What are the management options for Meibomian Gland Dysfunction (MGD) in children?

Management of Meibomian Gland Dysfunction (MGD) in Children

For children with MGD, start with warm compresses and eyelid hygiene as first-line therapy, and when oral antibiotics are needed, use erythromycin or azithromycin instead of tetracyclines to avoid tooth staining. 1

First-Line Conservative Management

Warm Compresses and Lid Hygiene:

• Apply warm compresses to the eyelids for several minutes, once or twice daily, using hot tap water on a clean washcloth, over-the-counter heat packs, or homemade bean/rice bags heated in the microwave 1
• Instruct parents to ensure compresses are not so hot that they burn the child's skin 1
• Perform vertical eyelid massage to express meibomian gland secretions after warming 1
• Clean eyelid margins by gently rubbing the base of eyelashes using diluted baby shampoo or commercially available eyelid cleaners on a pad, cotton ball, or cotton swab 1
• Hypochlorous acid eye cleaners at 0.01% have strong antimicrobial effects for anterior blepharitis 1
• Counsel parents that this treatment may be required long-term, as symptoms often recur when discontinued 1

Topical Antibiotic Therapy

When Conservative Measures Are Insufficient:

• Apply topical antibiotic ointment (bacitracin or erythromycin) to the eyelid margins one or more times daily or at bedtime for a few weeks 1
• Repeat treatment intermittently using different antibiotics with different mechanisms of action to prevent resistant organisms 1
• Guide frequency and duration by severity of MGD and response to treatment 1

Oral Antibiotic Therapy for Moderate-to-Severe Cases

Critical Pediatric Consideration:

• Tetracyclines (doxycycline, minocycline, tetracycline) are contraindicated in children under 8 years of age due to tooth staining 1
• Use oral erythromycin as the alternative: 30-40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4-6 weeks 1
• Alternatively, use azithromycin: 5 mg/kg daily for 2 months has shown clinical improvement in small case series 1
• These macrolide antibiotics also have anti-inflammatory activity beyond their antimicrobial effects 1

Advanced In-Office Procedures

For Refractory Cases:

• Low-energy intense pulsed light (IPL) treatment has been found effective and safe for treating moderate-to-severe blepharitis in children 1
• IPL should be used with caution in more darkly pigmented individuals (above Fitzpatrick skin type IV) due to risk of burns and pigmentation changes 1
• Vectored thermal pulsation therapy and manual meibomian gland expression with heat application are options, though primarily studied in adults 1

Topical Anti-Inflammatory Agents

When Inflammation Is Prominent:

• Short-term topical corticosteroids can be used, with loteprednol etabonate 0.5%/tobramycin 0.3% suspension being safer than dexamethasone due to less risk of intraocular pressure rise or cataract progression 1
• Limit steroid use to short courses to avoid complications 1

Important Caveats

• Patients must understand that cure is usually not possible, and treatment focuses on symptom control 1
• Frequent eyelid manipulation may lead to mechanically induced irritation 1
• Consider the child's and parent's ability to safely perform home treatments when tailoring the therapeutic plan 1
• Evaluate children with recurrent MGD for underlying conditions like chronic blepharokeratoconjunctivitis 2
• The optimal treatment regimen often requires persistence and a trial-and-error approach 1