MGD - Meibomian Gland Dysfunction (Meibomitis)
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What is MGD?
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Where are the Meibomian glands located?
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What
are their functions?
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What happens when they dysfunction?
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Why do the Meibomian glands dysfunction?
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How is MGD
treated?
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How
does Doxycycline work?
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How do I get more information?
MGD is the acronym for Meibomian Gland
Dysfunction. It is more commonly known as Meibomitis. Some refer to it as
posterior blepharitis. It refers to a dysfunction and inflammation of the
Meibomian glands.
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There are around 50 glands on the upper
lids and 25 glands on the lower lids. These glands are positioned vertically in
rows throughout your upper and lower eyelids, with the lipid-like secretions
ending up on your eyelids.
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Meibomian gland secretions help keep the
eye moist. Upon blinking, the upper lid comes down, presses on the oil and pulls
a sheet of oil upwards, coating the tear layer beneath to keep it from
evaporating.
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Dysfunction of these glands causes the
tears to evaporate more rapidly and leads to symptoms of dryness, burning and
irritation. There is a natural bacterial flora that thrives on the ocular
surface; mostly staphylococcal, these bacteria can colonize the Meibomian
glands.
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The number one reason the glands
dysfunction is because they get clogged up. The reason they get clogged up is
usually due to hormonal changes - changes in estrogen levels can cause a
thickening of the oils. It has been suggested that changes in estrogen levels
also cause a proliferation of the staphylococcal bacteria that inhabit the eyes
and these bacteria invade the Meibomian glands and thrive there. The double
trouble caused by the thickening of the oils plus the bacteria gradually
decrease the secretion of oils from the glands.
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Oral and topical antibiotics are warranted
in these cases. Doxycycline orally and erythromycin topically are mainstays of
treatment. The first medical line of therapy usually will be Doxycycline 100 mg
tabs twice a day (to break down the lipid conjugation), with Erythromycin
ophthalmic ointment use at bedtime in the affected eye (to stop the bacterial
proliferation). Tetracycline, 250 mg 4X a day may be used as an alternative
along with the erythromycin ointment.
You have to keep the gland oils from
solidifying by using warm compresses AT LEAST 3 times a day - they help to melt
the lipid "plug", and allow the cycline compounds and antibiotics to penetrate.
You have to try to help them along by expressing them - this is a manual way to
make the plug less solid - grab the lower eyelids between your thumb and
forefinger and massage back and forth. Look down and apply continuous pressure
on your upper lids for five to ten seconds.
I advocate the use of lid hygiene gels
containing Aqua, Poloxamer 188, PEG-75, Sodium Borate, Carbomer, Methylparaben (Blephagel).
They are hypo-allergenic (formulated to minimize risks of allergic reactions),
perfume-free, non-greasy, effective eyelid cleansers. I believe that the
mechanical rubbing motion of cotton tipped applicators containing this gel
contributes dramatically to reducing debris on the lids and helps in opening up
clogged pores.
Punctal occlusion can provide some relief
from the symptoms of dry eye. I do not believe that they should be placed in all
cases of dry eye. Attempting the use of temporary plugs may provide information
for the potential success of more permanent occlusion plugs. If the temporary
plugs do not provide any relief, then this is a good indication that the
permanent plugs will not work. If the temporary plugs provide any relief at all,
the permanent plugs provide more relief generally.
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The "cycline" derivatives such as
Tetracycline and Doxycycline function as enzymes that break down lipids that
congeal. They are not effective in killing the staphylococcal flora, so when
your doctor puts you on these compounds, they must be knowledgeable of the fact
that they are not using these compounds as antibiotics, and use them in
conjunction with an antibiotic that will actually keep the bacterial flora to a
minimum.
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EYE REPUBLIC
Ophthalmology Atlas
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MEIBOMIAN GLAND DYSFUNCTION information
compiled by Dr.
Manolette R. Roque and initially uploaded on May 1, 2005.
Last updated on
September 14, 2007. |
