Meibomian gland dysfunction (MGD) can be a chronic and often frustrating condition for both patient and practitioner. It can be implicated as a factor in many conditions such as ocular surface disease (OSD), chronic blepharitis, recurrent chalazia, and ocular rosacea. Patients may complain of lids stuck together upon awakening, a foreign body sensation, blurry vision—especially with near tasks, burning/stinging, and contact lens intolerance. MGD has typically been defined as a chronic abnormality of the meibomian glands characterized by an increase in meibum viscosity that often leads to obstruction of the meibomian glands.¹

Meibomian glands (or “tarsal” glands, as they were previously known) are sebaceous glands located in the upper and lower tarsal plates. These glands produce both polar and non-polar lipids, which are then stored in lysosomes. These lysosomes gradually coalesce into storage granules. These, in turn, merge and enlarge until they disgorge their contents into the meibomian glands, which release these oils onto the ocular surface.² This lipid layer that forms on the surface of the tear film helps to slow evaporation of the underlying aqueous layer.

Normal meibum is a clear, thin layer of oil that is easily viewed with mild expression of the glands. In MGD, this oil becomes thicker and often cloudy. As the condition advances, the meibum may resemble a white “toothpaste” upon expression and eventually may obstruct the gland completely. The presence of white “caps” over the tops of the glands is common and may lead to chalazia. Loss of meibomian gland function often results in an increase in tear film osmolarity due to rapid aqueous evaporation. Clinicians involved in the management of OSD may employ in-office tests to measure osmolarity both to aid in diagnosis as well as to track the efficacy of treatment.³

Treatments for MGD are often multifaceted. They may include debridement of the lid margin, paying particular attention to the meibomian gland orifices; hot compresses with heated washrag or bead masks; lid massage; in-office thermal pulsation devices, or intense pulsed-light therapy.⁴ Oral antibiotics doxycycline or minocycline have been advocated to reduce inflammation of the glands. Clinicians often recommend ingestion of omega-3 fatty acids in the form of fish oil.

References

1. Abelson MB, Oberoi S. Treating Dysfunctional Meibomian Glands. Rev Ophthamol. 2006 Aug 16. Available at https://www.reviewofophthalmology.com/article/treating-dysfunctional-meibomian-glands . Accessed June 22, 2021.
2. 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.
3. Roach L, Asbell PA, McDonald MB, Nichols KK, Tamayo GE, Tauber J. Rethinking Meibomian Gland Dysfunction: How to Spot It, Stage It and Treat It. Eyenet. 2011 Jul/Aug:27-29.
4. American Association for Pediatric Ophthalmology and Strabismus. Meibomian Gland Dysfunction and Treatment. 2020 Dec 16. Available at https://aapos.org/glossary/meibomian-gland-dysfunction-and-treatment . Accessed June 22, 2021.