The Meibomian glands are small oil glands located along the base of the eyelashes. There are about 30-40 glands in the upper eyelid and 20-30 glands in the lower eyelid. These glands secrete oil that helps coat the surface of the cornea, preventing the evaporation of tears and maintaining moisture, keeping the eyes hydrated.
Normally, the oil secreted by the Meibomian glands is clear and can easily flow out. However, when the Meibomian glands are not functioning properly (Meibomian Gland Dysfunction, MGD), the oil becomes thick and cloudy, leading to blockages in the ducts of the glands at the eyelid margin. This makes it difficult for the oil to exit and reduces its quantity, causing instability in the tear film. As a result, the tears evaporate easily, leading to dry eyes, and the thickened oil can harden and form crusts on the eyelid margin, causing irritation and increasing the risk of bacterial infections as well as the proliferation of Demodex mites on the eyelashes.
If left untreated or inadequately treated, the dysfunction can worsen, eventually causing the glands to atrophy and lose their ability to produce oil, making later treatment more difficult. Patients may experience eye irritation, eyelid pain, and severe, chronic dry eyes, which increases the risk of infections in the conjunctiva and eyes.
Risk Factors
- Eye conditions: Chronic blepharitis, allergic conjunctivitis, dry eye from wearing contact lenses.
- Physical conditions: Increasing age, menopause, hypertension, Pemphigoid, psoriasis, drug reactions (e.g., Stevens-Johnson syndrome).
- Medication side effects: Use of glaucoma medications.
- Demodex mites on eyelashes.
- Environmental factors: Dust, smoke, pathogens, cosmetic residue.
Symptoms
Symptoms are similar to dry eye disease and may include:
- Eye irritation, redness, and discomfort.
- Itching and blurred vision.
Treatment
Warm Compress: Applying warmth to the eyelids helps melt the thickened oil and clears the blockages in the Meibomian gland ducts. You can use:
- A warm gel pack, a warm towel, or a device like Blephasteam®, which provides consistent and appropriate heat (around 40°C) for about 10-15 minutes. Be cautious not to apply too much heat to avoid skin burns.
Eyelid Cleaning: Use a cotton pad soaked with a mixture of warm water and baby shampoo (1:1 ratio) or a special eyelid cleaning solution. Gently clean the eyelid margin and base of the eyelashes once or twice a day.
Eyelid Massage: Gently pull the outer corner of the eyelid to stretch it, then use the opposite hand’s finger to massage the eyelid. For the upper eyelid, look downward and massage from top to bottom. For the lower eyelid, look upward and massage from bottom to top, applying moderate pressure to massage along the entire eyelid where the Meibomian glands are located.
Artificial Tears: Use artificial tears to increase moisture in the eyes.
Antibiotic Ointment or Drops: To reduce inflammation and eliminate bacterial infections around the Meibomian glands.
Oral Tetracycline: Tetracycline medications can help reduce the number of bacteria and inflammation in the Meibomian glands.
By addressing the underlying causes and using proper treatments, Meibomian Gland Dysfunction can be managed to alleviate symptoms and improve eye health.
