From the Guidelines
Explanation and Treatment of Meibomian Gland Dysfunction (MGD)
Meibomian gland dysfunction (MGD) is a condition characterized by the obstruction of meibomian glands, leading to altered lipid composition and quantity of the tear film.
Treatment Options
Treatment for MGD typically involves a combination of:
- Warm compresses to soften adherent scurf and scales or discharge and/or warm the meibomian secretions 1
- Lid hygiene, including eyelid massage in cases of MGD to express the meibomian glands 1
- Medications such as:
- Topical perfluorohexyloctane 1
- Antibiotics (topical and/or systemic) 1
- Antiparasitic medication (metronidazole, ivermectin, lotilaner) 1
- Topical anti-inflammatory agents (e.g., corticosteroids, cyclosporine) 1
- In-office procedural treatments (e.g., vectored thermal pulsation, microblepharoexfoliation) 1
Additional Considerations
In more severe cases, oral doxycycline (100mg, twice daily for 4-6 weeks) or omega-3 fatty acid supplements (1000mg, twice daily) may be prescribed to reduce inflammation and promote gland function 1. It is essential to note that the optimal treatment regimen often requires persistence and a trial-and-error approach 1.
Key Points
- MGD is a chronic condition, and treatment may be required long-term to manage symptoms 1
- A combination of treatments may be necessary to achieve optimal results 1
- Patient education and compliance are crucial for successful treatment 1
From the Research
Explanation of Meibomian Gland Dysfunction (MGD)
- MGD is a common clinical problem often associated with evaporative dry eye disease, characterized by a reduction in meibum secretion and/or a change in meibum composition, leading to disruption of the tear film lipid layer and increased tear film evaporation rate 2.
- Alterations of the lipids of the meibomian glands have been identified in several studies of MGD, including changes in meibum fatty acid composition 3, 4.
- MGD can cause a range of symptoms, including dryness, burning, stinging, and eyelid redness, as well as signs such as thickened secretions, occlusion of glands, and corneal staining 2, 5.
Treatment of MGD
- Traditional treatments for MGD include warm compresses, lid hygiene, antibiotics, and anti-inflammatory agents, but these have limitations and may not provide complete relief of signs and symptoms 6.
- Emerging treatment options for MGD include intraductal meibomian gland probing, emulsion eye drops containing lipids, the LipiFlow thermal pulsation system, N-acetyl-cysteine, azithromycin, oral supplementation with omega-3 essential fatty acids, and cyclosporine A 6.
- Topical ophthalmic prescription medications, such as lifitegrast, can help reduce inflammation and improve symptoms and signs of MGD 5.
- Oral antibiotics, such as doxycycline and minocycline, have been shown to improve clinical signs and symptoms of MGD, as well as modify meibomian fatty acid composition 3, 4.
- Thermal pulsation procedures, such as the LipiFlow system, can help improve gland patency and reduce obstruction, but may not be as effective as anti-inflammatory treatments in reducing symptoms and signs of MGD 5.