Why Do My Eyes Feel Dry: Meibomian Gland Loss

Why Do My Eyes Feel Dry: 

Meibomian Gland Loss
Many of my posts have focused on the many causes of dry eye:
1. Aqueous tear deficienty: usually due to an autoimmune disorder affecting the lacrimal gland; previous radiation or chemotherapy, and the issues below which can occur from a tumor, for instance. 
2. Meibomian Gland Dysfunction or Evaporative Dry Eye is the most common cause and the one we now know most about. We now have the Lipview and Lipiscan to show us your meibomian glands. And a photo is worth a lot here. See below. 
Another way of classifying Dry Eye is:
1. Aqueous tear-deficient dry eye 
a. Sjogren syndrome dry eye 
b. Non-Sjogren syndrome dry eye 
1) Primary lacrimal gland deficiencies 
2) Secondary lacrimal gland deficiencies 
3) Obstruction of the lacrimal gland ducts 
4) Reflex hyposecretion 
a) Reflex sensory block 
b) Reflex motor block 
2. Evaporative dry eye 
a. Intrinsic causes 
1) Meibomian gland dysfunction 
2) Disorders of lid aperature and lid/globe
congruity or dynamics 
3) Low blink rate 
b. Extrinsic causes 
1) Ocular surface disorders 
2) Contact lens wear 
3) Ocular surface disease 
4) Allergic conjunctivitis 
C. The causative mechanisms of dry eye 
1. Tear hyperosmolarity 
2. Tear film instability 
Case 1:
This is a 55 year old African patient with Rheumatoid Arthritis who has had 2 bouts of inflammation only in the left eye. She has recently been diagnosed and has not started any medicines. She has no other medical history and has never had radiation or chemotherapy.
This is her Right Eye.
This is her Left Eye.
Why is her left eye’s Meibomian Glands so much worse than her right. She has not had any styes in the past. Could it be the uveitis was a representation of inflammation happening in the meibomian glands as well? We do not know yet. 
Case 2

 This is a 57 year old patient who came in with an acute stye that was present for about 7-10 days before incision and drainage.

This is his Right Eye.

This is his left eye below. 

Again many glands missing. He has a long history of mild rosacea blepharitis and it is likely just that, given no symptoms of dry mouth or arthritis. 
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