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What is meibomian gland dysfunction (MGD)?

Meibomian gland dysfunction (MGD) is a major cause of dry eye symptoms. What exactly is it and how is it best treated?


Diagram of meibomian glands

Your meibomian glands are sebaceous or oil-producing. These small glands produce an oil called meibum, this oil creates a lipid-layer over the surface of the eye. The lipid-layer slows the rate of moisture evaporation from the eye and therefore helps to stabilise the tear film. If the quality of this lipid-layer is compromised you will lose too much moisture, dry spots will appear on the eye and those annoying symptoms could start: dry, tired, sore, aching, gritty, watery or red eyes. This is known as evaporative dry eye or EDE. You might even notice changes in vision quality which is explained shortly ….


Locating your meibomian glands

These series of small glands are found along the edge of the eyelids, just behind the eye lashes. There are typically 20-30 on the lower lid and 40-50 on the upper lid. If you look carefully you can see the tiny openings or ducts running the length of your eyelid. Your optician can see the glands on the inside of your eyelids, they look like silvery leaves! (but don’t try this at home)


Get the oil flowing

The go-to therapy is ‘heat’. This gets the meibum flowing again to help restore the

the protective outer layer (or lipid-layer) of the tear film. When MGD is present the glands can become blocked, the meibum having assumed the consistency of toothpaste instead of olive oil. Heat therapy literally ‘melts’ this natural oil allowing it to flow more easily into the eye and releasing debris ready for a post-therapy cleanse.


Treat your eyes to a massage

After heat treatment it is important to carry out an eyelid massage. This helps to clear out those ducts and get as much debris out as possible. Your eye care professional, or one of their team, will show you how, some practitioners will offer an in-practice massage and deep clean, which the Dry Eye Zone would recommend for the best possible results.

Essentially, you gently but firmly roll a clean finger along the eyelid edge, working from the nose outwards. Both top and bottom eyelids need to be massaged and ideally 2-3 times each to get things moving. There are also some excellent demonstrations available on line.


Deep cleansing to remove old skin cells

As our knowledge of MGD increases more attention is also given to clearing the excess old skin cells, a bit like dandruff but on the eyelid. This condition is known as ‘hyperkeratinisation’, it has the effect of blocking the gland ducts and mixing with the meibum to cause thickening. Some specialist cleaners contain ingredients with keratolytic properties which actually soften this debris making it easier to rinse away.


Getting a diagnosis

Your eye care professional will be able to make a diagnosis fairly quickly. To get an idea of the quality of the meibum they might gently squeeze your eyelid to express some of the oil. An experienced professional will be able to see if things are sub-optimal. They will also ask you about the quality of your vision, as well as slowing evaporation the lipid-layer also smooths the surface of the eye to allow good focusing. If your vision is unstable i.e. improves after a good blink, their suspicions will be aroused!


Eye care professionals with a specialist interest in dry eye may have more specialist diagnostic machines such as imaging tools which allow them to look and record the condition of your meibomian glands. This way it is easier to monitor any change in your condition.


A disciplined routine is critical

To get on top of your MGD you need to follow your eye care professional’s recommendations. Regular heat, cleanse and massage along with the use of a good quality dry eye drop will soon get your eyes feeling more comfortable. But remember, because dry eye is a chronic, progressive condition you need to keep to your routine. You will be pleased to know that you no-longer have to mess about with hot flannels as commercially available compresses are now available – they heat to the prescribed temperature for the time needed for effective relief. In fact, you can actually carry out your 10-12 minute heat therapy whilst reading your latest book or checking your messages thanks to new innovative open-eye masks.


If you are experiencing dry eye symptoms then you should ask the advice of your eye care professional. Why not book your next eye examination with an independent optician today.

Sources:

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. Epub 2018 Apr 15. PMID: 29656524; PMCID: PMC6619403.


Pflugfelder SC, Stern ME. Biological functions of tear film. Exp Eye Res. 2020 Aug;197:108115. doi: 10.1016/j.exer.2020.108115. Epub 2020 Jun 16. PMID: 32561483; PMCID: PMC7483968.


Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017 Jul;15(3):276-283. doi: 10.1016/j.jtos.2017.05.008. Epub 2017 Jul 20. PMID: 28736335.


Abelson M D et al. Review of Ophthalmology (online). The form and function of meibomian glands. 10 May 2016.


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. Epub 2018 Apr 15. PMID: 29656524; PMCID: PMC6619403.


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