What is Meibomian Gland Dysfunction?
Meibomian Glands are responsible for producing an essential component of the tear film that prevents your tears from evaporating too quickly. If the glands become clogged, they begin to atrophy. This causes an imbalance in the tears that can result in dryness, irritation, and fluctuating vision. The process cannot be reversed, however, treatment can prevent further gland loss from occurring.How is Meibomian Gland Dysfunction Diagnosed?
Meibomian Gland Dysfunction, or MGD, is graded based on the number of functional glands in the top and bottom lids. This can be assessed through imaging, or meibography, and by mechanically expressing the glands in office. MGD affects the quality of the tear film and accounts for approximately 86% of Dry Eye Disease.
Clinicians can test the quality of tears by assessing the tear evaporation time or "Tear Break-Up Time", quantifying inflammation, and by determining the presence of oil in the tears through diagnostic testing.How is it treated? The goal of treatment is to optimize functional meibomian glands to stabilize the tear film and decrease symptoms of dry eye. Treatments may include:
- Lid hygiene: The first step in treating MGD and dry eye is addressing the lid surface. Lid scrubs or foaming cleansers are often prescribed to reduce bacteria on the eyelids. These are typically available over the counter. However, newer solutions containing the biochemical hypochlorous acid, tea tree oil, and coconut oil are showing to be more beneficial.
- Warm Compresses: Studies have shown that sustained heat on the eyelids helps melt the oil within the meibomian glands. This allows for slowed evaporation and greater integrity of the tear lipid layer.
- Massage: After applying warm compresses, some doctors will recommend gently massaging the lid margin. This is the area located right above the eyelashes. It is important to be gentle since irritation can occur if someone uses too much pressure while performing the massage.
- Supplements: Omega-3 fatty acid supplements might be recommended. Supplementation with this nutrient has been shown to improve the quality and quantity of meibomian oil produced. Other nutrient supplements that may be beneficial include flaxseed oil and fish oil. The doctor can recommend a quality brand and the proper daily dose.
- Steroids: Topical steroids may be prescribed to reduce inflammation and provide quick relief to the patient. It is important to monitor patients using steroid eye drops in case there are adverse effects. Initially, the topical steroids are prescribed for two to four weeks.
- Tetracycline: Derivatives or tetracycline itself may provide a dual therapeutic effect for this condition. They work to reduce bacteria in the glands as well as provide relief to those with Rosacea. This effect may aid in alleviating inflammation affecting the glands. Doctors may prescribe tetracyclines for short courses or as a long-term treatment depending on how the person is responding to treatment.
- Antibiotics: Topical antibiotics can help reduce bacteria buildup on the eyelids. The duration of treatment may last from 10 to 30 days, depending on how the person is responding to the medication.
- Meibomian gland probing: A doctor will perform the probing, and it is a relatively simple procedure. The purpose is to open the main meibomian gland duct. The doctor applies eye drops that have an anesthetic effect to promote comfort. Using a handheld device, the doctor dilates the gland openings located at the eyelash base. This may encourage oil secretion or alleviate an obstruction.
- Eye drops: MGD can cause dryness on the eye surface and decrease in tear retention. Eyedrops that promote tear production and decrease inflammation may be prescribed in these scenerios. These may include: Restasis, Xiidra, Cequa, and other prescription eye drops.
- LipiFlow: This is a device used by an Optometrist in-office. LipiFlow is a type of thermal pulsation system that melts the built-up oil clogging the meibomian glands using heat. The pulsing pressure that occurs along with the heat helps to open the glands, so anything in them can be expressed.
- Each LipiFlow session takes about 12 minutes. The eyes are protected from the external heat and pulsation. The experience is best described as a heated eyelid massage and is generally comfortable. Research has determined LipiFlow to be the Gold Standard in treating meibomian gland dysfunction.
- Punctal plugs: In severe cases, punctal plugs may be used to increase tear retention on the eye surface. Dissolvable or permanent plugs can be placed in the tear ducts to prevent tears from draining.