Meibomian gland dysfunction, or MGD, is a widespread eye condition. However, many people with the condition don’t know they have it.
If you have dry eyes linked to MGD, you may be concerned that you can’t have laser eye surgery, but that might not be true. Let’s explore this eye condition below and find out more.
What Are Your Tears Made From?
First, it’s essential to realise that tears are not just saline. There are three main layers, and each plays an important role.
The innermost is the mucin layer, which allows the tears to spread and wet evenly across your eye. Without it, tears would form drops like water beads on a newly polished car.
The bulk of your tears are saline (aqueous layer), which contains many components, such as antibiotic compounds, antibodies and other immune system molecules.
The top part is called the lipid layer, an ultra-thin oil coating. More on this in a moment.
What is Meibomian Gland Dysfunction?
A few dozen tiny glands in your eyelids make the oil layer of your tears. These glands are called meibomian glands (named after the German physician and anatomist Heinrich Meibom).
The upper lid has around 20-30 meibomian glands, and the lower lid 40-50. These glands are parallel in a single row within the upper and lower eyelids.
They release an oil called meibum, composed primarily of lipids. The functions of the meibum are:
- It stabilises the tear film by lowering the surface tension.
- It acts as a lubricant during blinking.
- It prevents excessive evaporation of the tear film’s watery layer.
- It provides an outer barrier that prevents bacteria from entering the tear film.
If the meibomian gland function is interrupted, it won’t secrete as much oil or the quality of the oil is reduced, which affects the eye’s tear film and, as a result, can cause dry eye disease.
The oil helps prevent the watery layer from drying out too quickly. When tears evaporate too fast, it’s called evaporative dry eye; this is the most common reason people suffer from ocular dryness.
What Causes Dysfunction of the Meibomian Glands?
There are several risk factors which can increase your risk of meibomian gland dysfunction, including:
- Age – Individuals aged 4o and above have a significantly higher chance of developing the condition. The number of glands remains the same, but the cells inside them become less effective and more inflamed, and the glands may shorten
- Ethnicity – people with an Asian ethnic background have a much higher chance of developing the condition. One study also showed MGD in 61% of Hispanics.
- Acne rosacea – a common skin condition resulting in facial redness
- Health conditions, including diabetes, high serum LDL cholesterol, high blood pressure, rheumatoid disease and autoimmune conditions
- Soft contact lenses – wearing contact lenses increases your chances of getting MGD
- Taking oestrogen replacement medication (HRT) (Broadly, androgens stimulate oil release and suppress inflammation, while estrogens increase inflammation )
- Anti-androgen treatments, such as for prostate enlargement or cancer
- Wearing eye makeup (particularly eyeliner) and failing to remove it before you go to bed
- Demodex skin mite infestation
- Retinoids which are found in some acne medications (Roaccutane) and anti-ageing creams
- Blepharitis, or inflammation of the eyelid margins
- Eye drops, especially those used for glaucoma
- Medications like isotretinoin for acne, beta-blockers or antidepressants
The most common change, obstructive meibomian gland dysfunction, occurs when the glands’ openings get clogged, and less oil leaves the eyelid margins and heads to the eye.
MGD Symptoms
In the early stages of MGD, you may not have any symptoms at all, which can make early diagnosis difficult.
However, as MGD progresses and you have less oil or the quality is impacted, you may notice the following symptoms:
- Burning
- Itching
- Irritation
- A dry sensation
- A foreign body sensation (it can feel as though you have a grain of sand in your eye)
It’s not just your eyes that are affected; you may also notice that your eyelids become inflamed, irritated or red.
Some people can also experience moments of blurred vision, which improves as they blink.
How to Prevent Meibomian Gland Dysfunction
While you can’t prevent MGD completely, there are some things you can do to reduce your risk of getting it, including:
- Manage other health conditions like high cholesterol and blood pressure
- Avoid allergens
- Limit screen time
- Get regular eye tests
- Keep your eyes and eyelids clean
- Reduce soft contact lens wear
- Consume more oily fish
How is Meibomian Gland Dysfunction Diagnosed?
It’s tricky to diagnose meibomian gland dysfunction in the early stage, and there is no single thing or symptom that can show that you have it.
If you notice any of the symptoms above, visit your eye doctor. They will look closely at your eyelids, eyelid margins, and eyes to inspect the gland openings. They may also press on your eyelids to see how much oil is produced.
As the symptoms of MGD are very similar to other eye conditions, just because you have one of the symptoms above, it doesn’t always mean that you have MGD. You may have MGD and other eye conditions at the same time. So, before starting treatments, see your eye doctor to confirm what is causing the issue.
How to Treat Meibomian Gland Dysfunction?
The early treatments of MGD aim to loosen up the oil and get it flowing correctly again. To do this, you’ll need to remove anything blocking the meibomian gland orifice. You can do this by placing a warm washcloth or heat pack over your eyelids for five minutes once or twice daily.
After this, a light fingertip massage can continue to break up and remove any blockages to get the oil flowing again.
To help unblock the gland openings further, clean your face daily and use a humidifier to counter the drying effects of heating and air conditioning.
If you wear contacts, you should limit your contact lens use.
Your eye doctor may also recommend avoiding wearing certain beauty products containing retinoids.
Medical Treatments
For more advanced meibomian gland dysfunction, you may require medication. The primary goal of modern MGD treatment is to reduce inflammation
The types of medications given for MGD include:
- Topical or systemic antibiotics, e.g. azithromycin
- Topical steroids
- Cyclosporine drops
- Tacrolimus cream
These may be taken through eye drops, sprays, creams, or pills.
Meibomian gland dysfunction treated with medication or via the home treatments we’ve mentioned won’t go away forever.
MGD treatments can provide several months of relief, and if you do them regularly, even while not displaying symptoms, it can reduce the discomfort.
IPL Treatment for Chronic MGD Symptoms
The latest proven treatment for symptomatic meibomian gland dysfunction is using intense pulsed light (IPL). This therapy uses a very bright light to shrink the blood vessels, improve gland structure, and decrease inflammation in the skin around the eyes.
IPL has proved highly effective in providing relief from the symptoms and also treating the underlying conditions causing MGD. Three to four treatments of IPL are generally enough to see optimal results.
Can I Have Laser Eye Surgery With MGD?
If you’re worried about MGD preventing you from having laser eye surgery, let us put your mind at ease by saying that isn’t always the case. There is still an excellent chance of you being able to have laser eye surgery if you have MGD.
However, it can take several weeks to improve your meibomian gland dysfunction to a point where you can safely undergo laser eye surgery.
Those with pre-existing dry eyes and MGD may opt for lenticule extraction (SILK, SMILE) instead of LASIK or PRK.
Focus Clinics can provide IPL treatments for our laser eye patients experiencing MGD.
If you have dry eye disease symptoms and believe these to be caused by MGD, you might still be able to have laser eye surgery.
Contact us and book a consultation today to see how we can help you see clearly.
