Meibomian Gland Dysfunction: Signs, Causes & Treatment

Meibomian gland dysfunction (MGD) is a common condition where the tiny glands along the eyelid become blocked. 

Meibomian gland dysfunction is very common and may not cause symptoms in its early stages. The dysfunction is due to glands not creating enough of the oil or creating poor quality oil. 

If the oil glands get clogged, less oil is released. This contributes to the crusting and granularization of the oil, which can be unhealthy and create irritation.

What Are the Meibomian Glands?

Meibomian glands are small glands lining the edges of the eyelids. These glands secrete oil, called meibum. The oil plays an important function in coating the eye surface and keeping the eye from drying out. 

The upper eyelid has approximately 25 to 40 meibomian glands, and the lower eyelid has 20 to 30. The glands secrete oil that is vital for maintaining eye health.

The secretion keeps tears from evaporating too quickly and drying out the eye. The mixture of glandular secretion and water is called tear film. 

Tear film keeps the eyes healthy, lubricated, and able to see clearly. If the oil or water is diminished or if the oil is of poor consistency, vision can be blurry. 

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What Happens With MGD?

Meibomian gland dysfunction can create dry eye symptoms or make symptoms worse. It is also associated with eyelid inflammation. 

If the glands are chronically clogged, this can create permanent deterioration of the film quality, resulting in dry eyes. 

Signs of MGD

Common signs and symptoms of MGD include dryness, burning sensations, itchiness, and watery eyes. You may notice stickiness or crusting from the secretion near the eyelids. 

With MGD, it is not uncommon to have a stye or lump on the eyelid known as a chalazion. The eyes may become more sensitive to light. You may have intermittent blurring in your vision.

Causes & Risk Factors

Meibomian gland dysfunction is very common, and it is one of the leading causes of dry eye syndrome. These are some of the contributing factors:

Age

The risk of developing MGD increases with age. It is more common in people who are 40 and older. 

Eye Makeup

Women who wear eye makeup are at greater risk for MGD.

Hormonal Changes

Hormonal changes occurring near and during menopause can change meibum production. These hormonal changes can also influence the quality of the oil. 

Medications

AOA notes that the quality and quantity of meibum can also change with certain medications. One example is Accutane or 13-cis-retinoic acid, which can diminish the vitality of the glands.

Electronic Devices

Reading with the use of electronic devices changes blinking patterns. Blinking patterns tend to be less frequent when reading from an electronic screen rather than reading from a book. 

Blinking less frequently contributes to the meibum staying longer in the glands. This creates stagnancy, produces a thicker oil, and can contribute to blocked glands.

Diagnosis of Meibomian Gland Dysfunction

To determine if you have MGD, your eye doctor will conduct a comprehensive eye exam. 

As part of the exam, your doctor will press the eyelids and evaluate secretions. This is an important part of the exam to determine glandular flow. 

The diagnosis may also include testing your tears to determine the quantity, quality, and stability of your tear film. This is a painless procedure. 

Treatment for MGD

The first line of treatment for MGD is often home remedies. If these are insufficient, talk with your doctor about medical treatments. 

Home Remedies

This can be a chronic condition, so preventative treatment and eyelid hygiene are essential. 

According to the American Association of Pediatric Ophthalmology and Strabismus (AAPOS), home remedies include warm compresses, massage, eyelid scrubs, and adding omega-3 fatty acids to the diet. 

Warm Compresses

Warming the edge of the eyelid increases oil production and softens oil that has gotten crusty in the glands. It can also help to soften bits of crust on the lashes.

Run a washcloth under warm water to make a clean compress. Apply the heated compress to the eyelids for four or more minutes. This should warm the area and allow the oil to flow more freely. 

This can be done two times a day when symptoms are active and once a day as a preventative method.

Massage

While using the warm compress, gently apply light pressure just above the eyelashes. Use your fingertips to delicately roll the finger upward on the lower lid while looking up. Do the same movement, rolling down on the upper lid, while looking down.

Gentle massage is essential. The eyelid skin is delicate, so be careful and very gentle in order to avoid harming the eye.

Eyelid Scrubs

Once a day, you can gently scrub the lash line on the top and bottom lid. This removes oil, bacteria, and leftover crustiness that could block the openings of the oil glands. You can use a cotton swab, a cotton ball, or the edge of a warm washcloth. 

Create an eyelid wash by putting a couple of drops of very mild soap or baby shampoo in a warm glass of water. Make sure that the soap does not burn or irritate the eyes.

Omega-3 Fatty Acid

Omega-3 fatty acids can be taken to improve the quality and consistency of the oil secreted by the meibomian glands. These oils are available as liquid, gummies, and pills. 

Sources of omega-3 fatty acids include fish oil and flaxseed oil. Some people put these oils into juices, smoothies, and other foods to easily make them part of their daily nutrition.

Medical Treatment

There are different ways to treat MGD with medication and medical procedures. Depending on the severity of your condition, some treatment options may be combined. Talk with your doctor to discuss the medical treatment options that are best for you.

Eye Drops

Eye drops may be prescribed to increase oil production and improve tear quality. Steroid eye drops may also be part of the solution to reduce inflammation and increase oil flow. 

LipiFlow

LipiFlow is a medical procedure that combines gentle eyelid massage with heat. Treatment opens the glands and improves the production of oil. 

Tear Care

TearCare is a procedure to soften and melt waxy secretions that can be clogging the glands. The heating patches are placed over the outside of the eyelid and used with a hand-held heating unit. 

According to the American Academy of Ophthalmology, thermal eyelid therapy clears the meibomian glands. This type of therapy is delivered with either heat treatment or a combination of heat and pressure. 

A recent study compared two types of treatment, TearCare and LipiFlow. TearCare uses heat, and LipiFlow uses heat combined with pressure. The study found that both treatments are safe and successful, with 22 percent fewer TearCare patients using daily lubricating drops.

iLUX

iLUX is a hand-held heating unit that is LED-based. It is used to warm the eyelids, melting waxy buildup. The treatment from iLUX helps to unblock meibomian glands, improving the flow of oil. 

IPL

Intense pulsed light (IPL) is a treatment that is used over several months, using light wavelengths on the face. The process reduces bacteria that may be the root cause of MGD. 

Blephex 

This is a hand-held unit that exfoliates the eyelid to open up the meibomian glands. The procedure gently eliminates bacteria from the margins of the eyelid and can improve eyelid health. 

Lid Debridement 

This is a specialized procedure your eye doctor uses to clean the eyelid margins. This can unclog the glands.

Blephasteam 

This is a medical device that looks a little like swimming goggles. The treatment delivers the ideal temperature via moist heat to unblock meibomian glands. 

Meibomian Gland Dysfunction FAQs

How do you fix meibomian gland dysfunction?

Practicing good eyelid hygiene and preventative treatments can help to treat MGD and prevent this condition from being a recurring issue. If it’s a recurring issue for you, talk to your doctor about medical procedures that can address the problem.

What is the best treatment for meibomian gland dysfunction?

Since obstruction is the core mechanism of MGD, clearing out gland content is the best treatment, with options ranging from home remedies to medical procedures. The best treatment will depend on the specifics of your case, so talk to your doctor about the ideal approach. 

How do you unclog a meibomian gland?

Applying warmth and gentle pressure is the first step to treat and unclog a meibomian gland. If home remedies don’t work to unclog the oil-secreting glands, medical procedures that apply heat and warmth may be used.

References

1. Understanding MGD. (August 2018). American Optometric Association.

2. Meibomian Gland Dysfunction (MGD). (January 2022). Eye Wiki, American Academy of Ophthalmology.

3. Rethinking Meibomian Gland Dysfunction: How to Spot It, Stage It and Treat It. (July 2022). EyeNet Magazine, American Academy of Ophthalmology.

4. Chalazion (Lump on Eyelid). Tufts Medical Center.

5. Eye Exam and Vision Testing Basics. American Academy of Ophthalmology.

6. Meibomian Gland Dysfunction and Treatment. (December 2020). American Association for Pediatric Ophthalmology and Strabismus.

7. Conditions We Treat. John Hopkins Medicine.

8. Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease. (May 2017). Ophthalmology.

9. AAO 2020: Thermal Eyelid Therapy Devices Successfully Treat Dry Eye Disease From Meibomian Gland Dysfunction. (November 2020). Eye Care.

10. Functional and Morphological Evaluation of Meibomian Glands in the Assessment of Meibomian Gland Dysfunction Subtype and Severity. (September 2019). The American Journal of Ophthalmology.