Meibomian Gland Disease

What is Meibomian Gland Disease?

Meibomian gland disease includes a variety of disorders related to the meibomian glands in your eyes. Some of these disorders include malfunctioning of the glands known as meibomian gland dysfunction (MGD), tumors, or diseases present since birth. MGD involves abnormalities in how the meibomian glands work. An international group studying MGD has defined it to be a long-term widespread abnormality of these glands. The problems include blockages in the ducts combined with changes in the quantity or quality of the substance they secrete.

When the meibomian glands don’t function properly, it can negatively affect the amount and quality of the substance they produce, known as meibum. This can directly influence the makeup of your tear film leading to changes in eye health. It can give rise to abnormal tear film, inflammation or irritation of the eye surface, or eye surface disease.

The meibomian glands were named after Heinrich Meibom, a German physician and anatomist. They are special oil-glands located in the eyelids. The upper eyelid typically contains around 20 to 30 meibomian glands, while the lower eyelid has about 40 to 50. These glands rest in a single row inside the tarsal plates (dense connective tissue) of the eyelids, extending towards the innermost part of it. The meibomian glands secrete meibum to the edge of the eyelids.

Meibum is mainly made of fats and it is a crucial element for maintaining tear film. It lowers the surface tension, enabling smooth blinking, lessens the speed at which tears evaporate, and forms a barrier to keep bacteria out. MGD can be acute (short-term) or chronic (long-term), depending on how long symptoms last. The rate at which the glands secrete also determines further classification. When the glands secrete dismally, it may be due to the gland producing too little meibum or obstruction in the ducts.

When the glands secrete a lot, it can lead to a condition often seen in people with acne rosacea or seborrheic dermatitis. These conditions are then further split into primary and secondary causes.

What Causes Meibomian Gland Disease?

The most usual kind of MGD (Meibomian Gland Dysfunction) is the obstructive type. It develops from a blockage in the final tiny tube (duct) of the meibomian gland – the gland that produces oil for our tear film. This blockage is often caused by an increase in the size of the lining of the duct, a process known as keratinization, and the thick nature of the oil (meibum). The result is that the meibomian glands shrink or die off, which then reduces the production of oil.

This shrinking of the meibomian glands and effects of medications cause a condition called meibomian sicca, which is a reduction of functional (working) meibomian glands. Things that can increase the risk of developing MGD include:

– Age
– Lack of androgens (a type of hormone)
– A history of atopy (a can develop into conditions like eczema)
– Sjogren syndrome and Steven-Johnson syndrome (autoimmune illnesses)
– Psoriasis (skin condition)
– Acne rosacea (skin condition)
– Wearing contact lenses
– Eyelid tattooing
– Using systemic antibiotics
– Using certain medications like isotretinoin for acne, antidepressants, or hormone replacement therapy
– Using certain eye drops like epinephrine, beta-blockers, prostaglandin analogs, and carbonic anhydrase inhibitors
– Chronic blepharitis (an eye condition that affects the eyelids and lashes)
– Trachoma (an infection that can damage the eye)

The microbiome (community of microbes) of the eye surface also seems to play a role in MGD. Infestation of the eyelash follicle, the oil gland of Zeis, and the meibomian glands by the Demodex mite can affect the way the meibomian glands function. Studies show that about 50% of patients with MGD also have Demodex mite infestation. This infestation can cause a form of MGD known as cicatricial MGD, so can trachoma, erythema multiforme, and pemphigoid. Noncicatricial MGD is often linked to skin conditions like acne rosacea, atopic dermatitis (a form of eczema), seborrheic dermatitis, and psoriasis.

Risk Factors and Frequency for Meibomian Gland Disease

MGD, or Meibomian Gland Dysfunction, is a globally common disorder, affecting about 35.8% of the population. It’s more commonly found in men and is also more prevalent among Asian patients than White patients.

Common signs of MGD include the shrinking of the gland, obstruction, change in the quality of the oil produced by the gland (meibum), and changes to the blood vessels on the eyelid. According to research, 59% of people with MGD show at least one of these symptoms and older men show these abnormal signs more often.

Although the quality of the oil produced by the glands doesn’t vary much between races, White patients are more likely to show changes in the blood vessels on their eyelids. Interestingly, a study found that 93.8% of patients who reported having dry eyes, a total disregard of their age or gender, showed signs of MGD.

• MGD affects about 35.8% of people worldwide, and it’s more common in men.
• Asians generally have a higher occurrence of MGD than White people.
• Regular symptoms of MGD include gland shrinkage, blockage, alterations in glandular oil quality, and changes in eyelid blood vessels.
• About 59% of MGD patients have at least one abnormal symptom, often found in older men.
• Despite differences in racial prevalence of MGD, there’s no significant difference in the quality of glandular oil across races.
• White patients tend to show more frequent eyelid blood vessel alterations.
• The majority (93.8%) of patients who reported dry eyes, regardless of age or gender, have MGD.

Signs and Symptoms of Meibomian Gland Disease

Most people with MGD (meibomian gland dysfunction) show no symptoms, and the severity of the symptoms doesn’t always match the level of eye damage. However, those who do experience symptoms report things like dry eyes, a feeling like there’s something in the eye, light sensitivity, eye pain, and redness of the white part of the eye. It’s also possible to experience blurred vision, excessive tears, and redness around the eye. People with normal meibomian glands have clear and easily expressed, or expelled, meibum (oily substance that prevents evaporation of the eye’s tear film), but in people with MGD, this substance is usually cloudy and thick.

Testing for Meibomian Gland Disease

When a doctor suspects a patient may have Meibomian Gland Dysfunction (MGD), a condition that affects the eyes, there are several important steps they will take to confirm this. Firstly, they’ll start with a clinical examination of your eyes. This may involve applying gentle pressure to the lower eyelid to see how easily your glands release a kind of oil known as meibum. During this examination, the doctor will be looking for any changes in the easy release (expressibility) and consistency of your eye’s oily secretions (meibum).

There is a grading scale, developed by Efron in collaboration with CooperVision, that helps doctors score the condition of your eyes from 0 to 4. This scale takes into account what the eye area looks like, the state of the gland openings and other symptoms like tearing and redness. This grading scheme has specific descriptions for each level.

However, for patients who are experiencing symptoms, questionnaires can be helpful to measure the severity of symptoms. This analysis can make use of general purpose questionnaires like the Ocular Surface Disease Index (OSDI) and the Dry Eye Questionnaire (DEQ).

Once these steps are completed, the doctor may carry out an even more detailed examination of your eyes with a tool known as a slit-lamp. Other tests could include capturing images of the eyelids, studying how you blink, looking at the amount and quality of your tears, among others. To carry out these assessments, the doctor might use a variety of tools and techniques including a transillumination technique, infrared video camera, or a tool known as a LipiView analyzer.

It’s also important for the doctor to rule out other similar conditions like dry eye disease. So, they may run tests to check the levels of tears in your eyes, measure the thickness of the tear film, test the saltiness (osmolality) of your tears, and look for any damage on the surface of your eye. In addition, they may capture images of your glands to look for any need for further assessment.

Based on the results of all these tests, MGD can be categorized into four different stages. These stages range from 1 to 4, with 1 being very mild or asymptomatic and 4 being severe. This classification considers factors like your symptoms, the expressibility and quality of meibum secretion, and any damage to the surface of the eye.

As a closing note, it’s important to highlight that recent studies are working towards developing even more precise ways of analysing the condition of your Meibomian Glands. This should hopefully lead to improved diagnosis and treatment approaches in the future.

Treatment Options for Meibomian Gland Disease

Treating Meibomian Gland Dysfunction (MGD), a blockage in the small oil glands in the eyes, depends on the severity of the signs and symptoms. The treatment options are designed for the different stages of the disease.

In the first stage, patients can get benefits by adjusting the environment in their home and workplace. It’s important to avoid too much screen time and direct exposure to wind because these factors can quicken the rate at which tears evaporate. Applying a warm compress to your eyelids for at least four minutes once or twice daily and following up with a firm massage to relief blocked secretions can be beneficial. Eating foods rich in omega-3 fatty acids like fish and walnuts is also recommended. In some cases, doctors could prescribe artificial lubricants, certain eye drops, or sprays depending on the patient’s condition.

In stage two, patients are educated to understand how their diet, home, or work environment affects tear evaporation. Regular blinking is advised, especially during activities like reading or using a computer. You can also use humidifiers to increase moisture in your home and pay attention to other medications you’re taking that could affect tear production. Continue using warm compresses and eyelid massages and start warming water lid scrubs for regular lid hygiene. Cleaning the base of the eyelashes behind the lid margin helps reduce bacterial load, which can cause inflammation.

In the third stage, in addition to the earlier treatments, the use of topical anti-inflammatory medications becomes necessary. Lubricant eye ointment at bedtime can provide relief.

In the last stage, the use of additional anti-inflammatory medications, like eye drops, is necessary. One such medication, varenicline, stimulates a pathway to increase tear flow and meibum production, which are part of the tear film.

If severe MGD doesn’t respond to these approaches, surgical treatment may be necessary. One method is probing, where blocked glands are opened and dilated. Another method is electronic heating devices, which apply heat to the eyelids, melting the blocked secretions. Some of these devices can also express the gland’s content by providing pressure on the eyelid surface.

There are also other methods like Intense Pulse Laser Therapy, which is absorbing light waves to generate heat and cause blood vessel thrombosis, reducing redness in the eye. Or Intranasal Tear Neurostimulation, which uses neural pathways to maintain tear film. Treatments can be targeted based on specific conditions associated with MGD, including using tea tree oil scrubs for Demodex mite infestation or steroids for other related conditions.

What else can Meibomian Gland Disease be?

When diagnosing meibomian gland disease, doctors must consider other conditions that can present similar symptoms like inflammation of the eyelids, redness in the white part of the eyes, or dry eyes. Here are some medical conditions that can mimic meibomian gland disease:

• Staphylococcal anterior blepharitis: This is distinguished by deposits on eyelashes, loss of eyelashes, eyelashes growing in the wrong direction, and painful, red, swollen eyelid edges. It is often seen in patients with a skin condition known as atopic dermatitis and can cause dry eyes and damage to the cornea.
• Seborrheic anterior blepharitis: Associated with a skin condition called seborrheic dermatitis, it also leads to deposits on eyelashes and potentially loss of eyelashes. It too can cause dry eyes and damage to the cornea.
• Demodex blepharitis: Identified by scales around the base of the eyelashes that look like cylindrical dandruff, mites can be seen in this condition when examined closely with a slit lamp microscope.
• Evaporative dry eyes: Symptoms include eye irritation, a burning sensation, eyes feeling tired, blurry vision, sensitivity to bright light, and discomfort while wearing contact lenses. Tests may show decreased tear production and patients can have positive staining suggesting damage to the cornea and white part of eye. This could be associated with autoimmune diseases like Sjogren syndrome, rheumatoid arthritis, lupus, or diabetes.
• Conjunctivitis: This condition causes redness, increased watering, swelling of the eyelids, and light sensitivity. It can cause small bumps on the inside of the eyelids, and crusty or sticky eyelashes.
• Cicatricial conjunctivitis: A chronic form of conjunctivitis that leads to scarring of the conjunctiva (the clear tissue covering the white part of your eye and the inside of your eyelids). It can be caused by some conditions like Stevens-Johnson syndrome, mucous membrane pemphigoid, and injuries from heat or chemicals.
• Contact lens-related keratoconjunctivitis: Patients may present with red, irritated eyes. This condition is more common in people who sleep with their contact lenses in. If inflammation of the cornea is severe, it may affect the clarity of vision.
• Keratitis: This condition includes forms of corneal inflammation that can damage the cornea and result in ulcers, infiltrates, or scars that might affect vision.

What to expect with Meibomian Gland Disease

The success of treatment largely depends on how far along the disease is and how well the patient follows the recommended treatment. Simple steps like cleaning your eyelids daily, keeping the air around you humid, drinking enough water, using eye drops regularly, blinking often, and wearing sunglasses to protect your eyes from wind or sun can help prevent Meibomian gland dysfunction (MGD) and its associated dry eye symptoms from getting worse. If MGD is in its early stages, it can be managed with just eye drops and can even be reversed if the patient is diligent about treatment.

In more advanced cases, more aggressive treatments like probing, heat treatment, or intense pulsed light therapy might be needed. Serious dry eye can result in blurry vision, not being able to wear contact lenses, headaches, corneal keratinization (hardening of the cornea), scarring, or corneal ulcers (open sores on the cornea). Effective treatment and follow-ups are critical to prevent serious problems that can threaten vision in people with MGD.

Possible Complications When Diagnosed with Meibomian Gland Disease

If Meibomian Gland Dysfunction (MGD) isn’t treated correctly at early stages, it can cause severe symptoms of evaporative dry eye disease. Alongside this, patients might have inflammation of the eyelids, which puts them at risk of bacterial infections, increased redness around the eyes, and poor quality of tears. MGD patients may also suffer from a condition called Demodex infestation.

Even though treatment can somewhat restore the health of the glands, the general view is that damage caused to the oil-secreting meibomian glands is only partially reversible. If MGD is left untreated, it is likely to result in permanent gland damage and loss in most cases.

Advanced stages of MGD can start to lead to keratinization of the cornea, a condition which may be hard to reverse with medication. Over time, the tubes within the glands can become dilated and cause the glands to shrink, making it difficult to restore their normal function.

It’s important to be extra careful if MGD patients are planning to undergo cataract surgery, or any other eye-related procedure. Research has indicated that these patients have a greater chance of having ongoing dry eyes issues and gland loss after cataract surgery. They are also at risk of infections entering from around the eyes when having eye surgery. As a result, examining the health of the eyelids and any signs of dry eyes in a patient with a cataract is very crucial to prevent serious complications like endophthalmitis.

Regular eyelid cleaning and topical antibiotic ointment might be good enough to inhibit serious complications like endophthalmitis in MGD patients. However, long-term use of topical corticosteroids might increase eye pressure or lead to cataracts. So, patients should try other treatment options and be closely monitored to prevent any more complications.

Probable Side Effects of MGD:

• Severe symptoms of evaporative dry eye disease
• Increased eyelid inflammation
• Risk of bacterial infections
• Increased redness around the eyes
• Poor quality tears
• Demodex infestation
• Permanent gland damage and loss
• Keratinization of the cornea
• Ongoing dry eyes issues after cataract surgery
• Risk of intraocular infection after eye surgery
• Potential serious complication like endophthalmitis

Recovery from Meibomian Gland Disease

MGD, or Meibomian Gland Dysfunction, is a illness that comes and goes on its own. Even though patients often feel better for a bit, after some time the symptoms usually come back if treatment isn’t continued. That is why it’s crucial for patients to learn about their condition. This includes regularly checking in with their doctor and making daily changes to their lifestyles to help stop the disease from coming back.

After certain treatments, like probing, thermal laser treatment, or intense pulse laser therapy, patients need to apply certain medications to the area, clean their eyelids regularly, and use warm compresses. These steps can help stop the meibomian ducts (the tiny tubes inside your eyelids that produce oil) from getting blocked, and can also make the release of this oil (meibum) easier. This helps in preventing the symptoms from coming back.

Preventing Meibomian Gland Disease

Meibomian gland disease, or MGD, is a term used to describe different conditions that affect the meibomian glands in your eyes. These glands make an oil called meibum, which helps keep your eyes moist by creating a layer of tears. When the production of this oil is insufficient or the oil is too thick, it can lead to dry eyes as the tear layer is not maintained.

The symptoms of MGD can include:

* A feeling like there’s grit in your eyes.
* Watery eyes.
* A sensitivity to light.
* Difficulty seeing properly.
* Dry or flaky skin on the eyelids.
* Swelling of the eyelids.
* Trouble with wearing contact lenses.
* Feeling like there’s something in your eye.

Meibomian gland disease can happen as you age, when you have hormonal changes, if you’re not blinking enough, or if your diet is low in omega-3 fats or high in omega-6 fats. It occurs when the opening of the meibomian glands gets blocked.

The most important part of dealing with MGD is a daily routine for caring for your eyes. This routine should involve putting warm cloths on your eyes for 10 minutes each day, cleaning the eyes with baby shampoo or special scrubs for your lids, and using certain types of preservative-free eye lubricants and sprays.

Failure to properly care for your eyes can make MGD worse and can lead to a decrease in the number of meibomian glands. If the disease gets worse, not only can the symptoms become more severe, but it might also necessitate the use of prescription medicine or even surgery. If left untreated, it could cause permanent damage to the eye or even loss of vision.