Meibomean Gland Dysfunction

meibomian-gland-300x211Meibomian glands are glands that are arranged vertically within the eyelid near the lashes. The force of an eyelid blink causes oil to be excreted onto the posterior lid margin. The oil is the “staying power” of the tears that helps prevent rapid tear evaporation. In a patient with Meibomian gland dysfunction (MGD), vision is affected because there is too much or too little oil in the tear film.

What is Meibomian Gland Dysfunction?

Many individuals experience the annoyance of having dry eyes, yet few pursue adequate  treatment. Although in most situations, dryness does not permanently damage the eye or impair eyesight, it causes significant irritation. It especially causes discomfort on windy days.  Many times, dry eyes cannot be properly treated with generic artificial tears or eye drops. Dr Pflug.pptxIn many cases, Meibomian Gland Dysfunction (MGD) causes the discomfort. Experts have said that nearly 1 in 4 people may suffer from MGD with cases being more frequent in older individuals.

MGD, is the most common form of lid margin disease. In the early stages, patients are often asymptomatic, but if left unmanaged, MGD can cause or exacerbate dry eye symptoms and eyelid inflammation. 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.  Symptoms include:

  • Dryness
  • Burning
  • Itching
  • Stickiness
  • Watering
  • Light Sensitivity
  • Red Eyes
  • Foreign Body Sensation
  • Chalazion/Styes
  •  Intermittent Blurry Vision

 Who is Affected?

68% of people over the age of 60 will suffer from some form of Meibomian gland dysfunction although younger people can be affected. Acne Rosacea can be a contributing factor for some patients.

What is the Treatment?

WARM COMPRESSES

Heating the lids will increase oil production and melt the oil that has solidified in the glands. Use a warm washcloth to apply heat on the eyelids for two minutes. This warms the oil, allowing it to flow more freely, and helps soften lash debris.

MASSAGE

Apply light pressure with your index finger or a Q-tip to the lid margin near the lash line.  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 lid massage and scrubs should be performed only twice a day during the acute stage, and once daily during maintenance.

LID SCRUBS

This helps to remove oil, bacteria and debris. It also stimulates the oil glands. Use a Q-tip or a warm washcloth on the tips of your fingers to rub along the lash line on the top and bottom lid.

DOXYCYCLINE

Doxycycline can be effective in treating MGD.  With MGD the drug is being used as an anti-lipid agent, not as an antibiotic therapy. In addition, they do not require an initial load at a higher dose. Accordingly, low-dose doxycycline will achieve the desired effect with fewer patients experiencing side effects commonly associated with higher doses of doxycycline such as stomach upset.

AZASITE

There are several studies concerning the use of topical azithromycin in ocular surface diseases. One of these studies compared the effectiveness of topical azithromycin versus oral doxycycline therapy in Meibomian gland dysfunction ( Blepharitis). Twenty-two subjects were treated with topical azithromycin solution for one month and seven subjects were treated with oral doxycycline for two months. The study concluded that while both topical azithromycin and oral doxycycline improved clinical signs and symptoms of Meibomian gland dysfunction, the “response to azithromycin is more rapid and more robust than doxycycline.”

OMEGA -3 (FISH or FLAX SEED OIL)

A diet rich in Omega 3 fatty acids has been proven to be helpful for long term lid care. These can be found in foods such as salmon, sardines and other oily fish, flax seed, flax oil, and walnuts.  Note that Omega 6’s are not recommended.

Supplements of Omega 3’s are helpful for many patients as dietary amounts are often not sufficient or practical. 2000 mg/day of a good quality Omega 3 supplement (triglyceride form) is the recommended dosage.

RESTASIS

Once gland obstructions have been removed via  therapy, Restasis (topical cyclosporine) may then help alleviate any associated inflammatory components.

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