MGD (Meibomian Gland Dysfunction)

What is MGD?

MGD is a blockage or other irregularity in your meibomian glands. These large sebaceous glands secrete oils that coat your eyes and retain moisture. Also known as meibomian gland dysfunction or meibomian gland disease, MGD causes your eyes to dry out quickly. Therefore, MGD is linked to dry eye syndrome and posterior blepharitis.

How do Meibomian Glands Normally Function?

Meibomian glands make an oil called meibum, which they secrete onto the eyeball. These glands are named after the German doctor who first described them in 1666, Heinrich Meibom.

Meibum, water, and mucus comprise 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 to the equilibrium of the three layers of tear film can cause damage and may lead to dry eyes.

There are approximately 40 to 50 meibomian glands in the upper eyelid and 20 to 30 in the lower eyelid. 

What Happens When You Have MGD? 

MGD changes the amount or quality of your meibum oil. This results in less oil reaching the eye, lowering your tear film's quality. 

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.

Eye Conditions Linked to MGD

Blepharitis, MGD, and ocular surface diseases like dry eye syndrome are closely linked. Many people suffer from two or three of these conditions. 

Dry Eye Syndrome

MGD is one of the leading causes of dry eye syndrome (also called dry eye disease). Symptoms of dry eye disease include dry, red, and inflamed eyes.

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 with rosacea — a skin condition that causes the oil glands in your face, nose, and eyelids to clog.

Allergic Conjunctivitis

Conjunctivitis, also known as pink eye, is when the clear covering of the eye is red and inflamed. 

Unlike contagious forms of conjunctivitis, the allergic type can persist for several weeks or longer. MGD can occur during an extended bout of conjunctivitis.

MGD Causes

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.¹

Contact Lenses 

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

Eye Makeup

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

Bacterial Infections 

Bacterial infections can be a result of MGD because they can disrupt oil production. Without proper tear fluid, your eyes are more susceptible to infection.

Autoimmune Diseases

Autoimmune diseases linked to MGD include:

• Sjögren's syndrome
• Rosacea
• Lupus
• Rheumatoid arthritis

Other Medical Conditions

Other medical conditions that increase your risk for MGD include:

• Stevens-Johnson syndrome
• Polycystic ovary syndrome (PCOS)
• Hypertension (high blood pressure)

Medications

Certain medications can interfere with oil production and cause MGD. These include:

• Estrogen replacement therapy
• Drugs that reduce androgens, such as birth control pills
• Retinoids (commonly found in anti-aging creams and acne medications)

MGD Symptoms

Most of the time, MGD is asymptomatic, meaning it causes no symptoms. When symptoms do occur, they may include:

• 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
• Light sensitivity
• Crusty eye discharge

Diagnosing MGD

An eye doctor may use several tests to see if you have MGD. These include:

Eye Exam

Your eye doctor will closely examine your eyelids to check the meibomian gland openings. 

They may apply light pressure to your eyelids with their hands or a meibomian gland evaluator (MBE). Applying pressure releases oil from your meibomian glands. Then, your doctor will examine your meibomian gland secretions to determine if you have MGD.

Tear Breakup Time Test (TBUT)

This painless test 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.

Dynamic Meibomian Imaging (DMI)

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

MGD Treatment Options

Self-care may be enough to treat mild cases of MGD. Several medical treatments are available for more advanced cases.

Home Remedies

People have had to rely on short-term home remedies for MGD and dry eye symptoms for many years. 

Many home remedies are still effective today, including:

• Warm compresses and eyelid massages. Place a warm compress over your eyelids for five minutes twice daily. Follow this by gently massaging your eyelids with your fingertips.
• Washing your eyelids. Use a gentle, non-soap cleanser once a day to clean your eyelids along the lash lines.
• Using a humidifier. Humidifying the air in your home can help counteract the drying effects of heat and air conditioning.
• Change contact lenses. If you wear contacts, ask your doctor about switching to a less-drying type.
• Omega-3 supplements. Talk to your doctor about supplementing with omega-3 fatty acids. Their anti-inflammatory properties may improve the quality of meibum.

Medical Treatment

Medical treatments for MGD 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. This allows the glands to express their oils healthily and improves 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 been 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. This removes keratin and other debris from the meibomian gland orifices around the lid margins. 

Antibacterials

Some eye doctors may prescribe antibacterial eye drops 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 erythromycin.

Cyclosporine Eye Drops

Cyclosporine (brand names: Restasis and Cequa) modifies the body’s immune response. This drug 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 approved for the treatment of dry eye. 

Your doctor may prescribe dry eye medications as an off-label treatment for symptoms of MGD.

Summary

MGD, or meibomian gland dysfunction, is a common eye condition that causes your eyes to dry out quickly. The meibomian glands are large, oil-secreting glands that keep your eyes moisturized.

MGD is the leading cause of dry eye syndrome and is linked to other eye diseases like blepharitis. Most of the time, MGD doesn’t cause symptoms, and many people don’t realize they have it.

If MGD is causing discomfort, home remedies may provide sufficient relief. Otherwise, many medical treatments are available.