More on MGs (the tear oil glands)
In dry eye patient chats, I commonly come upon questions like - “My doctor says I’ve lost a lot of my Meibomian Glands. How many MGs do I need to have a good tear?” And: How fast can they disappear?” “How do I get them back?”
Dr. Donald Korb is the Optometrist who invented Lipiflow (the first well-sorted tool to provide a good heated expression for obstructive MGD). He is a great observer and excellent researcher. He is also the one that told me 6 good MGs/lid is sufficient to support an adequate tear (usually measured by the tear break up time and lack of dry spots on the cornea). I don’t believe this has been supported in peer reviewed studies but based on his expertise and my clinical observations, I can say that I believe this to be true. That’s good news for those struggling to keep 6 or more well functioning glands. This doesn’t necessarily speak to the quality of the oil, the constitution of salts and proteins nor the volume of water that is the bulk of a tear. It also is bad news for patients who don’t yet have a handle on the number of glands they still have, as most people have 25-30 glands per lid at birth. If you’re down to your last 6 good glands, life is good until you lose one more gland. So the short answer is that it is best if you can hang onto more than 6 and keep them in good shape.
It would be unusual to lose 50% of the MGs in 6 months (or even a year, since it appears to take years-to-decades for the average dry eye sufferer to see major losses) - but in cases where blinking is severely impaired - like a Bell’s Palsy - or in cases where medications like Accutane have been used, I believe it may be possible to lose as much as 50% in less than a. year. Sadly, the imaging used to detect the glands is far from perfect and the state of MG activity appears to greatly influence how "white" (and therefore detectable) they appear on InfraRed photography (the standard way of imaging them). If you can support them with adequate Omega Oil supplements, warm moist compresses with "lid crunches," blink exercises and good lid hygiene after ensuring adequate purging of obstructions, then I have found it is possible to see many of these ghostly MGs "bounce back."
Regeneration of the glands remains controversial, but it does appear that glands that are not “too far gone” can bounce back if given the chance. In general this means adequate unclogging and then adequate “homework” as I outlined in earlier postings. IPL appears uniquely suited to stimulate them, and Maskin Probing is sometimes required to sufficiently unclog them, but a good heated expression is often needed with or without the probing and IPL treatments. Best to work with a good dry eye specialist and do the homework.