Sjogren's Related Meibomian Gland Dysfunction and What You Can Do About it

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One of my favorite features about the Sjogren's Syndrome Foundation newsletter The Moisture Seekers is their "The Questions You Asked and the Answers You Need" column.

The April 2013 issue included this question: I've heard that cleaning your eyelids is important. Why is that? And how do you go about cleaning your eyelids and how often do you suggest it be repeated?

Answer: The eyelid margin is a very important contributor to protection of the surface of the eye and stability of the tear film. Lid margin problems occur in two forms that can aggravate dry eye: anterior and posterior.
     In patients with Sjogren's not only is there the problem of reduced production of liquid tears, but there is often a problem with obstruction of the glands in the eyelid that secrete lipid onto the tear film to prevent evaporation of the tears. These glands are called meibomian glands and your eye care practitioner may alert you to "meibomian gland dysfunction," which is the obstruction of the openings of the glands at the edge of the eyelid margin just behind the base of the eyelashes. Such obstruction leads to evaporative dry eye which can aggravate the dry eye situation. Symptoms of the eyelid margin problem, meibomian gland dysfunction, can be irritation with redness of the eyelid margin and frequently difficulty reading or working at a computer.
     The first step in managing the lid margin is lid hygiene and massage. Precede the massage with application of warm compresses to the eyelid for at least minute using a warm washcloth. Some patients will use a bag of rice heated in the microwave oven, but it is important not to use too much heat such that it turns the skin red or, worse yet, burns the skin of the eyelid or face. The heat melts the lipid secretion so that the massage can express the secretion. The massage is done with the flat pulpy area of the index finger starting at the base of the nose and moving towards the ear. Four or five such swipes to compress the eyelid is usually all that is needed and the pressure should not be so great as to cause discomfort in the eyeball. I recommend to my patients to do the hot compress/massage method twice a day for a week then once a day thereafter. It is important to remember that you are trying to press on the eyelid to squeeze the glands in order to express the secretions.
     If the hot compress/massage method does not completely resolve the plugging problem, it is possible to use topical azithromycin solution, (Azasite) once daily for two to four weeks to clear the problem. Some patients require the use of oral medications to treat the problem. Doxycycline by mouth once or twice daily for two months works well but some patients do not tolerate the doxycycline due to upset stomach. Oral omega - 3 essential fatty acids also have been reported to improve the meibomian gland secretion but usually require at least 3000 mg (three pills) per day to be effective.
     There is a recently developed technique using an instrument called the Lipiflow system that provides continuously controlled application of heat to the eyelids. It is approved by the FDA for in-office use in treatment of the meibomain gland dysfunction, but there have not yet been controlled clinical trials to confirm it's effectiveness. At present it is an expensive procedure that may or may not be covered by insurance, but if other treatments fail to control the problem, this could be an alternative treatment.
     It is important to remember that there are two types of lid margin problems. The meibomian gland dysfunction (the glands in the posterior eyelid) is the most common problem, but inflammation of the glands at the base of the eyelashes (anterior location in the eyelid)  can cause irritation and crusting on the eyelashes. This problem responds best to eyelid wipes, such as Eye-Scrub pads. The daily use of the eyelid wipes helps to clear the crusts but if inflammation and irritation persist, then topically applied antibiotics or antibiotic/steroid combination therapy may be needed. Remember that the eyelid wipes do not control the posterior meibomian gland problem but only the anterior problem.
     Since the occurrence of the eyelid margin problems can be so frequent, it is a good idea to practice good eyelid hygiene to prevent as well as treat the meibomian gland dysfunction or lid margin disease.

-- Gary N. Foulks, MD

You can read this and other great answers to important sjoggie questions by joining the Sjogren's Syndrome Foundation. All members receive copies of the Moisture Seeker Newsletter both in the mail and are also available in the members-only section online.