What is the treatment for Grade 2 Meibomian Gland Dysfunction (MGD)?

From the Guidelines

For Grade 2 Meibomian Gland Dysfunction (MGD), treatment typically involves a combination of warm compresses and eyelid hygiene, along with topical antibiotics such as azithromycin 1% ophthalmic solution, administered twice daily for 2-3 weeks 1. Additionally, anti-inflammatory agents like loteprednol etabonate 0.5% ophthalmic suspension may be prescribed, used 4 times daily for 2-4 weeks 1. In some cases, oral doxycycline 100mg, taken twice daily for 3-6 months, may be considered to reduce inflammation and promote meibomian gland function 1.

Key Treatment Components

• Warm compresses: applied to the eyelids for several minutes to soften adherent scurf and scales or discharge and/or warm the meibomian secretions 1
• Eyelid hygiene: brief, gentle massage of the eyelids, with eye cleaners having a strong antimicrobial effect, such as hypochlorous acid at 0.01% 1
• Topical antibiotics: such as azithromycin 1% ophthalmic solution, administered twice daily for 2-3 weeks 1
• Anti-inflammatory agents: like loteprednol etabonate 0.5% ophthalmic suspension, used 4 times daily for 2-4 weeks 1
• Oral doxycycline: 100mg, taken twice daily for 3-6 months, to reduce inflammation and promote meibomian gland function 1

Additional Considerations

• In-office procedural treatments: such as intense pulsed light (IPL), microblepharoexfoliation, meibomian gland probing, and devices using thermal pulsation, may be considered to improve meibomian gland function and reduce dry eye symptoms 1
• Demodicosis treatment: local application of tea tree oil, oral ivermectin, or topical lotilaner ophthalmic solution 0.25% may be considered for Demodex blepharitis 1

From the Research

Treatment Options for Grade 2 Meibomian Gland Dysfunction (MGD)

• Initial conservative therapy often includes a combination of warm compresses and baby shampoo or eyelid wipes 2
• Other manual and mechanical techniques to treat MGD include MG expression and massage, MG probing, and LipiFlow(®) 2
• Pharmacological treatments are another course of action, including:
  • Supplements rich in omega-3 fatty acids to improve MGD and dry eye symptoms 2
  • Tea tree oil to treat MGD associated with Demodex mites 2
  • Topical antibiotics, such as azithromycin, or systemic antibiotics, such as doxycycline or azithromycin, to improve MGD symptoms 2, 3, 4, 5
  • Topical N-acetylcysteine and topical cyclosporine as therapeutic adjuncts in patients with concurrent dry eye 2
  • A short course of topical steroid in severe cases, with monitoring for steroid-induced glaucoma and cataracts 2

Comparison of Topical Azithromycin and Oral Doxycycline

• Both topical azithromycin and oral doxycycline have been shown to be effective in treating MGD, with some studies suggesting that topical azithromycin may be superior in improving tear film quality and having fewer side effects 3, 4, 5
• Oral doxycycline may be more effective in healing meibomian gland obstruction and corneal staining, while topical azithromycin may improve eye redness 5
• The choice of treatment may depend on the individual patient's symptoms and response to treatment, as well as the presence of any underlying conditions or contraindications 6