What Is Meibomian Gland Dysfunction?
Meibomian gland dysfunction (MGD) is a common eye condition, yet many people don't realize they have it. You get it when there's a problem with a few dozen tiny glands in your eyelids that help make the oil layer of your tears.
What Happens
These meibomian glands, named after the German doctor who studied them, make an oil called meibum. Meibum, water, and mucus form the three layers of tear film, the fluid that keeps your eyes moist. The oil helps prevent the water layer on the eye surface from evaporating or drying out too quickly.
Changes to the amount or quality of the oil, or to the glands themselves, can lead to MGD. It's often the result of a combination of things. The most common type, obstructive MGD, happens when the gland openings get clogged, and less and less oil reaches the eye surface.
Your doctor will tailor treatment based on the stage of your MGD as well as any underlying medical condition you have.
Causes
Age plays a part; the number of meibomian glands goes down over time. So does your ethnicity; Asian people are about three times more likely to get MGD than people with a European ancestry.
Wearing contact lenses makes you more likely to get it.
Common medical issues linked to MGD are:
- High cholesterol and triglycerides
- Allergic conjunctivitis and other eye diseases
- Inflamed or damaged eyelid or cornea
- Bacterial infection
- Autoimmune diseases like rosacea, lupus, rheumatoid arthritis, and Sjögren's syndrome
Some medications can cause problems with oil production, including:
- Estrogen replacement therapy
- Drugs that reduce androgen
- Retinoids, from acne medication to anti-aging creams
Symptoms
In its early stage, you might not have any.
But as MGD progresses and you have less oil or poor-quality oil in your tear film, your eyes may burn, itch, or be irritated or dry. It might feel like you have a grain of sand or dust in your eye. An irritated, inflamed eyelid may be red.
The inner rim of your eyelid looking uneven or rough is a classic sign of MGD, but not everyone has it.
Some people have moments of blurred vision that improves when they blink.
Symptoms can get worse when you're on the computer for a long time or if the air in your home or office is very dry, either from air conditioning or heating.
Complications
MGD is the most common cause of dry eye syndrome (also called dry eye disease). MGD may lead to eyelid inflammation, called blepharitis, especially along the rims.
There's a lot of overlap among these three conditions, and it's possible to have them all at once. In fact, experts aren't entirely sure what comes first, or exactly how they're connected. It could be that MGD causes inflammation that leads to dry eye, or that inflammation from dry eye could hurt the meibomian glands.
If you're having eye surgery, untreated MGD raises the chance of getting an infection and inflammation afterward.
In its advanced stage, MGD may lead to cornea disease.
Diagnosis
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.
The Schirmer's test checks 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.
At Home
Early on, self-care might be all you need.
Put a warm, wet washcloth or heat pack over your eyelids for 5 minutes, twice a day, to help loosen the oil. Follow this with a light fingertip massage. For the upper lid, look down and very gently roll one side of your index finger from the top of your eyelid down to the lash line. For the lower lid, look up at the ceiling and roll your finger up to the lash line.
To help unblock gland openings, clean with a non-soap cleanser once a day. Dab it on a warm, wet washcloth and gently go along your upper and lower lash lines.
Use a humidifier to counter the drying effects of air conditioning and indoor heating.
If you wear contacts, daily disposable lenses that are the "water gradient" type may be more comfortable.
Avoid your eye area completely when you use beauty products with retinoids.
Check with your doctor about taking omega-3 fatty acid supplements. They have anti-inflammatory properties and may boost the quality of your meibum.
