Meibomian Gland Dysfunction (MGD) - What You Need To Know

MGD is a common ocular surface disease (OSD) that affects the Meibomian glands. These glands are responsible for producing the oily part of tears. Meibomian gland dysfunction is when the glands that make the oily layer of the tears are not working properly, allowing the watery layer of the tears to dry out too quickly. As a result, common symptoms include dry, itchy eyes, and without treatment, MGD can lead to dry eyes and other more serious vision problems.

How Ghosh Medical Can Help

Ghosh Medica delivers quality, private medical healthcare in Liverpool, Manchester, and Chester. The extensive range of services includes eye care for meibomian gland dysfunction sufferers, and our expert and compassionate optical team provides you and your family with first-class care when you need it. With a whole range of Private GP, Health Care & Medical Services available across our clinics you can give yourself total peace of mind about your health by registering as a private patient.

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In this article, we'll discuss what MGD is, its symptoms, and how it's treated. We'll also explore why it's important to seek treatment if you think you might have MGD. So read on to learn more about this little-known condition.

What Is Meibomian Gland Dysfunction?

Meibomian gland dysfunction (MGD) is a common eye condition that occurs when the Meibomian glands, which are responsible for producing the oily part of tears, become blocked, clogged, and don't produce enough oil.

In the early stages, patients are often asymptomatic, but if left untreated, watery tears occur, tear production decreases, and the eyes can become dry, irritated, and susceptible to infection. When this happens, MGD can cause or exacerbate dry eye symptoms and eyelid inflammation.

MGD is often caused by a buildup of oil and debris in the glands, which can be the result of several factors, including:

• Ageing
• Hormonal changes
• Certain medications
• Exposure to irritants
• Poor eyelid hygiene
• Wearing heavy eye make-up

While MGD can occur at any age, it's more common in older adults. Women are also more likely to develop MGD, especially during menopause when hormonal changes can cause the glands to produce less oil.

Where Are The Meibomian Glands?

The Meibomian glands are located in the eyelids, just behind the lash line. There are approximately 30 of these glands in each upper lid and 20 in each lower lid. These glands secrete an oily substance that helps to lubricate the eye and prevent the evaporation of tears.

Together, the water and the oil layer make up the tear film and if the Meibomian glands become blocked, the oil can't reach the surface of the eye and tears can evaporate too quickly, leading to dry, irritated eyes.

What Are The Risk Factors For MGD?

Several MGD risk factors can increase your chances of developing Meibomian gland dysfunction, including:

• Age: MGD is more common in older adults and after the age of 50 if you have diabetes or oily skin conditions.
• Gender: Women are more likely to develop MGD, especially during menopause when hormonal changes can cause the glands to produce less oil.
• Medications: Certain medications, such as antihistamines, can reduce tear production and lead to MGD.
• Irritants: Exposure to irritants, such as smoke or wind, or eye makeup can also cause the Meibomian glands to become blocked.
• Poor eyelid hygiene: If you don't regularly clean your eyelids, this can lead to a buildup of oil and debris in the Meibomian glands, which can cause them to become blocked.

What Are The Symptoms?

The most common symptom of meibomian gland dysfunction is dry eye, which can cause the eyes near the eyelid glands to feel gritty, itchy, or irritated. Other symptoms include:

• Eye fatigue
• Sensitivity to light
• Feeling of grittiness or sandiness in the eye
• Blurred vision & redness
• Watery eyes

Eye Fatigue

A common symptom of meibomian gland dysfunction (MGD) is eye fatigue. The meibomian glands are located in the eyelids and produce an oily substance that helps to lubricate the eye. When these glands become blocked, the eye does not receive the necessary lubrication and can become dry and irritated. This can lead to a feeling of fatigue, as the eye has to work harder to maintain moisture levels. In addition, MGD can also cause inflammation and redness. If you are experiencing any of these symptoms, it is important to see an optometrist or ophthalmologist for a proper diagnosis.

Sensitivity To Light

One symptom of MGD is sensitivity to light. This can make it difficult to be in well-lit rooms or outdoors in sunlight. Light sensitivity can also cause symptoms such as watery eyes, blurred vision, and headaches. Treatment for light sensitivity usually involves using artificial tears and sunglasses or other protective eyewear.

Grittiness Or Sandiness In The Eye

One of the first symptoms of meibomian gland dysfunction (MGD) is a feeling of grittiness or sandiness in the eye. This is caused by a build-up of oil in the meibomian glands, which leads to inflammation and thickened secretions. In severe cases, MGD can cause the glands to become blocked, resulting in dry eye syndrome. 

Blurred Vision

Blurred vision is a common symptom of MGD or meibomian gland dysfunction. When the glands become clogged and unable to produce enough oil, the eye becomes dry and irritated, leading to symptoms such as blurred vision, redness, and a burning sensation.

Together, the water and the oil layer make up the tear film. The tear film lubricates and keeps the surface of our eyes healthy; it also affects how we see. If either the water or oil layer is decreased or is of poor quality, you may also have symptoms of irritation and/or blurred vision. 

Watery Eyes

One of the symptoms of meibomian gland dysfunction (MGD) is watery eyes. This is because the meibomian glands, which are located on the eyelids, help to produce the oily layer of tears that prevents evaporation. When these glands become blocked or inflamed, they can no longer produce this important component of tears, leading to dry eyes and watery eyes.

If left untreated, MGD can lead to more serious problems like corneal ulcers and scarring. It can also make it difficult to wear contact lenses.

How The Condition Is Diagnosed

If you have any of the symptoms listed above, it's important to see an eye doctor for a comprehensive eye exam. Whilst there's no single thing that can show that you have MGD, your eye doctor will look closely at your eyelids to inspect the gland openings.

They may press on your eyelids to squeeze oil out and conduct a Schirmer's test to check if you make enough tears. Other tests can measure the quality of your meibum and how fast your tears evaporate. The combination of results can lead to a diagnosis of MGD.

During the assessment, the following tests will likely be performed to check for MGD:

• A slit lamp examination: This is a type of microscope that allows the doctor to get a close look at the surface of the eye.
• A Schirmer test: This test measures tear production by placing a strip of filter paper under the lower eyelid to see how much tears are produced in a set period.
• A Meibomian gland expression: This is a simple test where the doctor will gently massage the eyelids to express the oil from the Meibomian glands.
• The tear breakup time (TBUT) test is a common, painless procedure that your eye doctor may recommend to determine the stability of your tear film. This test involves placing a drop of dye on the front surface of your eye to be absorbed by the tear film. Your doctor will then examine your eye with a blue light which makes the Dyed tears more visible. The test usually takes less than a minute to perform and is generally well tolerated by patients.

Preventing Meibomian Gland Dysfunction

There are several things you can do to prevent Meibomian gland dysfunction, including:

• Avoiding irritants: If you know that certain things irritate your eyes, such as smoke or wind, try to avoid them.
• Wearing sunglasses: Sunglasses can help to protect your eyes from the wind and other irritants.
• Keeping your eyelids clean: Regularly cleaning your eyelids with mild soap can help to prevent a buildup of oil and debris in the Meibomian glands.
• Using artificial tears: If you have dry eyes, using artificial tears can help to lubricate the eyes and prevent tears from evaporating too quickly.
• Taking omega-3 supplements: Omega-3 fatty acids have been shown to help reduce ocular surface inflammation and improve Meibomian gland function. Flax seed oil and fish oil are excellent natural sources of omega- 3.

If you're at risk for MGD, or if you have any of the symptoms, it's important to see an eye doctor for a comprehensive eye exam.

The Treatments Available

There is no cure for MGD, but there are several treatments that can help to relieve symptoms and prevent the condition from progressing. These include a combination of self-care measures and medical treatment as outlined below to ensure the outer oily layer can successfully stop the watery layer of the tears from drying out. 

Self-care measures and lifestyle changes to treat MGD include:

• Avoiding irritants: Avoiding exposure to smoke, wind, hot & dusty environments, and other irritants can help to prevent MGD from worsening. The increased use of air conditioning or heating systems in the summer and winter months may intensify symptoms.
• Warm compresses: Applying hot compresses, or a wet compress to the eyelids for 5-10 minutes can help to loosen and express oil production from the Meibomian glands.
• Using a humidifier in your home
• Wearing glasses or sunglasses to protect your eyes from wind and sun
• Blinking often to keep your eyes lubricated
• Limiting your screen time
• Taking regular breaks during extended periods of screen time
• Using artificial tears: Over-the-counter artificial tears can help to lubricate the eyes and relieve symptoms of dryness. Just be sure to use them as directed.
• Cleaning your eyelids: Practising good eyelid hygiene by gently cleaning your eyelids with mild soap and warm water can help to remove oil and debris that can clog the glands.

Medical treatment for MGD often includes:

• Eye drops and ointments: Artificial tears or lubricating eye drops can help to keep the eyes moist and relieve irritation.
• Lipid-based eye drops: These drops contain oils that can help to lubricate the eyes and prevent tears from evaporating too quickly.
• Antibiotics: If there is evidence of bacterial infection, the doctor may prescribe antibiotics in the form of eye drops, ointments, or pills.
• Cyclosporine is a type of medication that is sometimes used to treat meibomian gland dysfunction. Cyclosporine works by decreasing inflammation and increasing tear production.
• Surgery: In severe cases, surgery may be necessary to remove the blockage from the Meibomian glands.

Gland Expression

• Gland Expression involves unblocking the small obstructions and fibrosis that are causing your MGD by applying gentle pressure to the eyelids to promote the secretion of Meibum (an essential oil) from your glands to your eyes. 

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Other Procedures That Can Help MGD

Whilst most cases of MGD are perfectly treated with gland expression or the medical options above, some new procedures can be used to express the glands either manually or with a laser.

Several procedures can help to treat MGD, including:

• Intense Pulsed Light (IPL) therapy is a type of light therapy that is sometimes used to treat meibomian gland dysfunction. Intense pulsed light (IPL) is performed using a special light that causes the blood vessels in the eyes to open for light absorption, coagulate, and then close. This process decreases both inflammation and bacterial overgrowth by destroying the overactive cells that are causing your symptoms.
• LipiFlow is a type of thermal pulsation therapy that is sometimes used to treat meibomian gland dysfunction. LipiFlow uses heat and pressure to massage the glands and loosen any blockages that may be present and Lipiflow treatment can significantly improve meibomian gland secretions and dry eye symptoms for up to three years.
• iLUX is used to melt the build-up of waxy secretions blocking the meibomian glands. TearCare involves a procedure in which heating patches are applied to the external eyelids and connected to a handheld heating device. This device melts the waxy build-up of secretions to unclog the meibomian glands. 
• Lid debridement. In this treatment, your optician uses a hand-held instrument to de-scale a material called keratin and other debris that can adhere to eyelid margins and clog meibomian gland openings.

Why Is Meibomian Gland Dysfunction Treatment Important?

While meibomian gland dysfunction is not a serious condition, it can lead to some uncomfortable symptoms, including dry eyes, eye fatigue, and blurred vision. If left untreated, MGD can also cause more serious problems, such as corneal ulcers and vision loss. That's why it's important to seek treatment if you think you might have MGD. Treatment can help relieve your symptoms and prevent the condition from progressing.

Where To Get Help For Meibomian Gland Dysfunction (MGD)

Ghosh Medical is experienced in treating meibomian gland dysfunction and can recommend meibomian gland expression as a simple, effective, cost-effective and painless treatment for MGD.

During the procedure, a nurse will unblock the small obstructions and fibrosis that are causing your MGD with a paddle, rolling forceps or other forceps, applying gentle pressure to the eyelids to promote the secretion of Meibum (an essential oil) from your glands to your eyes. 

Each expression session costs £40 and in some cases, multiple sessions may be required depending on the severity of your MGD.

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or call 0333 200 3338 to speak to our friendly team.

Related Questions

Do Contact Lenses Make Meibomian Gland Dysfunction Better Or Worse?

According to a recent study, contact lens usage is linked with meibomian gland changes, and that quitting use of contacts for up to six months doesn't eliminate these changes. However, it's unknown whether contact lens wear causes meibomian gland malfunction, and most researchers think additional research is required to see if people who wear glasses have a higher MGD risk.

As a result, there is no definitive answer to this question. Some people find that contact lenses help to relieve their symptoms, while others find that they make their symptoms worse. If you wear contact lenses and you're concerned about MGD, talk to your doctor about the best way to manage the condition.

How Is Tear Film Affected?

The tear film is a thin layer of tears that coats the surface of the eye and assists the production of normal tears. It has three main layers:

• The outer layer, called the lipid layer, is made up of oils produced by the Meibomian glands. These oils help to keep the tear film from evaporating too quickly.
• The middle layer, called the aqueous layer, is made up of water and mucus. The mucus helps to spread the tears evenly over the surface of the eye.
• The inner layer, called the mucin layer, is made up of glycoproteins. These glycoproteins help to keep the tear film from becoming too dense.

When the Meibomian glands are not functioning properly, the lipid layer of the tear film is disrupted. This can cause the tear film to evaporate too quickly, leading to dry eyes. Disruptions in the tear film can also cause the other layers of the tear film to become imbalanced, which can lead to further problems.

Summary

The Meibomian glands are small oil glands that line the eyelids. They secrete oil which coats the surface of our eyes and prevents tears from drying out.

Meibomian gland dysfunction (MGD) is a condition where the Meibomian glands don't produce enough oil, which disrupts the tear film and leads to dry eyes. It is not usually a serious condition but can cause discomfort and sometimes blurry vision, along with other symptoms such as irritation, redness and watery tears.

There are a few different treatments available for MGD, including self-care and lifestyle changes, or simple medical procedures such as meibomian gland expression. 

If you think you might have MGD or need help treating the symptoms that you havet, you should talk to your doctor about the best treatment option for you. It's important to seek the right treatment for you early to help relieve symptoms and prevent the condition from progressing to something more serious. 

Contact Ghosh medical on 0333 200 3338 or via our web form for more information.