What Is Meibomian Gland Dysfunction?

If you have meibomian gland dysfunction, you may not know the name, but you do know that your eyes are dry and sensitive and something is amiss.

With meibomian gland dysfunction, either the numerous tiny glands on the edges of the eyelids are not making enough oil or this is not of good quality. The oil produced by these glands, together with water, makes up the tear film, which keeps the surface of the eyes moist and healthy.

However, when the meibomian glands are not working properly, the result can be eyelid inflammation and dry eye. If the glands are clogged for a long time, they may become unable to make oil, something that causes dry eye and permanent changes in the tear film.

Meibomian Gland Symptoms

Determining if you have this condition means being alert for dry eye symptoms such as:

• Itchy eyes
• Redness
• Burning
• Light sensitivity
• Watery eyes
• Foreign body sensation
• Blurry vision that comes and goes

In some cases, this may also be associated with a condition known as blepharitis, in which the edges of the eyelids near the lashes become crusty. You may also notice a tender red bump known as a stye on the edge of the eyelid or a painless bump on the inside of the eyelid called a chalazion.

Causes

There are a variety of factors that can play a role in setting off meibomian gland dysfunction. A common factor is older age. One study showed that 59% of older adults with an average age of 63 had at least one sign of meibomian gland disease.

A person's ethnic makeup can also be a factor. Those with Asian heritage from China, Thailand, or Japan tend to be at increased risk, with some research indicating that up to 69% of the populations in these areas have this disorder.

However, for Whites in the United States and Australia who are non-Hispanic, just 20% develop meibomian gland dysfunction.

Factors that you can control, such as wearing contact lenses or makeup, can also heighten risk. With contact lens use, research indicates that changes to the meibomian glands can continue even after you stop wearing the lenses.

Likewise, wearing eye makeup such as liner can clog the meibomian glands, particularly if you're not scrupulous about thoroughly removing this before bed.

Diagnosis

Detecting whether you have a problem with meibomian gland dysfunction needs to be done by an eye doctor.

One thing they will likely do is gently push on your eyelid to press out some of the contents of your meibomian glands. By then examining the quality of the secretion, they can often tell if you are dealing with meibomian gland dysfunction.

Another step they will likely take is to examine your tear film to see how stable this is and whether you have a sufficient amount of tears.

A tear breakup time test (TBUT) can determine if your tears break up too fast and let your eyes dry out. Dye is placed on the eye, and a special light is shined on the eye that makes the tears glow. The doctor can see how quickly the tears break up on the eye's surface.

Treatment

Treatment may involve using a hot compress on your eyelids to help release the oil from the glands. To do this:

1. Run a washcloth under hot water (be careful that it is not too hot or you can burn the skin on your eyelids, which is very thin).
2. Wring out excess water.
3. Hold it on your closed lids for five minutes or longer.
4. Do this daily until the dryness improves.

If homemade hot compresses aren't enough, you can try using microwavable compresses instead to help keep the glands from getting blocked. You may find these easier to use than the damp cloth.

It can also be helpful to supplement your diet with fats such as omega-3 fatty acids, flaxseed, and fish oil. These can help improve the quality of the oil in the meibomian glands.

However, the Dry Eye Assessment and Management (DREAM) study found that taking omega-3 fatty acids for 12 months had no additional benefit to taking an olive oil placebo. As a follow-up, withdrawing the omega-3 supplements and replacing them with placebos did not result in worse outcomes.

Your doctor may also prescribe dry eye medication such as Restasis or Cequa. These can help to control the body's inflammatory response and allow your body to produce more tears.

If these measures aren't sufficient, there are some in-office treatments for meibomian gland dysfunction that may be more effective, such as the following:

Blephex

Using this handheld device with its rotating sponges, your eye doctor can scrub the lid margins, removing any inflammation-causing biofilm that may otherwise clog the glands from the area.

Treating all four lids with this device takes only about 10 minutes.

Lid Debridement

Keratin and other substances clogging the eyelid margins can be removed with the aid of a handheld instrument. This can relieve symptoms for about one month after the procedure.

LipiFlow

With this device known as the LipiFlow thermal pulsation system (Johnson & Johnson Vision), which is used in an eye doctor's office, heat applied to the eyelids melts the meibomian oil while the gland contents are pressed out using pulsed pressure.

Expect this session to last for 12 minutes. With this, even one treatment may be effective in improving gland secretions, as well as symptoms of dry eye for as long as three years.

Systane iLux

This handheld treatment device known as the Systane iLux (Alcon) melts waxy secretions trapped in the lids by warming the surfaces. Once these are warmed sufficiently, the doctor can then press out any clogged oil.

This process usually can be done in less than eight minutes, with improvements in meibomian function lasting for up to four weeks.

TearCare

The TearCare (Sight Sciences) uses adhesive heating patches that are applied in-office to the lids. They heat the lids for 12 minutes. Then, by squeezing the lids, the doctor can press out meibomian secretions.

This has been shown to reduce dry eye symptoms for at least six months.

Intense Pulsed Light (IPL) Treatment

With this, pulses of both visible and infrared light are applied to the eyelids typically for 20-minute periods. The idea is to reduce the eyelid inflammation that leads to clogged glands. Usually more than one session is needed with IPL, with additional treatments scheduled for about one month later.

Summary

Meibomian gland dysfunction is a condition in which the oil-producing glands that help make up tears do not function well, resulting in dry eye. It can be diagnosed by an eye doctor. Treatment includes warm compresses. If these do not work well, there are in-office procedures that may help.

A Word From Verywell

Be sure to educate yourself on meibomian gland dysfunction and all the available options. Your doctor may well suggest several different treatments to try in combination to best control this condition.

The good news is that if one approach to treating this condition is not successful, others may provide the answer here and enable you to control the symptoms successfully for long periods of time.