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Meibomian Gland Dysfunction: Causes, Symptoms, and Treatments

Science shows that 86% of patients diagnosed with dry eye also exhibit symptoms of another condition known as Meibomian Gland Dysfunction or MGD. 

In short, MGD describes a blockage of some kind that inhibits the activity of your eye’s meibomian glands. Though they’re tiny, these glands have a big job.

They secrete oil that contributes to your tears, preventing them from drying up before they can come out. When they’re rendered inactive, your tears evaporate too quickly, leading to dry eye. 

Meibomian Glands (yellow/orange) release oil to keep your eyes clear (Dryeyedirectory.com)

Today, we’re taking a deep dive into MGD. We’ll discuss what can cause it, the symptoms to recognize and which treatment options are available to help.

Ready to learn more? Let’s get started.

The Function of Your Meibomian Glands

Before we delve into the specifics of MGD, let’s review what your meibomian glands do and why they’re so important. 

You’ll find these oil-secreting glands along your upper and lower eyelid. Your upper eyelid has about 25 to 40 individual glands, while your lower eyelid has 20 to 30.

They owe their complex name to Heinrich Meibom, a German doctor who first noticed and drew images of them back in 1966.

In addition to causing dry eye, MGD can also cause your eyelids to become inflamed, leading to a condition known as blepharitis.

Meibomian Gland Dysfunction leads to the white stripes (also known as Meibomian Glands) clogging and shrinking over time

Risk Factors for Meibomian Gland Dysfunction

As with all healthcare, knowledge is the key to prevention. If you know ahead of time that you’re at risk of developing MGD, you can take earlier steps to help combat and reverse the condition. 

To this end, let’s review a few known risk factors that can contribute to MGD.

Age

The older you get, the more you’re prone to dry eyes. This is because the senior population is more likely to experience one or more of the following conditions, which can upset a healthy ocular surface:

  • Polypharmacy (taking multiple drugs to treat one condition)
  • Androgen deficiency
  • Lower blink rates
  • Oxidative stress

As such, people over the age of 40 are more susceptible to MGD than younger populations. In fact, in one study of 233 older adults, researchers found that 59% showed at least one sign of MGD. 

Ethnicity

Data suggests that one’s ethnic background also plays a role in determining the risk factor for MGD. Specifically, Asian populations appear to be especially vulnerable. 

One study found that 46% to 69% of patients in Japan, Thailand, and China suffer from the condition. This is in comparison to 3.5% to 20% of Caucasians who have the condition. 

Eye Makeup Use

Do you wear heavy eye makeup on a regular basis? If so, the cosmetics can clog the opening of the meibomian glands and affect their performance.

Chemicals in cosmetics can also be toxic to your eyes. Check out this post for some of the main ingredients to avoid.

This is one more important reason why you should always remove all of your makeup before going to bed! One non-toxic remover is the WeLoveEyes Makeup Remover Oil.

Contact Lenses

More conclusive research is required before an official relationship can be drawn, but researchers believe there may be a correlation between contact lenses and MGD.

This is because the lenses themselves can disrupt the glands, changing their functionality. 

Relationship with Other Medical Concerns

When you suffer from MGD, you’re also more vulnerable to other medical concerns, not all of which are eye-related. Here are a few to keep in mind.

  • Allergic conjunctivitis and other eye diseases
  • Autoimmune diseases (including rosacea, rheumatoid arthritis, lupus, and Sjögren’s syndrome)
  • Inflamed eyelids and corneas
  • Bacterial infection

Are you wondering if you might have MGD? There are myriad symptoms to help you identify the condition, though most of them overlap with dry eye.

In the early stages of MGD, you may not have any symptoms at all. Over time, however, they can begin to present themselves. Here are a few to be on the lookout for:

  • Red eyes
  • A gritty sensation inside your eyes
  • Itchy eyes
  • Blurred vision
  • Inflamed eyelids

In addition, your low oil levels may be due to medications you’re currently taking.

For instance, if you’re on estrogen replacement therapy medication or drugs meant to reduce androgen hormones, your eyes may be drier than usual. This is also the case if you’re using retinoids or any other anti-aging skincare that may drip into your eyes.

Trigger Factors

Do you spend a large part of your day on the computer? Do you live in an arid environment with dry air pumping in your home or office? If so, you could notice that your MGD symptoms worsen in his atmosphere. 

In some semi-rare cases, you may also notice a rough and uneven surface along the inner rim of your eyelid. Not everyone has this unevenness, so it’s always important to call your eye doctor to determine what you’re looking at.

In the same vein, though it’s tempting to self-diagnose, always consult your eye doctor before beginning treatment for any eye-related condition. Failing to do so could exacerbate your symptoms rather than mitigate them.

How can your eye doctor test for MGD? He can put pressure on your eyeball itself. When this happens, normal meibomian glands should secrete oil. 

Your doctor will examine the level and content of the oil production to help determine if MGD could be the underlying cause of your dry eye symptoms.

Tear Breakup Time Test

Your doctor can also examine the contents of your tears as a diagnostic measure, analyzing their stability, quality, and quantity.

If this is the route taken, your doctor will perform what’s known as a tear breakup time test, or TBTT. He’ll apply a small amount of dye to the front surface of your eye, on your tear film.

He’ll then perform an eye exam using a special cobalt blue light. Why blue? It makes your tears glow! 

During this painless exam, your doctor can measure how long it takes for your tears to break down. In other words, what’s their stability level? This can help lead to an MGD diagnosis or dismissal.

Tear breakup time can also be measured without dyes. This is called Non-Invasive Tear Breakup Time. This test uses an infrared device (e.g. Oculus Keratograph 5M) to measure how rapidly your normal tears begin to evaporate.

Devices such as the Keratograph 5M are used to take baseline dry eye scans (e.g. non-invasive tear breakup time)

Meibomian Gland Evaluation

A Meibomian Gland Evaluator (MGE) is a simple device shaped like a USB stick. It has a spring inside at a certain level of pressure. It replicate the force of a normal blink.

The MGE gently touches the lower eyelid edge. A tiny amount of pressure is applied to see how much oil comes out (and whether it is clear or thick and pasty). The thicker and cloudier the oil, the more Meibomian Gland Dysfunction is present.

Effective Treatments for MGD

Before more advanced, tech-savvy treatments came along, the go-to meibomian gland dysfunction treatment was to apply a warm compress to the closed eyelid. 

Before more advanced, tech-savvy treatments came along, the go-to Meibomian Gland Dysfunction treatment was to apply a warm compress to the closed eyelid. 

Though it wasn’t effective for the long term, this exercise could provide quick relief for those suffering from MGD. It worked to thin out and loosen any thick oil that might be blocking the glands.

Looking for more at-home remedies you can use while you wait for your eye doctor appointment? Here are a few more tips.

Eyelid Massage

Ever heard your parents say to stop rubbing your eyes? Eyelid massage is the same. It is generally not recommended, unless via an eyecare professional.

Choosing Cleansers and Cosmetics

It’s best to be as gentle on your eyes as possible, especially if you’re suffering from MGD. Avoid irritating soap cleansers and instead, use a natural non-soap alternative to wash your face. 

As you cleanse, avoid getting any solution on or around your eyes. Instead, use a makeup remover to get rid of all traces of the day.

You should also avoid touching your fingers or cotton pad near your eyes when you apply skincare products containing retinol on your face. 

Adding Moisture the Environment

If you can attribute your dry eyes to your climate or your home’s HVAC unit, try running a humidifier at night. This adds moisture into the air and can counter any damaging effects of indoor heating and air conditioning. 

Looking for a more powerful, longer-lasting treatment than DIY remedies can provide? Your eye doctor has a host of tools designed specifically with MGD patients in mind.

Let’s take a look at five modern treatments that are changing the game.

Gland Probing

Has your doctor mentioned meibomian gland probing?

While it sounds intimidating, don’t fret. This is a practice that’s performed as it sounds. It’s effective in unclogging the main duct and surrounding openings of your meibomian glands.

Your eye doctor will give you a few drops of anesthetic eye drops, then get to work. He’ll use a small, handheld tool to probe and dilate your gland openings, focusing his efforts on the skin right at the base of your eyelashes. 

As evidence of its effectiveness, consider one study of 25 patients with MGD symptoms. When they underwent gland probing, 96% of them experienced immediate relief. What’s more, 100% felt relief four weeks after the procedure. 

While the probing can be effective on its own, other studies suggest it can be even more helpful when performed in conjunction with the use of corticosteroid eye drops. This combination can provide quicker and more effective results compared to those who relied on the eye drops alone. 

Cyclosporine Eye Drops

If you’ve ever grabbed a bottle of Restasis (Allergen) off the pharmacy shelf in a pinch, you know it can be a helpful addition to your dry eye regimen. 

Cyclosporine helps enhance your eyes’ natural ability to create tears. It does this by altering your body’s immune system response so you’re more prone to tearing.

Antibacterial Eye Drops

For some people who suffer from MGD, antibacterial eye drops are all they need to keep the symptoms at bay.

While there is some merit to this approach, researchers require more advanced studies before they can draw a direct connection of healing. 

Omega-3 Supplements

Healthcare professionals around the world have long heralded omega-3 supplements for the nutritious fatty acids they contain. 

Your doctor might recommend that you start a diet focused on foods rich in omega-3s to help improve your tear function. You can find omega-3s in salmon, walnuts, eggs, bread, spinach and more!

Keep in mind that these supplements aren’t meant to replace one of the above steps, but to complement it. Stick with the plan you received from your doctor, adding in the changes when possible. 

LipiScan and LipiFlow

Recently, Johnson and Johnson partnered with TearScience. Together, the two entities created solutions known as LipiScan, LipiFlow and LipiView II.

LipiScan works to provide high-definition scanning capabilities so doctors can get a better view of how your glands are operating. LipiFlow delivers pulsating therapeutic energies to your meibomian glands to encourage them to loosen any thickened oil.

Finally, the LipiView II lets doctors visualize your lipid layer in real time, leading to important discoveries about your eye health. It can also measure your blink dynamics and take a granular-level photo of your meibomian gland structure.

All of this imaging capability is possible through a trademarked technology called Dynamic Meibomian Imaging or DMI.

Intense Pulsed Light (IPL) for Dry Eye

You may have heard of IPL in skin treatments. IPL has been used for many years by Dermatologists. However, when doing facial treatments, patients often reported improvements in dry eyes.

IPL involves flashes of light across the skin. It may improve the look and feel of your skin, as well as helping your eyes. Learn more about IPL for Dry Eye.

Find Your Next MGD Doctor Today

When your eyes are dry, even the most simple task can seem like an overwhelming chore. Between the burning and itching, it can be difficult to make it through the day.

The good news? There’s no shortage of treatment options designed to help you treat your Meibomian Gland Dysfunction. 

Today’s best eye doctors are well-versed in all the latest industry news and updates. They’re ready and waiting to take your call and set you down the path toward an improved quality of life. 

When you’re ready to find the best dry eye specialist near you, let us help.

We offer a dry eye doctor directory complete with the contact information of some of the best in the business.

Browse the specialties, locations and more to find one that’s a good fit. Then, feel free to make an appointment. Take that first step together!