From the Guidelines
Meibomian Gland Dysfunction (MGD) is a condition characterized by the abnormal secretion of the meibomian glands, leading to altered lipid composition of the tear film and resulting in dry eye symptoms 1.
Key Characteristics of MGD
- Chronic, diffuse abnormality of the meibomian glands
- Terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion
- Alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease ### Diagnosis of MGD
- Abnormal morphology (observed using a slit lamp)
- Lid margin abnormalities (gland orifice morphology, gland number, patency, telangiectasia, displacement of the mucocutaneous junction, or signs of blepharitis)
- Abnormal meibum quality
- Abnormal meibomian gland expression ### Treatment Options for MGD
- Warm compresses
- Lid hygiene
- Topical medications such as azithromycin 1% ophthalmic solution, dosed at 1 drop twice daily for 2 weeks, followed by a maintenance dose of 1 drop daily for 2 months 2
- Oral doxycycline 100mg daily for 3 months to reduce inflammation and promote gland function 2
- In-office procedural treatments such as intense pulsed light (IPL), meibomian gland probing, and devices using thermal pulsation may also be effective in improving meibomian gland function and reducing dry eye symptoms 3 It is essential to note that the treatment of MGD should be tailored to the individual patient's needs and may involve a combination of these options. Regular follow-up appointments with an eye care professional are necessary to monitor the effectiveness of treatment and make any necessary adjustments.
From the Research
Definition and Prevalence of Meibomian Gland Dysfunction (MGD)
- Meibomian gland dysfunction (MGD) is a common and chronic disorder that has a significant adverse impact on patients' quality of life 4.
- MGD is the leading cause of evaporative dry eye disease (DED), as meibomian glands play an important role in providing lipids to the tear film, which helps to retard the evaporation of tears from the ocular surface 5, 4.
- MGD is characterized by a reduction in meibum secretion and/or a change in meibum composition that results in the disruption of the tear film lipid layer and an increase in the tear film evaporation rate 5.
Causes and Risk Factors of MGD
- Obstructive MGD, the most commonly observed type of MGD, is probably caused by a combination of separate conditions: primary obstructive hyperkeratinization of the meibomian gland, abnormal meibomian gland secretion, eyelid inflammation, corneal inflammation and damage, microbiological changes, and DED 4.
- Skin diseases such as rosacea may also play a part in the pathology of MGD 4.
- Age is a significant risk factor, with MGD being more common in elderly patients 6.
Diagnosis and Treatment of MGD
- Accurate diagnosis of MGD is challenging, as it is difficult to differentiate between ocular surface diseases, but is crucial when choosing treatment options 4.
- Traditional treatments of MGD consist of warm compresses, lid massage, and improving lid hygiene, all measures aimed at relieving glandular obstruction and facilitating meibum outflow 7, 8.
- Newer diagnostic imaging modalities and therapies for MGD, such as vectored thermal pulsation and intense pulsed light therapy, have emerged 7.
- 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 8.
- Treatment of MGD can lead to significant improvement in patients' condition, with all DED metrics improving significantly with appropriate treatment 6.