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Meibomian Gland Dysfunction, Oil Deficiency and Dry Eye
This page deals with the following aspects of Meibomian gland dysfunction (MGD):
Introduction:
A lack of oil on the thin oil layer on the aqueous tear film is regarded as the main reason for dry eye disease, mainly by obstruction of the numerous small oil glands inside the eyelids.
Replacing water and preferably also oil by tear supplements typically leads to an immediate but only temporary improvement of the annoying symptoms. A more thorough approach is aiming to improve the gland obstruction by physical therapy (warmin, massage and cleaning) of the eyelids.
Meibomian gland dysfunction (MGD) is often associated with other disease conditions of the ocular surface such as chronic dry eyes and chronic inflammation of the eyelids (chronic blepharitis), mainly of the eyelid margin with the eyelashes.
=> here is more information on Meibomian gland dysfunction (MGD)
On this page you will find the following topics:
Various factors favor oil gland obstruction and dry eye disease - in addition to general risk factors, local risk factors at the eyelids also play a role, such asl overgrowth of normal bacteria on the eyelid margin
Inflammatory depositions and incrustations on the eyelid margin favor inflammation and worsening of the condition
Besides congestion, there are other meibomian gland disorders (stye, hailstone)
Therapy options for Meibomian gland obstruction
BASIC Therapy for Dry Eye by Meibomian Dysfunction (MDD)
Some options for APPARATIVE therapy for dry eye in meibomian gland dysfunction (MDD)
Various factors favor oil gland obstruction and dry eye disease
Apart from factors such as increasing age, hormonal changes and some sorts of chronic medication there are further local risk factors for Meibomian gland dysfunction and chronic eyelid inflammation (chronic blepharitis). Both of these conditions are closely linked to chronic Dry Eye Disease.
The increase of normal bacteria on the edge of the eyelid and inside the meibomian glands plays a role.
This is regarded as an overgrowth of normal resident bacteria due to favorable conditions on a diseased eyelid margin and not regarded as an infection.
If the number of bacteria and thus their excretion products increase too much, they can have negative effects and promote inflammation of the eyelid.
Bacteria and their products can change the meibomian oil and also promote the cornification of the cells.
=> here is more information about the eyelid margin and harmful depositions
Schematic animated illustration of the development of some important pathological changes on the edge of the eyelid. These occur in various chronic diseases of the eye, including chronic Meibomian gland dysfunction (MGD). => please see here for a photo of incrustations on the eyelid margin and eyelashes.
Deposits and incrustations on the eyelid margin and on the eyelashes (please see photo image) occur in basically all chronic forms of dry eyes, in Meibomian gland dysfunction and in inflammatory eyelid disease (blepharitis). They build up together with other alterations of the eyelid margin (please see animated image)
The deposits typically contain, apart from skin scales and dust, inflammation-promoting substances that irritate the tissue and can disturb the tear film, for example
Bacteria and the substances they excrete
Meibom oils are modified by bacterial enzymes with release of cell-irritating inflammation promoting fatty acids
free fatty acids reduce the stability of the tear film
=> here is more information about the eyelid margin and inflammatory depositions
Therapy options:
Cleaning and care of the eyelid margin is a sensible measure to remove harmful coatings on the eyelid margin and adhesions of the lashes..
Meibomian Gland Dysfunction (MGD) typically goes along with blocked Meibomian glands
A blockage of the meibomian oil glands inside the eyelids
is not always obvious from the outside
occasionally there is visibly slight whitish bulging of the openings of the Meibomian glands (´pouting´).
inspissated secretion can also protrude from the openings on the posterior eyelid margin (please see image) or it can be produced by a clinical test (´diagnostic expression´) by pressing with a finger
deposits and encrustations on the lid margin are typically already present in such cases
Meibomian gland dysfunction (MGD) by blockage of the meibomian glands (please see image) is a common disorder of the eyelid margin. It leads to oil deficiency on the tear film with increased evaporation ot the tear water and thus to dry eyes. This is in fact the main cause of dry eye disease according to current scientific knowledge.
Apart from oil deficiency and dry eyes at the ocular surface the gland blockade typically leads to unnoticed damage of the gland tissue inside the eyelids.
Other meibomian gland disorders (stye, hailstone).
Besides chronic meibomian gland dysfunction (MDD), the most common cause of dry eyes, usually with glandular congestion, there are other glandular disorders.
Stye (Meibomitis/ Meibomianitis)
Stye is an acute inflammation of the meibomian glands in the eyelid. It causes redness and swelling of the eyelid usually with pain. A collection of pus forms in one or more meibomian glands. Typically, a stye heals on its own by opening inward to the conjunctival sac or outward to the skin, the pus drains out, and the wound heals.
Hailstone
A hailstone is a chronic inflammation of the meibomian glands with slow onset. It involves the formation of a mostly painless swelling, typically without distinct redness of the eyelid. A chalazion may heal on its own, but typically tends to persist and may need to be removed by the ophthalmologist with minor surgery.
If the meibomian glands inside the eyelids are frequently disturbed, additional systemic diseases may be present, such as skin diseases or immune system disorders, e.g., chronic diabetes.
As always with all changes in the eye, an ophthalmologist should be consulted for accurate diagnosis and therapy recommendation !
Therapy options for Meibomian gland obstruction
It goes without saying that the diagnosis of an ocular disorder or eye disease as well as corresponding recommendations for treatment should always be made by an ophthalmologist.
Oil deficiency on the tear film results in evaporation of the tear water with subsequent dry eyes
Some important BASIC therapy options for meibomian gland dysfunction (MGD) and blepharitis are:
Regular Hygiene and care of the eyelids for cleaning away irritant lid margin depositions is generally recommendable
A daily physical eyelid therapy that can be done by the patient at home as the basic therapy
Tear supplements can temporarily improve a lack of tears.
Aqueous tear supplements to replace the evaporated tear water
Lipid-containing tear substitutes or pure lipids to replace the missing oil to reduce water evaporation certainly make sense in oil deficiency due to Meibomian gland dysfunction.
Specialized APPARATIVE therapy in medical practice:
mechanical abrasive EyeLid Cleaning (BlephEX)
computer-controlled automatic warming of the eyelids with subsequent automatic expresseion of the Meibomian glands (LipiFLOW System)
Intense Pulsed Light Therapy (IPL) - a very intense light therapy or Colored light therapy that are derived from dermatomogy and are also effective for the skin-associated Meibomian glands inside the eyelids.
etc….
Prescription medicine (eg anti-inflammatory, anti-biotic) by the ophthalmologist
Basic Therapy for Dry Eye by Meibomian Dysfunction (MGD)
A simple regular daily lid hygiene and lidcare may already bring sufficient improvement
In addition, tear supplements preferably with an oil addition or pure oil, can provide immediate relief of annoying dry eye symptoms until improvement of the blocked Meibomian glands occurs
Physical therapy (warming, massage, cleaning) of the eyelids to re-liquefy the inspissated oil inside the blocked Meibomian oil glands is more laborious but typically also more effective and can be done at home.
… A quicker and typically even more effective approach, according to studies, is apparative device-based physical Meibomian gland therapy in the eye doctor´s office
=> Some options for BASIC therapy for meibomian constipation
=> Some options for APPARATIVE therapy for dry eye in meibomian gland dysfunction (MDD)
