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Hope for meibomian gland regeneration

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Professor Chris Lievens
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By Helen Carter

 

Optometrists may be able to regenerate meibomian glands that have truncated in dry eye patients by using new treatments to bring the glands back to life, dry eye expert Professor Chris Lievens told SRC.

Professor Lievens said it had been thought that once the meibomian glands truncated, they were forever dysfunctional but he and others who treated patients with severe dry eye had started to see glands grow back and restored to functional use.

‘What’s exciting is that once the gland is truncated, with treatment we’ve seen glands grow back over time to the margin and using imaging technology, seen glands regenerate that we thought were gone,’ he said.

‘Meibomian glands produce oil except if they are not functioning properly. Of those with dry eye, 86 per cent have evaporative dry eye so we need to target this group and help them regenerate their meibomian glands so they can produce healthy oils on their own.’

Professor Lievens is at the Southern College of Optometry and chief of staff at The Eye Center in Memphis, Tennessee.

He urged optometrists to give patients hand-outs on blinking exercises as this also improves dry eye symptoms.

‘Patients need to feel their eyelids close completely because if they don’t close, lipids will not be expressed. People who do lid-blinking exercises become far better blinkers and symptoms improve.

‘We have many advances to treat dry eye now like never before. While 72 per cent of people with dry eye use only artificial tears as treatment, 82 per cent using tears demand something better,’ he said.

Professor Lievens treats patients who have been to many eye care practitioners and have almost given up hope of resolving their problems. He said lid disease, ocular allergy and blepharitis were included under the dry eye heading.

‘Dry eye is a multifactorial disease requiring multifactorial treatment and this is the key to our success,’ he said.

‘To help change their life talk to your dry eye patients about their diet, living conditions, where they sit and work, their hobbies and oral supplements such as fish oil and Omega-3s.’

He urged optometrists to look for and treat Demodex folliculorum, eyelash mites that overpopulate lashes and are a factor in blepharitis and dry eye, contributing to symptoms.

‘Upwards of 80 per cent of people with blepharitis have eyelash mites. Eighty-four per cent of people aged 60 and close to 100 per cent of those over age 70 have them,’ he said.

‘If optometrists do an epilation manoeuvre and rotate a lash for 15 seconds, a lot of times the mites’ tails will poke out. You can pull out the lash and take a photo on an iPhone to show the patient as this strongly motivates them to comply with treatment.

‘We show patients what is growing in their eyelids under a microscope and get 100 per cent compliance rate with our instructions,’ Professor Lievens said.

He says he has had great success using the Blephex sponge brush to clean and buff eye lashes and eyelids, and suggests using Blephex first then Lipiflow, which massages, heats and evacuates meibomian glands to produce normal lipids.

‘One Lipiflow treatment results in tremendous improvement in symptoms and the ocular surface. It is repeated every 12 to 18 months,’ Professor Lievens said.

He says tear supplements are not a cure but provide valuable symptom relief while undergoing treatments.



15 comments for “Hope for meibomian gland regeneration”

  1. Gravatar of Delia Ferrer GarciaDelia Ferrer Garcia
    Posted Sunday, September 27, 2015 at 6:32:59 AM

    I read your article on regeneration of miebomian glands after being tested on the tear science miebomian gland analyzer. I was greatly surprised to with the results of my test. My tear film thickness was very good but I am a poor blinker. I have extensive dropout of my miebomian glands and would like to know how I could regenerate them.

  2. Gravatar of DavidDavid
    Posted Tuesday, December 1, 2015 at 12:40:59 AM

    Could you give us any further information on what these exercises are, how to do them properly and how often (and for how long)? I'm very interested in this!

  3. Gravatar of jamesjames
    Posted Wednesday, December 2, 2015 at 10:22:11 PM

    Much agreed with the other comments! It would be great to know what we can do to create a good environment to encourage regeneration!?

  4. Gravatar of AstridAstrid
    Posted Friday, September 16, 2016 at 6:46:26 PM

    This is the only article saying regeneration is possible, all others say it isn't possible. I think we all want/need more information on how to establish this. My hope is almost completely gone like my meibom glands. If there is a way we need to know. Where I live I don't receive help and is said it will only become worse due to ageing, even though I'm only 32 at the moment. If you need a test subject please consider me.

  5. Gravatar of Dana Dana
    Posted Sunday, September 25, 2016 at 1:33:14 AM

    I am desperate for help. I am a 42 year old single mother of 3 boys and a special needs teacher. I have been diagnosed with meibomian gland dysfunction. Had lipiflow, serum tears, and everything under the sun. Currently using testosterone eye drops, dapsone eye drops, and spirolactone eye drops. It just keeps getting worse and is affecting my job and quality of life greatly. I have lost my motivation to do anything but lay down and close my eyes. My children are getting use to their mother crying and laying in bed and I am so discouraged. Please help me and provide some hope.

  6. Gravatar of AlexAlex
    Posted Monday, January 23, 2017 at 12:15:07 PM

    Dr. Lievens never emailed us back and it's been over a year.

  7. Posted Tuesday, January 24, 2017 at 3:04:56 PM

    Please share our dry eye disease and corneal neuralgia petition, we hope to get closer to effective treatments. Thank you. https://www.change.org/p/provide-urgent-research-funding-for-severe-dry-eye-disease-corneal-neuralgia-pain?source_location=topic_page

  8. Gravatar of CindyCindy
    Posted Sunday, June 11, 2017 at 7:37:52 AM

    Hi,
    My son is 27 and has been told most of his glands have died. He is on a regime to treat the chronic symptoms, but do you have any information about the possiblility of treatment for regrowth of the glands, or is that not possible.
    Thank you,
    Cindy

  9. Gravatar of WithHeldWithHeld
    Posted Saturday, October 14, 2017 at 12:49:45 PM

    I trusted my ophthalmologist, who told me there was nothing to do about "the styes" that caused my watering eyes, except warm compresses and OTC drops.

    I trusted this doctor for FAR too long, then saw a second doctor, and asked about Lipiflow, and Dr. #2 said NOTHING about it, or the fact that I have MGD, until AFTER I asked him about both of these!

    I made an appt. within a week, had a Lipiscan, and learned I have severe MG die-off.

    IS THERE ANY LEGITIMATE RESEARCH ON REGENERATION OF THE MEIBOBIAN GLANDS?

    Thanks in advance!

  10. Gravatar of CherCher
    Posted Wednesday, March 7, 2018 at 6:59:21 PM

    I never had eye dryness issues except random allergies that were easily targeted with drops. But a dermatologist did a V-beam esthetic eyelid procedure that was unnecessary and it resulted in hurting the mebomian glands and now my tears are watery and insufficient for 8 years and it's getting works to people thinking I am tired or sick or on something with all the redness, no matter what I use.
    Is there any way to regenerate the glands ???

  11. Gravatar of Greg OsborneGreg Osborne
    Posted Tuesday, July 3, 2018 at 5:24:44 PM

    Like the previous commenters, I would like to know what the latest progress might be in the regeneration of MGs.

  12. Gravatar of Dhruti DaliaDhruti Dalia
    Posted Sunday, August 5, 2018 at 3:51:01 PM

    This article surely gives some hope. My mother,71yrs got mgd soon after cataract surgery. Shes on warm compresses n eye lid massage.is this enough to get MGs functioning again.
    Thanks in advance.

  13. Gravatar of Optometry AustraliaOptometry Australia
    Posted Monday, August 6, 2018 at 4:45:36 PM

    Optometry Australia does not provide clinical advice.

  14. Gravatar of NavjotNavjot
    Posted Friday, October 5, 2018 at 12:40:34 PM

    I was diagnosed with Steven Johnson syndrome year ago due to which I have got several dry eyes and complete loss of mybomian glands. I am in Nz and currently using serum drops and ointments etc. I had lipiview done and was advised that lipiflow and IPL is of no benefit to me. Kindly advise please if there is any treatment for me for regeneration of mybomian glands plz. Desperate to get help.

  15. Gravatar of Optometry AustraliaOptometry Australia
    Posted Tuesday, October 9, 2018 at 4:25:55 PM

    Optometry Australia has responded directly to this message.

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