Why do some people produce “pasty meibum?” PART 3

Part 3:

It is clear that there is a significant difference in the composition of oils from those with MGD and those without - and it appears that bacteria may play a major role in some of these differences: I quote from a scientific paper (and add interpretations) below: 

"Using the compiled data, the team semi-quantitatively revealed the variety of FAs and OAHFAs (Fatty Acids or FAs and (O-acyl)-omega-hydroxy fatty acids or OAHFAs = building blocks of tear oils) present in MGD-affected human meibum. Overall, they identified 161 molecular species. Of these, 100 were long-chain FAs containing 12 to 37 carbons, which is a marked increase in comparison with other detection methods. The remaining 61 species were long-chain OAHFAs 34 to 56 carbons. The researchers note that a wider mass range could result in identifications beyond the 37-carbon threshold for FAs but indicate that this study is the first report of large numbers of very-long-chain species in human meibum (tear oil). Given the rare nature of species longer than 35 carbons in blood, skin or cell samples, this finding confirms the unusual lipid composition of meibum (tear oil). Interestingly, the team also detected odd-numbered carbon-chain FAs, which previously have been linked to bacteria. Mori et al. recommend further investigation into a potential link between this finding and possible bacterial infection in the eyelids of MGD patients."

(This is one of the reasons I stress good, regular lid hygiene to my dry eye patients.) From: http://acceleratingscience.com/proteomics/meibum-lipid-composition-in-dry-eye-disease/

 Once one thinks about the normal, wide range of complex oils in the healthy, human tear, it is easy to understand how difficult it will be to create a sufficient “tear substitute!”

Now that I look harder at my routine patients, I find MGD to be nearly ubiquitous - and prevalent even in those as young as early teens (& probably earlier - I just no longer see young kids in my practice). I think this begins with poor blinking (a subconsciously "learned" response that is encouraged by use of computer-related activities like smart-phones, tablets, video games, computers and the like - and discouraged by outdoor play, where bright lights, wind and vigorous activities encourage better blinking). Inactivity may also lead to reduced blood flow in the lids that may reduce eyelid temperature. Poor diet (the high levels of processed foods in the America diet are said to have reduced healthy Omega oil intake by over 95% compared to 100 years ago, when such processed foods hardly existed) needs to be reversed - with a better focus on good eating habits and proper supplements (I like the MaxiTear Dry Eye Formula, which comes closest to Hydroeye as an all-in-one, based on the work of Drs. John Sheppard and Stephen Pflugfelter, but includes a bit more fish oil, some Curcumin to help fight inflammation and an enteric coating to prevent fishy, after-taste burps). Once oils become stagnant, they become the “buffet table” for common skin germs, who feast on the oils, create inflammatory byproducts and lead to the vicious cycle of dry eye disease.

Part 4 focuses more on how to correct this…