Meibomian gland dysfunction (MGD) refers to a condition where meibomian glands secrete poor quality meibum (oil). The glands may also not secrete enough oil as they should. Meibomian glands are small oil glands located on the eyelids' edges. The oil helps to keep the tears from drying out. The oil layer, mucous, and water together comprise the tear film, which lubricates the eye's surface.
The tear film keeps the eye's surface healthy and a dysfunction will affect vision. The child may experience blurry vision if the required oil layer or water decreases. Children may also have eye irritation if the oil turns crusty. It is believed that MGD is widespread among children except that it is underdiagnosed or misdiagnosed. If the glands get clogged chronically, they may not produce oil resulting in permanent tear film changes and dry eyes. If not treated, MGD can lead to inflammation and infection. Corneal diseases may also result from an advanced, untreated MGD. MGD may also cause blepharitis, which is eyelid inflammation.
Causes & Risk Factors
The precise cause of MGD remains unknown. However, it is believed that bacteria on the eye’s surface may be responsible. Risk factors include the following:
- Computer screen use
- The Asian race compared to others
- Diet due to lack of omega-3 fatty acids
- Presence of autoimmune conditions like rosacea
- Contact lens wearing because the lenses can cause less meibum production
- Medications where some drugs can alter the volume and functioning of the glands
- The environment - MGD affects mostly those under low humidity conditions such as winter heating and air conditioning
- Hormones - Estrogen increases inflammation while androgens stimulate the secretion of meibum and suppress inflammation
- Age, with older people likely to be affected than children because of the changes in the quality and quantity of meibum secretion
Signs & Symptoms
The signs and symptoms include:
- Dry eyes
- Eye redness
- Watery eyes
- Burning eyes
- Stye or chalazion
- Sensitivity to light
- Crusting of the eyes
- Feeling of a foreign body in the eye
- The eyelid’s inner rim may look rough or uneven
- Blurry vision that is on and off but may improve with blinking
It may be challenging to diagnose MGD because it can be confused with corneal swelling or dry eye. Diagnosis of MGD is made through:
- The patient’s medical history
- Transillumination is used to examine the glands via the eyelids
- Laboratory analysis where a sample is examined for bacterial analysis
- A slit-lamp examination to look at the eye in greater detail and check for meibomian gland abnormalities
- A physical examination where the eyelids and eyes are assessed using special equipment. The eye is dilated to explore the inner structures
- Measurement of lipids by blotting the eyelid margins using a special tape. The meibomian gland output is also measured. Some tests can be used to check if enough tears are being produced, tear quality, and the rate of tear evaporation
Treatment aims to alleviate a patient's MGD symptoms.
To reduce inflammation and improve the meibum, the doctor prescribes systemic antibiotics. Topical corticosteroids may help decrease inflammation. Immunosuppressants and disposable contact lenses can also help.
Surgery may be performed to open blocked meibomian glands.
Eyelid hygiene is essential to clear dead skin, bacteria, and oil. Warm compresses melt the crusts and increase oil production. Warm washcloths apply heat on the eyelids, which warms the oil. The oil can now flow freely and soften eyelash debris. This is done for about four minutes two times a day when active symptoms are present. A massage using light pressure from the fingertips is applied to the eyelid margin.
Lid scrubs help remove bacteria, oil, and debris. Omega-3 fatty acid, which includes flaxseed and fish oil, can improve the consistency and quality of oil from the glands. Toddlers take one teaspoon a day, while older children use a tablespoon a day. The omega-3 fatty acid can be mixed with smoothies, hot cereal, or juice.
Prognosis & Long-Term Outlook
MGD is a chronic condition, so care should be taken to effectively manage the symptoms and enable comfort.
Prevention & Follow Up
Prevention of MGD involves maintaining high hygienic standards, keeping the air humidified, and staying hydrated. Others include lubricating the eye, which can be done through blinking. Wearing protective eyewear and avoiding smoking or being around smokers, is also recommended.