Meibomian gland dysfunction (MGD): The cause of your dry eyes?

Meibomian gland dysfunction may be one of the most common eye problems you've never heard of.

Meibomian ("my-BOH-mee-an") refers to a particular type of gland in the eyelids. Meibomian glands are named after Heinrich Meibom, the German doctor who first described and made drawings of them way back in 1666.

There are about 25 to 40 meibomian glands in the upper eyelid and 20 to 30 in the lower eyelid. The function of these glands is to secrete oils onto the surface of the eye. These oils help keep the tears from evaporating too quickly.

Meibomian gland dysfunction (MGD) is blockage or some other abnormality of the meibomian glands so they don't secrete enough oil into the tears. Because the tear film on the surface of the eye then evaporates too quickly, MGD is associated with dry eye syndrome. It also is connected with an eyelid problem called blepharitis.

Another name for meibomian gland dysfunction is "meibomianitis."

MGD risk factors

There are several factors that can increase your risk of getting meibomian gland dysfunction.

Like the risk of dry eyes, the risk of MGD increases with age. People over age 40 have a significantly greater risk of developing it than children or young adults.

A study of 233 older adults (91 percent male; average age 63) found that 59 percent had at least one sign of meibomian gland dysfunction.

Your ethnic background also plays a role. An extensive review of published research concerning MGD showed that some studies have found that up to 69% of Asian populations in Thailand, Japan and China have meibomian gland dysfunction.

By comparison, other studies have found that only up to 20% of non-Hispanic whites in the U.S. and Australia have MGD.

Wearing eye makeup is another contributing cause of MGD. Eyeliner and other makeup can clog the openings of meibomian glands. This is especially true if you don't thoroughly clean your eyelids and remove all traces of eye makeup before sleep.

Some researchers believe wearing contact lenses also may increase the risk of MGD. Recent research has shown that alterations of the meibomian glands are associated with contact lens wear, and that discontinued use of contacts for up to six months doesn't eliminate these changes.

But it's unclear whether contact lens wear actually causes meibomian gland dysfunction and most researchers say additional study is needed to determine if people who wear contacts have a greater risk of MGD.

How is MGD detected?

The symptoms of meibomian gland dysfunction — red eyes, a gritty feeling, itchy eyes, and blurred vision — are nearly the same as those of dry eye syndrome.

Only an optician can tell for sure if you have MGD.

A simple technique your optician might use to detect MGD is to apply pressure to your eyelid and thereby express the contents of the meibomian glands. Observing these secretions often can enable a trained eye care professional to determine if you have meibomian gland dysfunction.

Because meibomian gland dysfunction affects the stability of the tear film, your optician also may test the quality, quantity and stability of your tears.

One common test is called the tear breakup time (TBUT) test. This simple, painless procedure involves the application of a small amount of dye to the tear film on the front surface of your eye. Your optician then examines your eye with a cobalt blue light (which causes your tears to glow) to see how quickly your tear film loses its stability (breaks up) on your eye.

SEE ALSO: Applying eye drops: A guide on how to put in eye drops

Treatments for meibomian gland dysfunction

In the past, the typical treatment recommended for MGD was applying warm compresses to the eyelids, followed by massaging the eyelids. The goal of this treatment was to melt and express any thickened oil clogging the openings of meibomian glands.

Unfortunately, warm compresses and massage usually aren't sufficient to adequately treat the problem and restore normal functioning of meibomian glands.

Another option was meibomian gland probing. In this treatment, numbing eye drops are applied to your eye and your optician uses the end of a hand-held instrument to probe and dilate the openings of your meibomian glands (near the base of your eyelashes). This procedure is quite effective, but it is tedious and somewhat uncomfortable.

New treatment options are now available. These include:

LipiFlow. The LipiFlow thermal pulsation system (Johnson & Johnson Vision) is an in-office medical device that applies sufficient heat to the eyelids to melt waxy deposits in the meibomian glands. At the same time, it applies pulsed pressure to the eyelid to open and thoroughly express the contents of the glands.

The LipiFlow device attaches to the eyelid for the 12-minute treatment session, and the system is designed so there is no transfer of heat or pressure from the eyelids to the eyeball itself. Research has shown that a single Lipiflow treatment significantly improved meibomian gland secretions and dry eye symptoms for up to three years.

iLUX. This is relatively new an in-office treatment for MGD developed by Tear Film Innovations and marketed by Alcon. The iLUX MGD Treatment System uses a portable, hand-held LED-based heat source to warm the inner and outer surface of the eyelids to melt waxy secretions trapped inside the meibomian glands.

Once sufficient heat has been applied to melt the secretions, your optician will apply compression to the lids to express the clogged meibomian glands while directly observing the process. Most patients can be treated with the iLUX system in less than eight minutes.

Studies have shown that iLUX treatment resulted in significant improvements in the signs and symptoms of meibomian gland dysfunction and dry eyes at two to four weeks after the treatment.

The iLUX MGD Treatment System was selected as a Gold winner at the 2019 Medical Design Excellence Awards (MDEA).

TearCare. This is an in-office treatment for MGD developed by Sight Sciences that consists of single-use adhesive heating patches that are applied to the external eyelids. The patches are connected by a cable to a small, reusable handheld heating unit. After the 12-minute heating period, the optician uses expression forceps to squeeze the lids to open and drain the clogged meibomian glands.

A pilot study of the TearCare system showed it was an effective treatment option for MGD and dry eye disease, and that it reduced signs and symptoms of dry eyes that lasted at least 6 months. No such improvement was seen in the control group of patients that used daily at-home warm compresses.

Adjunct meibomian gland therapies

Some opticians will recommend a combination of treatments for MGD and dry eyes. Therapies that might be suggested for use with the treatments above include:

Intense pulsed light (IPL). This treatment, used by dermatologists for years to treat acne rosacea, has also been shown to be effective for relieving meibomian gland dysfunction and dry eye symptoms.

IPL treatment, which applies intense pulses of visible and infrared light to the eyelids, last about 20 minutes. Typically, multiple treatment sessions are scheduled approximately a month apart.

It's believed that IPL treatment decreases inflammation in the eyelids that cause obstructions of the meibomian glands. A three-year study of IPL showed promising results as a treatment for MGD, with 93 percent of subjects reporting satisfaction with the level of improvement in their symptoms of dry eye after a series of IPL sessions.

Blephex. This is an in-office treatment for blepharitis that also has been shown to reduce the symptoms of meibomian gland dysfunction. The hand-held instrument gently debrides the margin of the eyelids with a rotating, medical-grade sponge. This exfoliating action removes an inflammation-causing biofilm that can form on the eyelids that causes the meibomian glands to clog. The treatment usually takes less than 10 minutes to clean all four eyelids.

Lid debridement. In this treatment, your optician uses a hand-held instrument to de-scale a material called keratin and other debris that can adhere to eyelid margins and clog meibomian gland openings. Research has shown that lid debridement-scaling produced statistically significant relief of dry eye symptoms and meibomian gland function one month after the procedure.

Antibacterial eye drops. Some studies have shown that antibacterial eye drops have helped resolve meibomian gland dysfunction. During your eye exam, your optician will advise you whether this is a good option for you.

Cyclosporine eye drops. Cyclosporine is an agent that modifies the body's immune response in a specific way. This medication is found in the prescription eye drop Restasis (Allergan) that is used to manage dry eye symptoms.

Omega-3 supplements. Some opticians recommend dietary supplementation with omega-3 fatty acids as an adjunct treatment to one of the MGD treatments above. A diet rich in omega-3s also may decrease the risk of future episodes of meibomian gland dysfunction. It appears these essential fatty acids may help suppress inflammation associated with MGD and decrease the risk of waxy build-up within the meibomian glands.

THINK YOU MIGHT HAVE MGD? Find an optician near you and schedule an appointment.

Page published on Sunday, 24 May 2020