Meibomian Gland Dysfunction (MGD): What It Is and How It Is Treated

Meibomian gland dysfunction (MGD) is a chronic condition in which the oil glands of the eyelids become blocked or stop producing oil of normal quality, so the tear film evaporates too quickly and the eye becomes dry, gritty and irritated. It is the single most common cause of dry eye disease, and it is frequently missed because the symptoms are put down to tiredness, screens or allergy.

If your eyes often feel dry, gritty, watery or tired, MGD is the first thing worth ruling in or out.

Looking for assessment and treatment? Our full meibomian gland dysfunction (MGD) treatment page explains how we diagnose it with meibography and tear film analysis, and every treatment available at our Hamilton clinic — IPL, LipiFlow, Blephasteam, BlephEx, low level light therapy and Tixel 2.

Questions about Tixel 2 or low level light therapy specifically? These are answered by Jacqueline Rowe. Please email Info@roseoptom.co.nz and mark your message for Jacqueline, so your question reaches her directly rather than our reception team.

What is MGD?

Your eyelids contain 25 to 40 tiny oil-producing glands in the upper lid and 20 to 30 in the lower, called meibomian glands. They secrete oil that forms the outer layer of your tear film, which slows evaporation of the watery layer underneath. When the glands block, or the oil they make becomes thick and waxy, that outer layer fails. Tears evaporate faster than they can be replaced, and the surface of the eye becomes dry and inflamed. That is meibomian gland dysfunction.

The signs we look for

• Burning, grittiness or a foreign-body sensation, usually in both eyes
• Symptoms that build through the day rather than easing — the reverse of blepharitis, which is typically worst on waking
• Watery eyes. This surprises people, but reflex tearing is a common response to an unstable tear film
• Fluctuating or smeary vision that clears momentarily when you blink
• A rapid tear break-up time despite an adequate volume of tears
• Thickened, irregular or capped gland openings along the lid margin, with turbid or toothpaste-like oil when the glands are expressed
• Recurrent chalazia or styes

Why it matters

MGD is chronic and progressive. Glands that stay blocked long enough drop out and do not grow back, which is why the useful question is not only how to relieve today's symptoms but how much gland structure is still there to protect. In a clinic-based study of 224 patients with dry eye disease, 86% showed signs of MGD — poor tear quality rather than a lack of tear production (Lemp et al., Cornea, 2012). Contributing factors include ageing, hormonal change, prolonged screen use and reduced blink rate, some medications, allergy, makeup, and skin conditions such as rosacea.

How MGD is diagnosed

MGD cannot be diagnosed from symptoms alone, and it cannot be assessed from a photograph. A proper workup looks at four things: the lid margin and gland openings at the slit lamp; what actually comes out when the glands are expressed; the structure of the glands themselves using meibography, which images gland dropout directly; and the stability and osmolarity of the tear film. That combination is what separates evaporative dry eye from aqueous-deficient dry eye — a distinction that changes the treatment entirely, because conserving tears helps one and not the other.

How MGD is treated

Treatment works down a ladder, and the foundation is unglamorous: sustained warmth to soften the blocked oil, lid margin cleaning, and blink retraining. A purpose-made heat mask holds temperature far better than a flannel, which cools within a minute or two. Lubricant drops ease symptoms but do not change the disease.

Where that is not enough, in-clinic treatment targets the glands directly. TearScience LipiFlow applies controlled heat to the inner lid surface with gentle pulsatile pressure to clear blockages and restore gland function. In a published trial of 200 patients a single treatment produced a sustained mean improvement in gland function and dry eye symptoms at 12 months, with 86% of those treated needing only that one treatment over the year (Blackie et al., Clinical Ophthalmology, 2016). Intense pulsed light (IPL) is used where inflammation and lid margin telangiectasia are driving the picture, particularly in ocular rosacea. Results vary between people, so we measure the tear film with TearCheck, image the glands with meibography and check osmolarity before and after rather than quote a percentage.

MGD often begins before you notice symptoms, which is why early detection matters — you are protecting gland structure you still have.

Assessment and treatment are at Rose Optometry, 38 Lake Road, Frankton, Hamilton. Our MGD treatment page and Dry Eye Clinic page explain how we work out which treatment you need, and you can book a Dry Eye Evaluation online — the appointment is preselected; just choose a time.

Rose Optometry is a member of the Dry Eye Specialist Group, a network of independent New Zealand optometry practices with a shared dry eye protocol. Our affiliated Hamilton practice is Visique Rototuna, which is usually the closer clinic if you live north of the river.

References

• Nelson JD, Shimazaki J, Benitez-del-Castillo JM, et al. The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930-1937. doi:10.1167/iovs.10-6997b
• Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283. doi:10.1016/j.jtos.2017.05.008
• Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628. doi:10.1016/j.jtos.2017.05.006
• Blackie CA, Coleman CA, Holland EJ. The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye. Clin Ophthalmol. 2016;10:1385-1396. PMID 27555745. doi:10.2147/OPTH.S109663
• Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472-478. PMID 22378109. doi:10.1097/ICO.0b013e318225415a