What is the treatment for meibomian gland dysfunction?

From the Guidelines

The treatment for meibomian gland dysfunction (MGD) typically involves a combination of eyelid hygiene, warm compresses, and sometimes medications, with the most recent evidence suggesting that in-office procedures such as intense pulsed light therapy may be recommended for persistent cases 1.

Treatment Approach

The treatment approach for MGD involves a step-wise approach, starting with:

• Daily warm compresses applied to closed eyelids for 5-10 minutes to melt the thickened oil in the glands, followed by gentle eyelid massage to express the oils
• Cleansing the eyelid margins daily with diluted baby shampoo or commercial eyelid cleansers to remove debris and bacteria
• Artificial tears without preservatives for moderate cases, used 4-6 times daily
• Omega-3 fatty acid supplements (1000-2000mg daily) to improve oil quality

Medications and In-Office Procedures

For more severe cases, doctors may prescribe:

• Topical antibiotics like azithromycin or oral doxycycline (50-100mg daily for 6-12 weeks) which works at low doses as an anti-inflammatory rather than an antibiotic
• In-office procedures such as LipiFlow, intense pulsed light therapy, or meibomian gland probing may be recommended for persistent cases, with intense pulsed light therapy showing promise in improving meibomian gland function and reducing dry eye symptoms 1

Key Considerations

It is essential to note that the treatment of MGD should be tailored to the individual patient, taking into account the severity of symptoms, the presence of any underlying conditions, and the patient's ability to perform eyelid hygiene and other treatments 1. Additionally, the use of intense pulsed light therapy should be done with caution, particularly in patients with darker skin tones, due to the risk of burns and changes in pigmentation level 1.

From the Research

Treatment Options for Meibomian Gland Dysfunction

The treatment for meibomian gland dysfunction is diverse and can be categorized into conservative measures, medical treatments, and procedures.

• Conservative measures include:
  • Warm compresses
  • Lid hygiene, such as using baby shampoo or eyelid wipes 2
• Medical treatments include:
  • Antibiotics, such as azithromycin 2
  • Nonsteroidal and steroidal anti-inflammatory agents 3
  • Essential fatty acid supplementation, such as omega-3 fatty acids 2, 4
  • Hormone therapy 3
  • Control of Demodex infestation 2
• Procedures include:
  • Intraductal meibomian gland probing 3
  • The use of electronic heating devices 3
  • Intense pulsed light therapy 3, 5
  • Intranasal neurostimulation 3

Emerging Therapeutic Strategies

Recent studies have explored emerging pharmacological treatments for meibomian gland dysfunction, including:

• Miebo, the first FDA-approved drug for patients with dry eye disease associated with meibomian gland dysfunction 6
• AZR-MD-001, a keratolytic and lipogenic agent that improves meibum quantity and quality 6
• Combination treatment approaches, such as using lipid emulsion eye drops, eyelid cleansing wipes, and omega-3 vitamin supplements 4

Efficacy of Treatment Options

Studies have demonstrated the efficacy of various treatment options for meibomian gland dysfunction, including:

• Improved symptoms and signs with intense pulsed light therapy 5
• Significant improvement in meibomian gland functionality and dry eye symptoms with combination treatment regimens 4
• Reduced tear film layer evaporation rate and minimal impact on vision quality with Miebo 6