Meibomian Gland Dysfunction

What is meibomian gland dysfunction?

Meibomian gland dysfunction (MGD) happens when oil-secreting glands in your eyelids don’t secrete the quantity or quality of oil you need to prevent your eyes from drying out. MGD is a very common cause of dry eye syndrome.

The meibomian glands are the parts in your eye that produce this necessary oil. This oil (meibum) makes up the oily outside layer of the tear film. There’s also a watery layer in the middle and a mucus layer inside.

MGD can be something you’re born with (congenital) or something that happens over time (acquired). It can happen to both older and younger people.

Most often, the glands fill up and oil can’t get out. The name for this is obstructive MGD.

How common is this condition?

Meibomian gland dysfunction is common. An estimated 35.8% of the people in the world have MGD. In the U.S., one estimate is that 70% of people over age 60 have MGD.

The condition is more common in people assigned male at birth (AMAB) than in people assigned female at birth (AFAB). The rates of MGD can vary among different ethnic groups. For instance, the rates are higher among people of Asian descent than among people who are white.

What are the symptoms of meibomian gland dysfunction?

Some people with meibomian gland dysfunction don’t have symptoms. If you do have symptoms of MGD, they can include:

• Eyes that itch or burn.
• Eyes that are red or sore.
• Swollen eyelids.
• Eyes that water.
• Eyes that feel like they have something in them. (The name for this is foreign body sensation.)
• Blurred vision.
• Styes and chalazions that keep coming back.
• Sticky or crusty substances on your eyelids.
• Issues with wearing contact lenses comfortably.

What causes meibomian gland dysfunction?

Meibomian gland dysfunction happens when the glands become blocked. Another factor is the quality of the oil the glands secrete. Certain medications, including glaucoma treatments, retinoids, estrogen for hormone replacement therapy and drugs that decrease androgen levels are potential causes.

What are the risk factors for meibomian gland dysfunction?

Risk factors are things that may increase your chances of getting or having a condition. The risk factors for MGD include:

• Getting older.
• Hormonal issues like not having enough androgen.
• Having a tendency toward allergic reactions.
• Wearing contact lenses.

You may be more likely to have MGD if you also have certain conditions, including those that affect your immune system.

Immune system disorders that are risk factors for meibomian gland dysfunction

• Rosacea.
• Sjögren’s syndrome.
• Lupus.
• Psoriasis.
• Rheumatoid arthritis.

Other conditions that are risk factors for meibomian gland dysfunction

• Chronic blepharitis.
• Stevens-Johnson syndrome.
• High blood pressure.
• High cholesterol levels.
• Eye infections like trachoma.
• Aniridia.

What are the complications of meibomian gland dysfunction?

Meibomian gland dysfunction is serious because of its complications. It can lead to dry eye syndrome (dry eye disease), diseases of the eye surface and blepharitis (eyelid inflammation). MGD, if not treated, can make it more likely for you to have an infection or inflammation in general. MGD can also make these things more likely if you have eye surgery.

Untreated, MGD can result in damage to your cornea.

How is meibomian gland dysfunction diagnosed?

Your eye care provider will ask about your health and medical history. They’ll do a thorough eye exam. Your answers to questions about your eye health are part of the diagnosis. Looking at the inside of your eyelids may allow your provider to see signs of MGD.

What tests will be done to diagnose meibomian gland dysfunction?

Your provider may perform one or more of the following tests to diagnose MGD:

• Oil expression: Your provider presses on your lids to see if, and how much, oily substance comes out.
• Tear film breakup test: Your provider puts a drop of dye into your eye, and you blink to spread it. Then, using the slit lamp equipment, your provider will time how long it takes for the tear film to break apart.
• Schirmer test (Schirmer tear test): Your provider will put test strips into your right and left eyes. The provider pulls down your lower lid and puts a bent part of the strip between your eye and your lower lid. The provider measures how far down the test strip moisture goes.
• Sampling: Some tests are able to determine what substances, like proteins, are making up your tears.
• Meibography: This test takes images of your meibomian glands. There are various techniques, including infrared, optical coherence tomography (OCT) and laser imaging.

How is meibomian gland dysfunction treated?

Treatment of meibomian gland dysfunction depends on many things, such as how advanced it is, why it’s happening and your overall health.

Specific medications and procedures used to treat meibomian gland dysfunction

Your provider may suggest some home remedies, including:

• Putting warm, wet and clean washcloths over your eyelids for about five minutes to loosen the oil.
• Pressing gently on your eyes near the lashes, massaging the glands.
• Cleaning your eyelids and lashes with or without mild soap or baby shampoo.
• Taking omega-3 supplements in the form of fish oil or flaxseed oil.
• Being careful about being in the wind and about how long you spend looking at screens.

Your provider may also recommend:

• Using lubricants for your eyes.
• Taking or using anti-infective medications or ointments.
• Topical anti-inflammatory medications like cyclosporine and steroids.
• Treating related conditions (like a mite infestation).
• Having procedures that unblock glands and press out oil. These procedures can use probes, lasers or machines.

How long does it take to recover from the treatment of meibomian gland dysfunction?

You won’t really have to recover from many of the treatments for MGD. In fact, your provider may recommend doing these consistently (like lid washes and taking supplements).

You may need some time to recover from any type of surgical procedure.

Can meibomian gland dysfunction be prevented?

You can’t prevent meibomian gland dysfunction, but you may be able to reduce your risks in some cases.

How can I lower my risk of developing meibomian gland dysfunction?

You can’t change some risk factors (like your age, sex or ethnicity), but there are modifiable risk factors.

You may be able to reduce your risk by:

• Managing any other health condition, including blood cholesterol levels and blood pressure.
• Managing your environment by avoiding allergens, staying out of the wind where possible and limiting screen time.
• Getting regular eye exams.
• Wearing and cleaning contact lenses as directed by your provider.
• Keeping your eyes and lids clean.

What can I expect if I have meibomian gland dysfunction?

You may not even know you have MGD in the early stages, which makes it more important to get your eyes examined.

You may need to continue good eye hygiene practices throughout your life. If MGD is untreated, you could develop more serious complications, such as dry eye disease or issues with your cornea.

However, the outlook if you have MGD is typically good, even if you have to keep up with certain routines to manage the condition.

When should I see my healthcare provider?

You should always see a provider if you have sight-related issues like eye pain or blurred vision.

If eye pain or vision loss comes on suddenly, go to an emergency room.

What questions should I ask my provider?

You may have many questions for your eye care provider, including:

• What’s causing meibomian gland dysfunction?
• What kind of treatment do you recommend?
• Are there complications related to these treatments?
• Is there anything genetic about this condition? Should I tell family members to get tested?
• How often should I have eye exams?
• Can I still wear contact lenses?
• Will meibomian gland dysfunction ever really go away?

Does meibomian gland dysfunction go away?

MGD may be a lifelong issue for some people, especially if you have another condition that’s treated but not cured, like an immune system disorder.

How do you unclog a meibomian gland?

You may be able to unclog a meibomian gland through self-care like warm compresses and massage. There are instrument- and machine-based options that are available to your provider.

These alternatives to self-care include things like:

• Machines that warm your eyelids and melt the dried or hard meibum.
• Machines that use lasers to probe and unclog your glands.
• Probes that your provider inserts into your glands to dislodge the meibum.

A note from Cleveland Clinic

One of the reasons it’s so important to have regular eye exams is that your eye care provider can find issues before you even know you have them. This is true of meibomian gland dysfunction, which your provider can spot before you have symptoms. While the occasional episode of dry eye isn’t really a problem, continuous dryness is. Your meibomian glands are part of the way that your eyes protect themselves. It’s important to discover and treat meibomian gland dysfunction early to prevent complications.