Your meibomian glands are irreplaceable, poor dry eye management can result in them being lost forever
As awareness and understanding of dry eye grows, eye care professionals are putting increased importance on meibomian gland management. These tiny glands are vital to maintaining comfortable healthy eyes. If diagnosed with meibomian gland dysfunction (MGD) a disciplined approach to lid care is vital. Here are the reasons why and how to help avoid things getting worse.
How common is MGD
It is difficult to give an exact percentage as diagnosis is sometimes tricky. But a recent investigation in the UK suggests that 1-in-3 of the population has dry eye, with other separate studies identifying MGD as a major cause of dry eye. In fact a study of over 1,000 dry eye patients identified MGD as a contributory factor in up to 70% of cases. This equates to an estimated 15 million people at risk in the UK alone.
Where are your meibomian glands
The meibomian glands are large sebaceous (oil producing) glands. They are located in the upper and lower eyelids, opening via small ducts found along the outer edge of the eyelid, just behind your lashes. Each duct represents a separate gland which runs in parallel up into the lid. You have 20 to 30 glands on the lower lid and 40 to 50 on the upper lid. You can actually see the ducts in the mirror if you look carefully.
What do meibomian glands actually do
These little glands are producing a constant supply of an oil called meibum. Your meibum is ideally the consistency of olive oil, and helped by your blinking, flows into the eye and forms a protective outer layer, known as the tear film lipid-layer. . Your lipid-layer helps reduce the evaporation of moisture from the surface of the eye and helps give you clear vision.
What is going wrong
Without sufficient quantity and quality of the lipid-layer, your eyes will quickly become dry. This dryness increases the saltiness of your tears and starts an inflammatory response which leaves your eyes feeling sore, tired and irritated.
The reason for this loss of function can be wide ranging but for many there is a blockage of the ducts due to a build-up of old cells and oil, and a thickening of the meibum. Your eye care professional tests the quality of your meibum by gently squeezing the gland – if the oil has the consistency of toothpaste rather an olive oil they know you have a problem.
There are many reasons that dry eye and MGD starts to develop, these include the natural aging process, certain medical conditions, the related medication and contact lens wear.
Lack of MGD treatment can result in the loss of your meibum glands
If left unchecked then this progressive condition can lead to ocular surface disease and eventual atrophy (the glands are either no-longer there or are no longer functioning). Once these little glands are lost they do cannotnaturally regenerate. This means it is vitally important that you visit your eye care professional for a proper diagnosis and treatment plan.
Advanced imaging helps monitor your condition
Eye care professionals with a specialist interest in dry eye are increasingly investing in diagnostic tools such as meibomian gland imaging devices. This technology, known as meibography, allows them to see directly the condition of your glands and monitor any changes.
The treatment plan is likely to involve the use of heat therapy, deep cleansing (using specialist cleaners) and lid massage. The exact routine required with vary from individual to individual but it is important that a good routine is developed. A new treatment option, called intense pulsed light (IPL) therapy, is an in-practice treatment that is growing in popularity that can provide loner-term relief from dry eye symptoms and help regenerate meibomian glands in some patients.
What next?
You can find out how to improve the quality of your natural tears in order to combat the effects of dry eye disease by visiting Dry Eye Zone – where you will find plenty of useful advice, more about dry eye disease and a curated range of products you will only find available from leading independent opticians. But most importantly book an appointment for an eye examination with an independent optician and take control of your ocular health.
And don’t forget to subscribe to Dry Eye Zone regular free information updates.
If you are experiencing dry eye symptoms then you should ask the advice of your eye care professional. Do not leave things untreated as symptoms may progress. Why not book your next eye examination with an independent optician today.
Sources:
Vidal-Rohr M, Craig JP, Davies LN, Wolffsohn JS. The epidemiology of dry eye disease in the UK: The Aston dry eye study. Cont Lens Anterior Eye. 2023 Jun;46(3):101837. doi: 10.1016/j.clae.2023.101837. Epub 2023 Mar 30. PMID: 37003925. https://pubmed.ncbi.nlm.nih.gov/37003925/#:~:text=Conclusions%3A%20Approximately%20one%2Dthird%20of,are%20positive%20predictors%20of%20DED.
Rabensteiner DF, Aminfar H, Boldin I, Schwantzer G, Horwath-Winter J. The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population. Acta Ophthalmol. 2018 Sep;96(6):e707-e711. doi: 10.1111/aos.13732. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619403/
Mark B. Abelson, MD, CM, FRCSC, FARVO, George Ousler, Aron Shapiro and David Rimmer, Andover, Mass.
The Form and Function of Meibomian Glands. Review of Optometry. 10 May 2016. Accessed 4 March 2024.
Yeu E, Koetting C, Calvelli H. Prevalence of Meibomian Gland Atrophy in Patients Undergoing Cataract Surgery. Cornea. 2023 Nov 1;42(11):1355-1359. doi: 10.1097/ICO.0000000000003234. Epub 2023 Jan 11. PMID: 36728320; PMCID: PMC10538615. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10538615/
Chhadva P, Goldhardt R, Galor A. Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease. Ophthalmology. 2017 Nov;124(11S):S20-S26. doi: 10.1016/j.ophtha.2017.05.031. PMID: 29055358; PMCID: PMC5685175. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685175/
M. Robin, H. Liang, C. Baudouin, A. Labbé, In vivo Meibomian gland imaging techniques: A review of the literature, Journal Français d'Ophtalmologie, Volume 43, Issue 4, 2020, Pages e123-e131, ISSN 0181-5512,