Meibomian Gland Dysfunction

What is Meibomian Gland Dysfunction?

Meibomian glands take the name of the German doctor who studied them. These glands produce a type of oil known as meibum and are also responsible for secreting just the right amount of oil into our tears. The mixture of meibum, water, and mucus combined give us the three layers of tear film present on the ocular surface, the very liquid that keeps our eyes comfortably moist. Meibum (the oil) helps prevent the water content on the eye from evaporating, and thus drying out more quickly than tears can be produced.

Meibomian Gland Dysfunction is often the result of a combination of factors gone wrong in the oil or glands involved. Changes in the quantity or quality of oil produced, or perhaps even changes or abnormalities affecting the meibomian glands themselves, may result in a case of Meibomian Gland Dysfunction. The most common observed, obstructive MGD, takes place when the openings of the meibomian glands get are blocked, resulting in reduced amounts of oil that reach the surface of the eye.

Hyperactive Meibomian glands can lead to lid infections, or recurrent chalazion and marginal keratitis (inflammation of the cornea) or a combination of the aforementioned conditions.

Treatment of Meibomian Gland Dysfunction is often decided only after a close examination from your eye specialist, while taking into account underlying physical conditions and the severity of the symptoms displayed by the dysfunction.

Causes of Meibomian Gland Dysfunction

Age is a big factor in changes regarding the meibomian glands. As we age, the number of meibomian glands we have gradually decrease.

Ethnicity also plays a big part. Asians run about triple the likelihood to develop meibomian gland dysfunction than people of European descent.

Contact lens usage also increases the likelihood that you may develop meibomian gland dysfunction.

Certain physical conditions may also increase the risk of MGD developing in a person. We list of few of the common examples below:

• High cholesterol
• Eye diseases, such as allergic conjunctivitis
• Damaged sustained on the eyelid or cornea
• Bacterial Infections
• Autoimmune diseases, such as rosacea, lupus or rheumatoid arthritis

Certain types of medication may hinder oil production and run the risk of MGD developing, such as:

• Estrogen replacement therapy
• Drugs that lower androgen levels
• Retinoids, found in acne medication and certain types of anti-ageing creams

Symptoms of Meibomian Gland Dysfunction

The early stages of Meibomian Gland Dysfunction are asymptomatic.

As MGD progresses, however, and as you produce lesser oils or a reduced quality of oil in your tears, your eyes may begin to feel burning sensations, feel itchy or irritated, or just a general feeling of dryness. You might get a gritty, sandy feeling in your eyes. The eyelids may start turning red and feel sore or irritated.

A telltale sign of meibomian gland dysfunction is when the inner rim of your eyelid starts looking rough or uneven, but not every case presents this symptom.

Another symptom commonly expressed is that some people experience blurred vision that gets better when they blink.

The symptoms experienced can worsen when you engage in activity that requires a great amount of visual attention, such as using the computer or if the air environment is dry – in Singapore, this often happens when you spend extended periods of time in air conditioning.

Complications of Meibomian Gland Dysfunction

MGD is the leading cause of dry eye syndrome (or dry eye disease). MGD may also result in inflammation of the eyelids, otherwise known as blepharitis.

Amongst these three conditions, there are many overlapping and connected causes. It is possible to have them all 3 of them at once. It is currently not clearly understood which could be an underlying cause, but it is postulated that MGD causes inflammation that can lead to a development of dry eye symptoms, or that inflammation resulting from dry eye symptoms could damage the nearby meibomian glands.

Left untreated, MGD may lead to cornea disease in its advanced stages. Consult your doctor if you experience the above-described symptoms. It is far easier to treat MGD and its associated complications in their early stages and runs a much higher possibility for no lasting damage sustained to your eyes and surrounding structures. 

Diagnosis of Meibomian Gland Dysfunction

Your eye specialist is the best source of diagnosis for meibomian gland dysfunction. Close inspection of your eyelids and the gland openings will give clues as to the general health of your oil glands. Sometimes, your eye specialist may even squeeze on your eyelids to force the oils within out.

A test known as “Schirmer’s Test” checks if your body produces enough tears. Other tests can ascertain the quality of meibum produced and the speed at which your tears evaporate.

The study of a combination of these results can give clues to whether you are indeed suffering from a case of meibomian gland dysfunction.

Medical Treatment for Meibomian Gland Dysfunction

Early stages of MGD may require no treatment as symptoms may not obstruct vision or interfere with daily living. Simple steps can be taken to manage the symptoms from home and the likelihood of recovery is substantial without medical attention. However, if the condition worsens, medical treatment administered from medical professionals will be required. In such cases, a combination of the below courses of treatment may be prescribed to alleviate symptoms and bring the condition under control:

• Lubricants
• Antibiotics if infection is present
• Drug to suppress your immune system
• Inflammation reduction medication, such as steroids may be administered

These could come in the form of eye drops, creams and orally ingested pills.

Your eye specialist may employ the use of devices that deliver heat or pulsed light to force open clogged meibomian glands and improve symptoms. At Asia Retina, we use a combination of treatments including IPL (Intense Pulsed Light) to treat meibomian gland dysfunctions effectively.

Your eye specialist will also advise you on how to care for your eyes at home. It takes a concerted effort on the patient’s end to keep up the home care procedures to bring about a reverse MGD symptoms. Remember to keep to your scheduled visits for follow up appointments for your eye specialist to track your progress, even if you feel a general alleviation of symptoms. This allows your eye specialist to keep track and detect any abnormalities early.