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MEIBOMIAN GLAND DYSFUNCTION (MGD):

MEIBOMIAN GLAND DYSFUNCTION (MGD):

If your eyes are bothering you, it is very important to have a thorough eye examination to properly diagnose the cause(s). If you have more than one condition (e.g. dry eye, allergies, meibomian gland dysfunction (MGD), contact lens related issues, conjunctival chalasis, other) it is imperative that each is identified. This is because treating only one condition will be met with limited success. Your eyes will be their healthiest when all issues adversely affecting them are properly identified and treated.

Meibomian Gland Dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian glands most often resulting from blepharitis*, meibomitis**, and/or ocular rosacea***. Meibomian glands are oil producing glands in the lid margins of both your upper and lower eyelids. These glands produce the oil which comprises the outermost layer of your tears. These oils protect your tears from evaporating too quickly. When these oils are reduced, the evaporation of your tears from the surface of your eyes is increased and your eyes become drier much more quickly, especially when you are reading a computer screen, cell phone, tablet, document, watching T.V., driving, etc..

Since MGD often results from blepharitis, meibomitis, and/or ocular rosacea, it is very important to determine whether or not you have these conditions. This is because these conditions are chronic and progressive. These conditions adversely affect your eyes in two very important ways: first, by increasing irritation and inflammation of your eyes, and second, by causing blockage, structural damage and loss of the oil secreting meibomian glands.

Blepharitis, meibomitis and ocular rosacea are very closely related and have a lot of overlap with regard to their causes, symptoms and treatment. They all cause damage to your meibomian glands secondary to thickening of the oily secretions and accumulation of debris on the eyelids, blocking the openings of the meibomian glands and shutting down oil production. If left untreated, meibomian gland blockage results in structural damage and eventual gland loss. Once lost, Meibomian glands don’t have the ability to regenerate.

Symptoms of MGD:

  • Dry eye
  • Burning
  • Irritation
  • Stinging
  • Itching
  • Red ("bloodshot") eyes
  • Gritty feeling
  • Foreign body sensation (as if a grain of sand or an eyelash is in your eye)
  • Blurred vision
  • Light sensitivity
  • Tearing
  • Red, swollen, or thickened eyelids
  • Dilated small blood vessels on the eyelid margins and/or overlying the white of the eye
  • "Dandruff" in your eyelashes
  • Contact lens intolerance
  • Styes, chalazia and/or cellulitis involving your eyelid(s)
  • Corneal erosions, infiltrates and ulcers resulting in scarring and, potentially, loss of vision

How to diagnosis and evaluate MGD:
The diagnosis of MGD is made by taking a thorough history and examining your eyes with a biomicroscope. Special attention is given to examining your corneas, conjunctivae, meibomian glands, eyelashes and eyelids, including the texture of the skin of your eyelids.

The gold standard to directly evaluate your meibomian glands is to image them using advanced technology known as LipiScan. LipiScan is a meibographer; it captures images of your meibomian glands. Using this state-of-the-art technology your meibomian glands can be viewed to assess and quantify them structurally.





Almost complete loss of meibomian glands in the eyelid

Holistic Treatment:

  • Warm compresses used immediately prior to cleaning your eyelids, then "shampooing" your eyelashes, a minimum of two times each day
  • Artificial Tears i.e. Retaine MGD
  • Omega 3 fatty acid supplements, both from a fish oil and a flaxseed oil source (in addition to a diet rich in Omega 3s)

Depending upon the severity of your meibomian gland dysfunction (MGD):

Plus or minus the following prescription medications:

  • antibiotic ointment at bedtime
  • Azasite drops massaged into your lashes at bedtime
  • antibiotics by mouth (doxycycline, tetracycline, minocycline, etc.)
  • Restasis and/or Xiidra
  • Alrex or Lotemax drops

Mechanical Treatment:

  • Blepharoexfoliation: Golf Club Spud Debridement-Scaling procedure (NCBI Research)
  • Microblepharoexfoliation (MBE) using BlephEx (Blephex, Healio Video, In-office treatment provides targeted approach to blepharitis, BlephEx News Story)
  • LipiFlow: LipiFlow is the only FDA-cleared electronic device for the treatment of MGD that removes gland blockages and restores gland function. Through advances in the application of Vectored Thermal Pulsation (VTP) technology, the LipiFlow treatment utilizes a patented algorithm of heat applied to the inner eyelids, along with massage, to remove the obstructions, allowing your meibomian glands to resume oil production. The entire treatment takes approximately 12 minutes (Dry Eye and MGD)

LID CLEANSING – JUST LIKE BRUSHING YOUR TEETH
Most of us know that brushing our teeth prevents the accumulation of plaque, and the development of cavities and gum disease. Another part of our daily hygiene should be taking a minute to clean our eyelids. Cleaning our lid margins removes debris that can build up over time and contribute to meibomian gland obstruction, ultimately leading to symptomatic MGD. Prevention of MGD, early detection and intervention are essential to the long term health of your eyes.

ROUTINE SCREENING AND EVALUATION ARE ESSENTIAL FOR THE EARLY DETECTION AND INTERVENTION OF MGD TO PREVENT PERMANENT MEIBOMIAN GLAND LOSS.

*Blepharitis:
Blepharitis is a condition where there is inflammation of the eyelids around the area of the eyelashes and the meibomian glands. You can also have a seborrheic component (often with "dandruff" in your eyelashes) and/or a bacterial (staphylococcal) component sometimes even causing styes or chalazia.

**Meibomitis:
Meibomitis refers to the inflammation and dysfunction of the meibomian glands in the eyelid margins. When the meibomian glands are healthy, the oil they produce has the consistency of olive oil, which is the desired quality. When the glands are inflamed the oils they produce are thicker, like toothpaste, which is of poor quality and are less effective at lubricating the eyes. Additionally, when the meibomian glands are inflamed and the oily secretions thicken, the glands become clogged. When the glands become clogged, they become damaged and often close off ("drop out"), ceasing to produce any oil at all. If this condition is allowed to progress you will ultimately have significant problems with dry, red, irritated and inflamed eyes. You will also be at an increased risk for recurrent infections involving your eyes and your eyelids.

***Ocular Rosacea:
Ocular rosacea is characterized by inflammation of the eyelids. It is often the first sign of rosacea of the face (which involves the nose, cheeks, forehead and chin). People with rosacea tend to blush or flush easily.