibomian glands as a way to see if we can make the glands re-grow or re-boot. This research is in need of funds, but I hope to get this going asap for many patients who are suffering from this condition.
Recently a group of patients suffering from dry eye from Accutane use have contacted me. It appears there are many who suffer from the
7. Chemotherapy: Some chemo drugs directly destroy the glands. I am still researching to see which ones are the biggest cuprits.
8. Radiation: Radiation directly destroys the glands. I have now had many patients, the youngest of whom is 15, who have no glands left on the side of the face where the radiation was applied for an orbital or peri-orbital mass. We need to create steel plates to cover the lids to protect these glands. Does anyone out there want to help me creat these? All radiation patients need these to prevent future misery from chronic eye pain.
9. Aging and Hormonal Changes: Aging and hormones affect the health of the meibomian glands. It is not clear all the factors involved, but both likely lead to the loss of gland function over time. Still, I have had 80-year-old ladies who have the glands of a teenager without any dry eye complaints. What makes them special? Are the frequent blinkers? I like to think of these patients as my “flirters” sine maybe they used to blink their eyelashes frequently to the handsome men out there.
10. Contact Lenses/LASIK: This is a bit of a stretch and a very bold statement I know: there is no proof yet that Contact Lenses or LASIK destroy Meibomian Glands. I am a long time contact lens wearer and so far I am doing ok with my glands. I know hundreds of CL users and LASIK patients that have normal Meibomian Glands. Still, there are a small number of patients that abuse contact lenses and wear them more than 12hrs a day. This likely leads to inflammation which destroys Goblet Cells (we have no easy way to image these yet). Similarly, there are a small number of patients who have LASIK which tips them over the edge into having devastating dry eye because they had poor meibomian gland scores before the LASIK. I also believe that in some patients, likely a very small number and this is yet to be proven. LASIK increases the ocular surface inflammatory cycle which can lead to inflammation in the Meibomian Glands and lead to their destruction. There is likely a genetic basis as to why some patients do fine with LASIK for essentially–forever, and some have debilitating dry eyes, partly due to Meibomian Gland loss. Now, in all patients who ask me if they are a LASIK candidate, I always check their LIPISCAN. If they few glands, I recommend against LASIK.
I am still doing more research to see which of the above causes will really be able to be proven as a publication-worthy cause. For now, be sure to blink a lot, especially when on an electronic device, do warm/hot compresses with lid massaging multiple times per day, eat 2000-4000mg of Omegawhatevery, and whatever you do, do not allow your children to play video games for their eye’s health. I would also add, get rid of your TV and ipad and especially their “smart” phones. I am convinced they will lead to chronic eye pain in your children and it is not worth it!
Sandra Lora Cremers, MD, FACS