What the Heck is Meibomian Gland Dysfunction and Why Does It Cause Dry Eye Disease?

What is the meibomian gland?

A meibomian gland is a modified oil gland in the eye. You have about 30-40 meibomian glands on your upper eyelid and about 20-40 on the lower eyelid. The meibomian gland orifices are tiny pores along the edge of your eyelids (where your eyelashes are). 

Tears are important for the health of your eyes; they keep your eyes lubricated, remove irritants, and protect your eyes from infection. Meibomian gland secretions (meibum) provide a superficial protein and lipid layer to the tear film. Meibum prevents evaporation of the tear film’s water layer, keeping your eyes from drying out too quickly.  

What is Meibomian Gland Dysfunction? 

According to the National Eye Institute, Almost 16 million Americans have dry eye disease (also called dry eye syndrome). And dry eye is one of the most common reasons patients visit Assil Gaur Eye Institute(AGEI). 

Meibomian gland dysfunction (MGD) is a leading cause of evaporative dry eye. MGD is caused by changes in the quantity and quality of meibum—resulting in a clogged meibomian gland. 

When this occurs, less oil reaches the surface of the eye, causing it to dry out quickly. 

What Causes Meibomian Gland Dysfunction?

Multiple factors can impact your meibomian gland function and put you at risk of MGD-caused dry eye. 

Age

As you get older, not only do your glands produce less meibum, your number of meibomian glands also decreases. 

Environmental factors  

Living or working in an environment with low humidity, as well as environments with wind, smoke, hot dry weather, air-conditioning, and winter heating, can cause changes to meibum production. These conditions also cause your eyes to dry faster. 

Eye contact lens use

Extended contact lens wear is linked to decreased meibum and other MGD symptoms due to chronic mechanical trauma resulting from increased friction. 

Medication

Some medications alter the composition of meibum and affect its production. This can include topical epinephrine, retinoic acid, and some glaucoma medications. 

Diet

A lack of omega-3 fatty acids in the diet may also contribute to meibomitis. These fatty acids are essential for healthy meibum. Omega-3 fatty acids (from food or supplements) may improve the symptoms of MGD by reducing inflammation and improving the quality of the meibum. 

Eye makeup

Eyeliner and other eye makeup can clog the gland openings which is why it’s essential to remove eye makeup before going to bed. It’s also important to clean makeup brushes regularly to avoid introducing bacteria to your eye area. 

What are meibomian gland dysfunction symptoms? 

In the early stages, dry eye symptoms may not reveal themselves, but when obstructed meibomian glands become a chronic condition and are not fixed, symptoms arise. The common symptoms of MGD include:  

• Burning or itching eyes 
• Irritation or a gritty feeling in one or both eyes 
• Inflamed eyelids 
• Red eyes 
• Uneven and rough inner eyelids 
• Blurry vision 
• Light sensitivity 
• Crusty eye discharge 
• Swollen glands  

How is MGD diagnosed?

For an accurate MGD diagnosis, the eye specialists at AGEI will review your medical history and current symptoms. Examination of your eyes and dry eye-specific tests can help us determine if MGD is causing your dry eye problems. 

One test is for tear breakup time (TBUT), a simple, painless procedure that involves applying a small amount of dye to the eye, TBUT tests how long tear film remains after you blink. If the tear film evaporates quickly, you may have dry eye disease. 

What are the possible complications of meibomian gland disease?

MGD is considered a mild disease by many ophthalmologists, especially when treated quickly. However, if not treated it can lead to severe evaporative dry eye and other complications. 

Persistent dry eye can result in corneal scarring as irritants are no longer properly removed from the eyes by natural tear production. Untreated MGD can also lead to atrophy of the meibomian glands. As the glands atrophy, they no longer function properly which increases your risk of future dry eye. 

When your meibomian glands are blocked, you also increase your risk of infection because bacteria and Demodex mites aren’t being properly flushed from the area. A bacteria infection can then cause posterior or anterior blepharitis (sometimes called “eye dandruff”) or ocular rosacea (burning, itching, inflammation of the eyes). 

If you notice dry eye symptoms, get them checked out early, before they evolve into more complex and painful eye problems. 

What are the treatment options for meibomian gland dysfunction?

A multifaceted approach is used for the best outcomes in the treatment of MGD. 

Treatment of meibomian gland dysfunction may include the following: 

Conservative treatments

For early meibomian gland dysfunction, we can try simple, at-home treatments to clear your glands and restore normal function. 

• Lid hygiene such as an eyelid scrub and warm compresses with a wet washcloth. 
• Gentle massage of the upper and lower lids to stimulate oil flow. 
• Topical or oral antibiotics (including tetracycline, azithromycin, and doxycycline). 

Eye drops

Steroid eye drops are commonly prescribed to reduce eyelid inflammation and improve oil secretion. Medicated eye drops are also commonly prescribed to stimulate oil production and increase tear quantity. 

Lubricating eye drops (such as artificial tears) can provide relief of eye dryness while the underlying cause is being treated. They can also protect your eyes in dry conditions. 

Lipiflow

Lipiflow treatment is an FDA-approved thermal pulsation system that uses heat and eyelid massage to open the meibomian glands and enhance meibum production. 

iLUX

iLUX is a portable, hand-held, LED-based heating device that warms the surfaces of the eyelids. iLUX treatment melts waxy secretions blocking the meibomian glands to improve meibum flow. 

Blephex

Blephex is a hand-held device used for lid debridement. It gently exfoliates the eyelid margins to eliminate bacteria and debris blocking your glands. 

TearCare 

TearCare is a cutting-edge technology that uses gentle heating to provide relief from dry eye syndrome. TearCare uses a unique approach called Blink-Assisted Meibomian Gland Expression. Most patients experience significant improvement after just one treatment. 

Every patient responds differently, and some patients may need additional treatment to manage their symptoms. That’s why the optometrists and ophthalmologists at Assil Gaur Eye Institute will monitor your progress at follow-up ophthalmology visits to determine the best course of action. 

Why choose Asil Gaur Eye Institute for your dry eye treatment?

If you are experiencing dry eyes, it’s important to understand the condition and seek appropriate care from our world-class ophthalmologists. Meibomian gland dysfunction can be a common cause of dry eye disease, but there are other causes as well. 

The doctors at Assil Gaur Eye Institute are experts at treating and preventing dry eye as well as offering truly world-class eye care and vision correction. Specializing in LASIK, cataract, cornea, retina, and glaucoma treatments, at AGEI, you will experience state-of-the-art medical facilities that bring together revolutionary technologies with the most experienced doctors in ophthalmology. Our goal is to help you achieve your personal best vision. 

Please call 866-945-2745 or visit us here to make an appointment online if you are experiencing any concerning symptoms to schedule a consultation. 

We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, and Manhattan Beach. 

Sources

Stonecipher K, Abell TG, Chotiner B, et al. Combined low level light therapy and intense pulsed light therapy for the treatment of meibomian gland dysfunction. Clin Ophthalmol. 2019;13:993-9. 

Tauber J, Owen J, Bloomenstein M, et al. Comparison of the iLUX and the LipiFlow for the treatment of meibomian gland dysfunction and symptoms: a randomized clinical trial. Clin Ophthalmol. 2020;14:405-18. DOI: 10.2147/OPTH.S234008. 

Tomlinson A, Bron AJ, Korb DR, et al. The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):2006-49.