Meibomian Gland Dysfunction (MGD)

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What Is Meibomian Gland Dysfunction?

Meibomian gland dysfunction, also referred to as MGD, is a widespread eye condition that many people don't realize they have. Meibomian glands secrete oils that coat your eye and hold moisture in. 

MGD is a blockage or other irregularity in your meibomian glands. This causes the moisture on your eye to evaporate quickly. Therefore, MGD is linked to dry eye syndrome and posterior blepharitis.

Meibomian Gland Dysfunction MGD

MGD is sometimes referred to as meibomianitis, meibomitis, or meibomian keratoconjunctivitis.

Meibomian Gland Functions

Meibomian glands are named after the German doctor who first described them in 1666, Heinrich Meibom. There are approximately 40 to 50 meibomian glands in the upper eyelid and 20 to 30 in the lower eyelid. These glands make an oil called meibum, which they secrete onto the eyeball. 

Meibum, water, and mucus make up the three layers of tear film. Tear film is the fluid that coats your eyes, keeping them moist and comfortable. It also serves many vital functions, such as:

  • Facilitating the movement of eyelids
  • Providing nutrients to the cornea
  • Maintaining a smooth refractive surface for proper vision
  • Protecting the eye from irritants and temperature changes
  • Eliminating bacteria and other foreign contaminants from the ocular surface

Any disruption of the to the equilibrium of the three-layers of tear film can cause damage and may lead to dry eyes.

What Happens When You Have MGD 

MGD is caused by a change in the amount or quality of your meibum oil. This may be the result of the glands becoming clogged or structural damage that prevents them from functioning correctly. This results in less oil reaching the eye, which lowers the quality of your tear film. 


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Poor tear film evaporates quickly and is closely linked to other eye problems. People with MGD also have a much higher chance of getting an infection after laser refractive surgery.

Dry Eye Syndrome

MGD is one of the most common causes of dry eye syndrome (also referred to as dry eye disease). An estimated 90 percent of people with dry eyes may suffer from MGD as well. 

Blepharitis

Blepharitis

Blepharitis is a condition that causes your eyelids to become inflamed and often leads to dandruff-like scales and debris at the base of the eyelashes. The meibomian gland orifices also become clogged, resulting in MGD. Blepharitis is very common in people who have rosacea — a skin condition that causes the oil glands in your face, nose, and eyelids to clog.

Blepharitis, MGD and ocular surface diseases such as dry eye syndrome are all closely linked. There are many ways these eye conditions can interact, cause, or worsen each other. Many patients suffer from two or three of these conditions. 

Causes and Risk Factors of MGD

Many contributing factors make up your risk for MGD, including:

Age 

As you age, your number of functioning meibomian glands decreases. People over the age of 40 are much more likely to develop MGD.

Ethnicity

Asian people are approximately three times more likely to develop MGD than people with European ancestry.

Contact Lenses 

Contact lens wear may increase your chances of MGD. Contact lenses may affect normal functioning of meibomian glands and cause abnormalities in your tear film.

Eye Makeup

Eyeliner and other eye makeup can clog meibomian gland openings. Not removing your makeup before bed increases the risk of MGD.

Bacterial Infections 

Bacterial infections can be a cause or a result of MGD. They can disrupt oil production, and without proper tear fluid, your eyes are more susceptible to infection.

Autoimmune Diseases

Rosacea, lupus, rheumatoid arthritis, and Sjögren's syndrome have all been linked to MGD.

Medications

Estrogen replacement therapy, drugs that reduce androgen (birth control pills, some anti-acne, and anti-body hair medications), and retinoids (anti-aging creams, acne medications), can all interfere with oil production.

MGD Symptoms

The early stages of MGD often do not present any symptoms. As it progresses, you may experience:

  • Burning eyes
  • Itching eyes
  • Dry eyes
  • Irritation or feeling like you have a bit of sand in your eyes
  • Inflamed eyelids
  • Red eyes
  • Uneven and rough inner eyelids
  • Blurry vision when blinking

Diagnosing MGD

An eye doctor may use a number of tests to see if you have MGD. One simple technique is for your eye doctor to apply light pressure to your eyelids using their hands or a meibomian gland evaluator (MBE). They will then examine your meibomian gland secretions to determine if you have MGD.

Another common test is the tear breakup time test, also known as TBUT. This is a painless test that involves applying a small amount of dye to the tear film on your eye. The doctor will then shine a cobalt blue light to see how long it takes for your tear film to break up on your eye.

An ophthalmologist may use Dynamic Meibomian Imaging, or DMI, to take a photograph of your eyelids. This image will show whether or not you have sufficient meibomian glands.

MGD Treatment Options

For many years, people had to rely on short-term home remedies for MGD and dry eye symptoms. Applying a warm compress, followed by gently massaging your eyelids, can help melt and express thick oil that clogs your glands. This may provide temporary relief, but it is not enough to treat the condition or make your meibomian glands function correctly.

Meibomian gland probing was another treatment option. The eye doctor would apply numbing eye drops and use a tool to probe and dilate your glands. However, this procedure is somewhat uncomfortable and laborious.

Luckily there have been several advancements in the treatment of meibomian gland dysfunction and lid hygiene over the last few decades. Modern treatment options include:

LipiFlow

Johnson and Johnson Vision make the LipiFlow thermal pulsation system. It applies heat and pressure to melt the waxy and oily deposits clogging meibomian glands, allowing the glands to express their oils healthily and improving the quality and quantity of the lipid layer. This 12-minute in-office treatment can improve MGD and dry eye symptoms for up to three years.

iLUX

The in-office iLUX treatment uses an LED heat source to melt the waxy oil clogging your glands. Then the eye doctor will apply pressure to help express the clogged glands. This treatment is manufactured by Tear Film Innovations and won Gold at the 2019 Medical Design Excellence Awards (MDEA).

TearCare

Sight Sciences developed TearCare. It uses adhesive heating patches connected to a small heating unit to warm the waxy deposits. Then forceps press your lids and glands open to begin proper expression.

Intense Pulsed Light (IPL)

IPL treatment has been used by dermatologists for years to treat acne rosacea. It has also shown to be successful in alleviating MGD and dry eye symptoms. IPL shines intense flashes of infrared and visible light on the eyelids over 20 minutes. This is done in multiple treatment sessions about a month apart.

Blephex

Blephex treats blepharitis and MGD through exfoliation. A hand-held instrument with a small rotating sponge attached applies pressure and scrubs the conjunctiva (eyelid margin). The sponge gently exfoliates and removes inflammatory biofilm that clogs your glands. The process takes about 10 minutes.

Lid Debridement

Mechanical lid debridement involves using tools to scrape the eyelid to remove keratin and other debris from the meibomian gland orifices around the lid margins. 

Antibacterials

Some eye doctors may prescribe you antibacterial eye drops in order to restore proper meibomian gland function. This includes topical antibiotics such as the gel azithromycin. They may also prescribe systemic antibiotics such as doxycycline or ertythromycin.

Cyclosporine Eye Drops

Cyclosporine (brand names: Restasis and Cequa) modifies the body’s immune response. It increases your ability to produce more tears, making it a treatment option for dry eyes and MGD.

Prescription Medications

There are no medications that are approved by the FDA to treat MGD, however, there are two medications Xiidra is FDA approved for the treatment of dry eye. It may be used off-label to alleviate symptoms of MGD.

Omega-3 Supplements

Some eye doctors suggest that omega-3 fatty acids may provide a useful adjunct treatment for MGD. These essential fatty acids may help suppress conjunctival inflammation and decrease the risk of future problems.

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Resources

Barash, Alexander, et al. Meibomian Gland Dysfunction (MGD). 1 June 2020,https://eyewiki.aao.org/Meibomian_Gland_Dysfunction_(MGD)

Geerling, Gerd, et al. “The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction.” Investigative Opthalmology & Visual Science, vol. 52, no. 4, 2011, p. 2050., doi:10.1167/iovs.10-6997g

Henry D Perry. “Topical Cyclosporine Use in Meibomian Gland Dysfunction.” TouchOPHTHALMOLOGY, 11 Jan. 2011, www.touchophthalmology.com/topical-cyclosporine-use-in-meibomian-gland-dysfunction/

Foulks, Gary N, and Anthony J Bron. “Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading.” The ocular surface vol. 1,3 (2003): 107-26. doi:10.1016/s1542-0124(12)70139-8

Chhadva, Priyanka et al. “Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease.” Ophthalmology vol. 124,11S (2017): S20-S26. doi:10.1016/j.ophtha.2017.05.031

Xiao, Jiaxin et al. “Diagnostic Test Efficacy of Meibomian Gland Morphology and Function.” Scientific Reports vol. 9,1 17345. 22 Nov. 2019, doi:10.1038/s41598-019-54013-4

Sullivan, D. A., Sullivan, B. D., Evans, J. E., Schirra, F., Yamagami, H., Liu, M., . . . Dana, M. R. (2002). Androgen Deficiency, Meibomian Gland Dysfunction, and Evaporative Dry Eye. Annals of the New York Academy of Sciences, 966(1), 211-222. doi:10.1111/j.1749-6632.2002.tb04217.x

Barash, Alexander , et al. Meibomian Gland Dysfunction (MGD). 1 June 2020, https://eyewiki.aao.org/Meibomian_Gland_Dysfunction_(MGD)

Geerling, Gerd, et al. “The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction.” Investigative Opthalmology & Visual Science, vol. 52, no. 4, 2011, p. 2050., doi:10.1167/iovs.10-6997g

Henry D Perry. “Topical Cyclosporine Use in Meibomian Gland Dysfunction.” TouchOPHTHALMOLOGY, 11 Jan. 2011, www.touchophthalmology.com/topical-cyclosporine-use-in-meibomian-gland-dysfunction/

Foulks, Gary N, and Anthony J Bron. “Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading.” The ocular surface vol. 1,3 (2003): 107-26. doi:10.1016/s1542-0124(12)70139-8

Chhadva, Priyanka et al. “Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease.” Ophthalmology vol. 124,11S (2017): S20-S26. doi:10.1016/j.ophtha.2017.05.031

Xiao, Jiaxin et al. “Diagnostic Test Efficacy of Meibomian Gland Morphology and Function.” Scientific Reports vol. 9,1 17345. 22 Nov. 2019, doi:10.1038/s41598-019-54013-4

Sullivan, D. A., Sullivan, B. D., Evans, J. E., Schirra, F., Yamagami, H., Liu, M., . . . Dana, M. R. (2002). Androgen Deficiency, Meibomian Gland Dysfunction, and Evaporative Dry Eye. Annals of the New York Academy of Sciences, 966(1), 211-222. doi:10.1111/j.1749-6632.2002.tb04217.x

Korb, D R, and A S Henriquez. “Meibomian gland dysfunction and contact lens intolerance.” Journal of the American Optometry Association vol. 51,3 (1980): 243-51.

Qiao, Jing, and Xiaoming Yan. “Emerging treatment options for meibomian gland dysfunction.” Clinical ophthalmology (Auckland, N.Z.) vol. 7 (2013): 1797-803. doi:10.2147/OPTH.S33182

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