Meibomian glands are the tiny oil glands that line both upper and lower eyelids margins (the edges that touch when the eyelids are closed). These glands secrete oil that coats the surface of our eyes and keeps the water component of our tears from evaporating (drying out). Together, the water and the oil layer make up the tear film. The tear film lubricates and keeps the surface of our eyes healthy; it also affects how we see. If either the water or oil layer is decreased or is of poor quality, we may have irritation and blurred vision symptoms.
Meibomian gland dysfunction (MGD) is when the glands are not secreting enough oil or when the oil they secrete is of poor quality. Often, the oil gland openings get plugged up so that less oil comes out of the glands. The oil that makes it out of the glands can be granular (crusty) or otherwise unhealthy and irritating.
MGD is very common. In the early stages, patients are often asymptomatic, but MGD can cause or exacerbate dry eye symptoms and eyelid inflammation if left untreated. The oil glands become blocked with thickened secretions. Chronically clogged glands eventually become unable to secrete oil which results in permanent changes in the tear film and dry eyes.
Your doctor will discuss ways to improve eyelid/eyelash hygiene to clear off the dead skin, oil, and bacteria that build up. The eyelid skin is extremely delicate, so please be gentle. Because this is a chronic condition, treatment and preventative treatment must be done every day and should include all or some of the following:
Heating the eyelid margin will increase oil production and melt the “crusty” oil that has become solid in the glands. Use a warm (not too hot) wet washcloth to apply heat to the eyelids for four minutes or more. This warms the oil, allowing it to flow more freely, and helps soften lash debris. This should be done twice a day when there are active symptoms and once daily for prevention or maintenance.
This can be done while applying the warm compress. Apply light pressure with your fingertips to the lid margin above the eyelashes. Roll the finger upward on the lower lid while looking up, then roll the finger downward on the upper lid while looking down. Excessive manipulation of the lids can cause additional irritation, so please be careful.
This helps remove oil, bacteria, and debris that block the oil gland openings. Use a Q-tip, your fingers, or a warm washcloth on your fingertips to gently scrub along the lash line on the top and bottom eyelids. You can use a mild soap like Cetaphil or dilute baby shampoo (a few drops in a small cup of water), which will not burn or irritate the eyes. Ask your doctor if you have questions about what to use. Lid scrubs should be done once a day.
In addition to the above, some people benefit from supplementing their diets with omega-3 fats. Omega- 3 fatty acids improve the quality and consistency of the oil produced by the Meibomian glands. Flax seed oil and fish oil are excellent sources of omega- 3 fatty acids. Do not take with blood-thinning medication or blood-sugar lowering medication.
Topical lubricants are proper as mainstays of treatment of evaporative dry eye due to MGD. Diquafosol sodium ophthalmic solution improves MGD and dry eye-related signs and symptoms in subjects with MGD. Using topical diquafosol sodium for at least three months likely increases lipid secretions from the meibomian glands in patients with MGD.
Cyclosporine (Ikervis once daily at bedtime; Restasis twice daily) are anti-inflammatory drops that improve aqueous tear production and decrease eyelid inflammation in MGD.
Oral tetracycline derivatives are helpful in short courses. The efficacy of azithromycin for the treatment of MGD has been attributed to its anti-inflammatory and antibacterial properties, which may suppress MGD-associated posterior blepharitis and bacterial growth on the eyelid. Oral doxycycline has been the mainstay oral antibiotic for treating MGD due to its unique ability to decrease inflammation by inhibiting matrix metalloproteinase and its antibiotic properties.
BlephEx treatments provide a pain-free, practical answer for patients with eyelid inflammation by alleviating the signs of blepharitis. Overall eye health and quality of life are significantly improved without the chronic and irritating symptoms associated with this condition. Eyelids are challenging to clean, and without proper care, an overgrowth of bacteria, biofilm, scurf, and debris can accumulate. The exotoxin-induced inflammation caused by this overgrowth may damage the eyelids and tear glands.
Intense Pulsed Light (IPL) is a relatively new adjunctive procedure in the management of evaporative dry eye and ocular rosacea. IPL therapy for MGD can improve tear film stability, meibomian gland functionality, and a decreased subjective feeling of ocular dryness. IPL causes photocoagulation (it closes abnormal vessels) and also photorejuvenation of the skin cells. IPL treatment also opens up the meibomian glands and liquefies the oil within the glands. After the IPL treatment, your doctor will manually express the meibomian glands to release the old oils in the lids.