Meibomian Gland Dysfunction (MGD): The Cause Of Your Dry Eyes?
Meibomian gland dysfunction (MGD) may be one of the most common eye problems you've never heard of. Its odd-sounding name is probably part of the problem. Another name for MGD is "meibomianitis," which sure isn't any easier to remember!
Meibomian glands in the eyelids. [Enlarge]
Meibomian ("my-BOH-mee-an") refers to a particular type of gland in the eyelids. They 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 is blockage or some other abnormality of the meibomian glands so they don't secrete enough oil into the tears. Because the tears then evaporate too quickly, MGD is a leading cause of dry eye syndrome. It also is associated with an eyelid problem called blepharitis.
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MGD Risk Factors
There are several factors that can affect 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, and 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. Some studies have found that 46 to 69 percent of Asian populations in Thailand, Japan and China have meibomian gland dysfunction. By comparison, other studies have found that only 3.5 to 20 percent of whites in the U.S. and Australia have MGD.
Wearing eye makeup is another contributing cause. 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?
Only your eye doctor can tell for sure if you have MGD.
One simple technique your doctor might use 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.
Recently, a company called TearScience developed a diagnostic tool called the Meibomian Gland Evaluator, which standardizes the amount of force used for expressing meibomian glands. Using this device may make it easier for your doctor to determine the presence or severity of MGD.
Because meibomian gland dysfunction affects the stability of the tear film, your doctor 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 doctor 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.
Treatment of 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.
New, more effective treatment options are now available. These include:
Meibomian gland probing. This is a simple technique performed by your eye doctor to unclog the opening and main duct of your meibomian glands. After anesthetic eye drops are applied to the eye, your doctor uses a hand-held instrument to probe and dilate the openings of your meibomian glands near the base of your eyelashes.
One study reported that 96 percent of patients had immediate relief of MGD symptoms after this procedure, and 100 percent experienced relief within one month. Another study found 76 percent of patients with MGD who underwent meibomian gland probing obtained relief of symptoms one day after probing, and patients who received a combination of probing and treatment with corticosteroid eye drops had faster and more complete relief of symptoms than those who were treated with corticosteroid eye drops alone.
Antibacterial eye drops. Some studies have shown that antibacterial eye drops have helped resolve meibomian gland dysfunction. During your eye exam, your eye doctor 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.
LipiFlow. The LipiFlow thermal pulsation system (TearScience) is an in-office procedure 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. Recent studies have demonstrated that the process significantly reduces the signs and symptoms of meibomian gland dysfunction.
Omega-3 supplements. Some eye doctors 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.
See Your Eye Doctor to Get Relief
Remember, only your eye doctor can tell for sure if you have meibomian gland dysfunction and determine the best MGD treatment options for your particular needs. If you suffer from dry, irritated eyes, make an appointment for a comprehensive eye exam and dry eye evaluation today.
Efficacy of intraductal meibomian gland probing on tear function in patients with obstructive meibomian gland dysfunction. Cornea. March 2016.
Impact of duration of contact lens wear on the structure and function of the meibomian glands. Ophthalmic & Physiological Optics. March 2016.
Revisiting the vicious cycle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. British Journal of Ophthalmology. January 2016.
New eye cleansing product improves makeup-related ocular problems. Journal of Ophthalmology. August 2015.
Meibomian gland dysfunction: an update. Contact Lens Spectrum. July 2015.
Meibomian gland dysfunction and contact lens wear. Contact Lens Spectrum. March 2015.
Emerging treatment options for meibomian gland dysfunction. Clinical Ophthalmology. September 2013.
Meibomian gland dysfunction and treatment. American Association for Pediatric Ophthalmology and Strabismus. November 2012.
MGD: getting to the root cause of dry eye. Review of Optometry. June 2012.
Meibomian gland dysfunction: all you need to know. Contact Lens Spectrum. July 2011.
The International Workshop on Meibomian Gland Dysfunction: report of the Definition and Classification Subcommittee. Investigative Ophthalmology & Visual Science. March 2011.
The International Workshop on Meibomian Gland Dysfunction: report of the Subcommittee on Anatomy, Physiology, and Pathophysiology of the Meibomian Gland. Investigative Ophthalmology & Visual Science. March 2011.
The International Workshop on Meibomian Gland Dysfunction: report of the Subcommittee on the Epidemiology of, and Associated Risk Factors for, MGD. Investigative Ophthalmology & Visual Science. March 2011.
[Page updated April 2016]