Description of meibomianitis / ocular rosacea

Meibomianitis is a very common condition that affects the function of the meibomian oil glands that line the upper and lower eyelids. It is also sometimes called ocular rosacea, although the terminology with the dermatological community has changed over the years in regards to this name.

It is also closely related to a condition called "blepharitis" which involves the inflammation and infectious process that stems from tissue around the eyelashes and the superficial skin of the edges of the eyelids.

The meibomian glands are designed to produce an oil that coats the surface of our eye. Our tear film has three components: a mucus protein layer, a water layer, and a thin layer of oil that coats the water on the surface. This oil comes from the meibomian glands. If it is missing or improperly formulated, our tears will evaporate very rapidly as there is nothing to prevent the water from completely drying out on the surfaces of our eyes.

Meibomianitis is a condition that occurs when the oils that are produced inside our meibomian glands are too thick and over-grow with bacteria that normally reside in those oil glands in smaller numbers. When this happens, the oil glands get inflamed and create an inflammatory condition on the surface of our eyes. An allergic reaction occurs to the bacteria that are over-growing inside these oil glands and our eyes also dry out because of the improper tear film that forms as a consequence. This results in redness of the eyes, itching of the surface of the eyes and eyelid margin, swelling and redness of the eyelid edges, chronic irritation, tearing, and ocular discomfort, and the formation of styes and chalazions. It is often also associated with rosacea in other parts of the face which most commonly include the nose, forehead and cheeks which may show up as fluctuating redness and formation of small pimples in these areas of the skin.

Treatment for meibomianitis / ocular rosacea

Rosacea is a very wide spread condition and may affect up to 15% of the population by some estimates. Some believe that rosacea occurs because our modern day diet contains a lot of fats with are thicker and more difficult for our body to process that what we were originally designed to consume. As one can imagine, up until very recently in human history, we tended to consume wild game that has only a small percentage of body fat and who's fats tend to be very liquid and a lot of raw natural food with nothing like the amount of saturated and processed fats that we consume in our diets today. It has been shown that dietary interventions can improve meibomianitis or ocular rosacea. This includes the consumption of fish oils and switching to non-processed cold pressed vegetable oils in the diet, including such oils as walnut oil, primrose oil, and other cold pressed vegetable oils.

Another very important aspect of the treatment of ocular rosacea in my estimation is a daily application of hot compresses to the eyes. This should be done with the eyes closed and with a hot compress applied against the surface of the lids. The compress needs to be quite hot and it needs to be held in contact with the eyelid for a five minute period in order to be effective. Compresses may need to be re-heated if necessary. The purpose of this treatment is to heat and liquefy the oils in the meibomian glands in order to encourage them to flow out of the meibomian gland. Although this treatment may feel good, the purpose is not to provide immediate relief, and it is unlikely that it will have any significant effect on the meibomian gland blockage in any less than a month or two of application. This type of treatment needs to be continued indefinitely for it to continue to work. A person who stops applying their hot compresses will more than likely have a recurrence of symptoms within a few months time. We also use a variety of antibiotic medications to control meibomianitis. These can be administered either orally or in an eye drop or ointment form or in some cases both ways. The antibiotics help to decrease the population of bacteria that live in the oil glands and contribute to the allergic and inflammatory conditions. In addition, some of the action of the antibiotic is actually to change the way that the fats in our oil glands are synthesized and, for not fully understood reasons, some of these antibiotics actually make our bodies produce oil gland secretions that are more liquid and flow out more easily.

Ocular rosacea may in its more aggressive episodes cause oil glands to get plugged up and infected which creates a stye or chalazion on the edge of our eyelid. These occasionally need to be treated surgically and cleaned out. However, even when styes or chalazions are not forming, it is sometimes necessary to mechanically open up and clean out the meibomian glands and we do offer a procedure in the clinic for heating and mechanically cleaning out blocked oil glands which can be performed in the office. It is important to remember that meibomianitis or ocular rosacea is a chronic skin condition. It is not something that can be cured although it may wax and wane depending on a variety of factors including our diet, stress levels (meibomian glands are under the control of stress hormones in our body), activities, our age, etc. However, it is not uncommon for people with ocular rosacea to need some type of management or treatment continuously during the course of their lives. People typically get symptomatic flare-ups when they have stopped doing any treatments to keep the condition under control.

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