MEIBOMIAN GLAND DYSFUNCTION (MGD)
Meibomian gland dysfunction (MGD) is a chronic eye condition that results from the meibomian glands in the eyelids not producing sufficient oils, leading to irregularities in the tear film and often is a root cause of dry eyes. This can result in symptoms such as dryness, irritation, a gritty sensation in the eyes, and even watery eyes. Here, we’re covering the potential signs and symptoms of this condition, what can cause it, how it can be the root cause of dry eye and how it can be managed.
What is meibomian gland dysfunction (MGD)?
Meibomian gland dysfunction (MGD) is a common eye condition that affects the meibomian glands located in the eyelids. These glands play a crucial role in producing the oily layer of the tear film. The tear film has three primary components – an inner mucous layer that holds the tear film on the eye, an aqueous or watery layer that hydrates and lubricates the eye and forms the main part of the tear film, and an outer oily layer that traps the watery layer and helps prevent evaporation of tears. When a person has MGD, there is a chronic irregularity in the function and/or structure of the meibomian glands, leading to a decrease in the quality and quantity of the oily layer. This can result in an altered tear film with an increase in tear evaporation, leading to symptoms such as eye irritation, redness, inflammation, and in some cases, watery eyes. These symptoms can significantly impact a person's vision and overall eye health.
What is a meibomian glad and what does it do?
The meibomian glands are found along the edge of the eyelids, behind the eyelashes. These glands are responsible for producing oils (meibum), which play an important role in the tear film structure.1 With normal meibum production, the tear film lipid layer (TFLL) can remain stable and protect the eyes from tear evaporation.
Causes of meibomian gland dysfunction (MGD)
Meibomian gland dysfunction isn’t typically linked with one singular cause. Multiple factors can contribute to somebody developing this chronic condition, including environmental, genetic, and hormonal influences. Understanding the potential causes can help manage and mitigate the signs and symptoms of MGD.
The commonest reason that MGD occurs is natural blockage of the ducts of these glands, which then prevents the oils from expressing onto the eye’s surface. These blockages can occur from the accumulation of old skin cells or external factors such as applying excessive eye makeup. This type of natural blockage occurs more with age, which is why MGD is more common in older people.2
Prolonged screen time may also reduce blink rate, leading to decreased lipid delivery from the meibomian glands and increased tear evaporation, as well as altering the structure of the glands, which can lead to less oil production, even in children. This highlights the importance of taking regular breaks away from the screen.3,4
Some experiencing hormonal changes, such as before, during and after menopause, may find that these changes also affect their meibomian gland function.5 Hormone Replacement Therapy (HRT), which can be offered to those going through menopause, might also be linked with MGD among postmenopausal women, but this depends on the type of HRT being taken as some might have beneficial effects in helping against MGD instead.6,7
Other factors, such as infections and infestations, may cause MGD. These may include chronic anterior blepharitis or Demodex mite infestation because they can affect the eyelid margins and lead to issues with the meibomian glands, such as physical blocking of the ducts.8,9
Symptoms of meibomian gland dysfunction (MGD)
Some people with MGD are asymptomatic, which can make it trickier to spot the condition. However, some common symptoms may include:
Blurry vision
Dry eyes
Irritated or sore eyes
Red eyes
Gritty eyes
A foreign body sensation
Contact lens discomfort
Watery eyes due to a lack of lipid, which leads to tear evaporation and then reflex tearing to make up for lost tears
How is meibomian gland dysfunction (MGD) diagnosed?
A visual examination by an eye professional using a microscope called a slit lamp is typically all that’s needed for a MGD diagnosis, making the process quick, simple and non-invasive. During the examination, your eye care professional will check the eyelid margins to see if there are visible signs of blocked meibomian glands and might check the expressibility and quality of the meibomian secretions, along with the health of your tear film. They can also check the general health of your tear film by instilling a drop of orange dye onto the surface of your eyes.
Further diagnostic testing with modern technology can also be undertaken. The commonest method used for this is known as meibography, which is a specially designed camera that takes a photo of your eyelids and visualises the meibomian gland structure so that your eye care professional can assess for any loss of glands.10-12
How does meibomian gland dysfunction (MGD) relate to dry eye?
MGD and dry eye often occur together. When the meibomian glands are not working efficiently, it can lead to dry eyes. Proper functioning of these glands is crucial to prevent the evaporation of the eye's natural moisture.
The tear film contains three layers, and each one can affect how the others function. Reduced lipid production in the outer layer of the tear film can cause tears to evaporate too quickly. This can cause tears in the aqueous (middle) layer to dry out, which can cause dry eyes.
How to treat meibomian gland dysfunction (MGD) at home
Treating meibomian gland dysfunction can be as simple as maintaining a regular eye care routine, including cleaning your eyelids, lashes and eyelid edge, using warm compresses to help open up the oil glands, and gently massaging the eyelids to express the built-up oils, all of which can make a significant difference to your symptoms. As part of the 3-step routine of warming, cleansing and hydrating, it can also help to use lipid-based eye drops to support with healthy replenishment of this layer of the tear film.
Warm compresses are vital for those with MGD because they can unblock the meibomian glands and provide gentle relief from symptoms like irritation, grittiness and watering. It’s important to select an appropriate eye mask that can retain the right temperature for the required time. Blepha EyeBag® is ideal for this because this user-friendly microwavable warming eye mask is proven to relieve dry, tired and sore eyes.13-15
Given that the skin around the eyelids can be delicate, anything used on the eyelids, such as cosmetics, must be preservative-free since this should prevent further irritation.
In addition, maintaining a healthy diet that includes foods rich in Omega-3 fatty acids, such as fish, flaxseeds, and walnuts, may also positively impact your MGD management and overall eye health.16
Of course, it’s important to consult with your eye care professional who can offer personalised advice and treatment options based on your circumstances.
Other MGD treatments that may be available
Treatments such as Intense Pulsed Light (IPL) Therapy and targeted medications can be used to increase the quality and quantity of your meibomian gland secretions. These treatments are mostly recommended for those suffering from more advanced MGD including those associated with Demodex.17,18
How to treat meibomian gland dysfunction (MGD) at home
How Théa can help
The Théa range contains products that can help soothe and alleviate the symptoms of MGD, while also supporting a healthy eye care routine.
Blepha EyeBag® warming eye mask can provide relief from dry, tired and sore eyes. Clinically proven for MGD treatment,13-15 this mask is easy-to-use, microwavable and can provide rapid, long-lasting relief from the symptoms of MGD.
Afterwards, you can then use our Blephaclean®PF eyelid cleansing wipes suitable for use around the lashes and eyelids. These can help remove crusts and gland secretion build-up, making your eyes feel more comfortable.
Finally, TheaLipid® and Thealoz® Duo Dry Eye Drops can be used to hydrate the eyes for those experiencing dry eyes as a result of their MGD. TheaLipid® will restore the lipid layer and reduce tear evaporation. Thealoz® Duo is formulated with a combination of trehalose and sodium hyaluronate to provide hydration, relief and long-lasting protection on the surface of the eyes.19
A note from Théa
If you think you might be experiencing MGD or have any unusual symptoms in your eyes, we recommend visiting an eye care professional who can examine your eyes and detect any issues. This is the best way to maintain healthy eyes.
References:
1. 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
2. Kaur K, Stokkermans TJ. Meibomian Gland Disease. [Updated 2024 Mar 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580474/
3. Al-Mohtaseb Z, Schachter S, Shen Lee B, Garlich J, Trattler W. The Relationship Between Dry Eye Disease and Digital Screen Use. Clin Ophthalmol. 2021 Sep 10;15:3811-3820.
4. Kocamiş Ö, Temel E, Aşikgarip N, Örnek K. Electronic Device Screen Time and Meibomian Gland Morphology in Children. J Ophthalmic Vis Res. 2021 Oct 25;16(4):531-537.
5. Suzuki T, Minami Y, Komuro A, Yokoi N, Kinoshita S. Meibomian Gland Physiology in Pre- and Postmenopausal Women. Invest Ophthalmol Vis Sci. 2017 Feb 1;58(2):763-771.
6. Koetting C. Do You Know the Ocular Effects of HRT? Modern Optometry. 2022 Nov/Dec; 56-58. Available at: Do You Know the Ocular Effects of HRT? (modernod.com)
7. Jin X, Lin Z, Liu Y, Lin L, Zhu B. Hormone replacement therapy benefits meibomian gland dysfunction in perimenopausal women. Medicine (Baltimore). 2016 Aug;95(31):e4268.
8. Hao Y, Zhang X, Bao J, Tian L, Jie Y. Demodex folliculorum Infestation in Meibomian Gland Dysfunction Related Dry Eye Patients. Front Med (Lausanne). 2022 Feb 24;9:833778.
9. Sun X, Liu Z, Sun S, Zhao S, Zhang X, Huang Y. The correlation between Demodex infestation and meibomian gland dysfunction at different ages. BMC Ophthalmol. 2022 Oct 1;22(1):388.
10. Rinert J, Branger G, Bachmann LM, Pfaeffli O, Iselin K, Kaufmann C, Thiel MA, Baenninger PB. Accuracy of a New Noninvasive Automatic Ocular Surface Analyzer for the Diagnosis of Dry Eye Disease-Two-Gate Design Using Healthy Controls. Cornea. 2023 Apr 1;42(4):416-422.
11. Gupta PK, Karpecki P. Comprehensive Assessment of the Meibomian Glands by Meibography: Why the Upper Eyelids Matter. Cornea. 2024 Oct 9. Epub ahead of print. PMID: 39383472.
12. Diz-Arias E, Fernández-Jiménez E, Peral A, Gomez-Pedrero JA. A Comparative Study of Two Imaging Techniques of Meibomian Glands. Life (Basel). 2023 Mar 15;13(3):791.
13. Bilkhu PS, Naroo SA, Wolffsohn JS. Randomised masked clinical trial of the MGDRx EyeBag for the treatment of meibomian gland dysfunction-related evaporative dry eye. Br J Ophthalmol. 2014 Dec;98(12):1707-11.
14. Rossi C, Vaccaro S, Borselli M, Carnovale Scalzo G, Toro MD, Scorcia V, Giannaccare G. Noninvasive Ocular Surface Workup in Patients with Meibomian Gland Dysfunction Using Microwave-Heated Eye Bag. Clin Ophthalmol. 2024 Mar 18;18:853-858.
15. García-Marqués JV, Talens-Estarelles C, Martínez-Albert N, García-Lázaro S, Cerviño A. Evaluation of the MGDRx eyebag treatment in young and older subjects with dry eye symptoms. J Fr Ophtalmol. 2022 Jan;45(1):20-27.
16. Al-Namaeh M. A systematic review of the effect of omega-3 supplements on meibomian gland dysfunction. Ther Adv Ophthalmol. 2020 Oct 16;12:2515841420952188
17. Gupta AS, Massaro M, Bunya VY. Intense pulsed light treatment for the management of meibomian gland dysfunction. Curr Opin Ophthalmol. 2024 Jul 1;35(4):322-328.
18. Li H, Huang L, Fang X, Xie Z, Xiao X, Luo S, Lin Y, Wu H. The photothermal effect of intense pulsed light and LipiFlow in eyelid related ocular surface diseases: Meibomian gland dysfunction, Demodex and blepharitis. Heliyon. 2024 Jun 28;10(13):e33852.
19. Schmidl D, Schmetterer L, Witkowska KJ, Unterhuber A, dos Santos VA, Kaya S, Nepp J, Baar C, Rosner P, Werkmeister RM, Garhofer G. Tear film thickness after treatment with artificial tears in patients with moderate dry eye disease. Cornea. 2015 Apr;34(4):421-6.
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