Meibomian gland dysfunction (MGD) : The most common cause of eye dryness

Meibomian glands are tiny oil glands within the eyelids that produce an oily meibum. When these glands don’t work as they should, then we call it meibomian gland dysfunction (MGD). MGD is a common eyelid condition that affects millions of people worldwide. MGD occurs when the meibomian glands get blocked or damaged, producing insufficient meibum. This can cause the tear film to become unstable, leading to dry, irritated eyes and even inflammation. Normal meibomian gland function is thus important to prevent tear evaporation and for the proper functioning of the eyes.

MGD is one of the commonest causes of dry eye disease.

Learn about  “What are Dry Eyes? Its Symptoms, Causes & Treatment”

Normal Tear film

The tear film is made up of three layers: the lipid (or oily) layer, the aqueous (watery) layer and the mucin layer. The meibomian glands, located in the eyelids near the base of the lashes, produce the lipid layer. This oily layer is essential for preventing tears from evaporating too quickly, thus keeping the eyes moist and lubricated.

The aqueous layer is produced by the lacrimal glands located above each eye. The mucin or mucus layer is made up of glycoproteins secreted by goblet cells in the conjunctiva (the tissue that lines the inner surface of the eyelids). Together, these three layers form a protective film covering and lubricating the ocular surface.

Tear production is thus not a very simple process.

What causes meibomian gland dysfunction (MGD)?

Five common factors found to contribute to the development of MGD are:

1. Age: As we age, the meibomian glands naturally become less efficient, which can lead to MGD.
2. Hormonal changes: Hormonal changes, like those during menopause, can affect the meibomian glands’ quality and quantity of meibum.
3. Environmental factors: Exposure to environmental factors, such as wind, air conditioning, and pollution, can cause the meibomian glands to become blocked or damaged.
4. Medical conditions: Certain medical conditions, such as rosacea, Sjogren’s syndrome, and blepharitis, can increase the risk of developing MGD.
5. Medications: Some medications, such as antihistamines and antidepressants, can cause dry eyes, which may contribute to the development of MGD.

Symptoms of meibomian gland dysfunction (MGD)

The symptoms of Meibomian gland dysfunction can vary but are similar to dry eye symptoms

1. Red eyes
2. Watery eyes
3. itchy eyes – more on the lid margins because of eyelid inflammations
4. Dry eyes
5. A gritty sensation – because of decreased meibomian gland secretions
6. Burning or stinging feeling
7. Blurry vision
8. Light sensitivity
9. Discomfort when wearing contact lenses

What causes worsening of these symptoms

1. Windy conditions
2. Dry conditions
3. Air travel
4. Air conditioned environments
5. Cold weather

What tests does a patient having MGD dysfunction undergo?

Your eye doctor will do one or more of the following

1. Detailed eye examination
2. Examine the meibomian gland orifices
3. Look for signs of eyelid margin inflammation
4. Measure the tear film break-up time
5. Stain the ocular surface to assess the severity of dry eyes

Meibomian Gland Dysfunction Treatment

Several treatments are available for Meibomian Gland Disease or MGD, depending on the severity of the condition. These include:

1. Warm compresses: Applying warm compresses to the eyes can help to loosen any blockages in the meibomian glands, allowing the meibum to flow more freely.
2. Lid massage: Massaging the eyelids can also help to stimulate the meibomian glands and improve the flow of the meibum. These massages can be done at home.
3. Eyelid hygiene or lid scrubs: Keeping the eyelids clean and bacteria-free can help to prevent blockages of the meibomian glands. Here one can use johnson’s baby shampoo and using an ear bud or cotton tip applicator which is dipped in the shampoo can clean the eyelid margins. Cotton pads can also be used instead of an ear bud.
4. Artificial tears eye drops: Using artificial tears or tear substitutes can help to lubricate the eyes and alleviate dryness and irritation.
5. Medications: In some cases, medications such as antibiotics or anti-inflammatory drugs may be prescribed to reduce inflammation and improve the function of the meibomian glands.
6. Omega-3-fatty acids: This supplement is also known to improve meibomian gland function.
7. Using Tea Tree Oil based products: A study published in Cochrane Library by Keyur Savla and the team at the University of Alabama at Birmingham, USA, found that the most common cause for MGD is due to mites called Demodex which are found on the eyelashes/eyelash follicles, and causes MGD recurrently, especially in elderly. Further, they found that tea tree oil-based products, either in the form of face washes to clean the face and eyelashes or eyelid scrubs, help in alleviating the symptoms caused due to MGD. However, we do not yet have long-term evidence published regarding the efficacy of tea tree oil-based products. Patients who were weaned off the tea tree oil products eventually get symptoms again.

Newer treatments for Meibomian gland dysfunction

Meibomian gland expression – Here your eye doctor will use an instrument to squeeze the meibomian glands to express the oil from the meibomian gland orifices.

1. Thermal pulsations – Here heat therapy is applied on the eyelids and helps in opening the blockages.
2. Lipiflow – is another newer form of therapy which massages the eyelids and helps squeeze out the oil.
3. Opening up of the meibomian gland blockages by using a very thin sharp instrument.

In conclusion, meibomian gland dysfunction is a common eye condition that can cause uncomfortable symptoms. While there is no cure for MGD, several treatment options can help alleviate symptoms and improve the function of the meibomian glands. If you are experiencing any symptoms associated with MGD, consulting with an eye care professional who can provide an accurate diagnosis and recommend an appropriate treatment plan is essential. We at Eye Solutions provide highly professional Eye Care Treatment in Mumbai & Chennai. You can reach out to us at “02071177990” or fill in an appointment form.