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What Is Meibomian Gland Dysfunction?

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Over the last few years, dry eye has become a focus for eye doctors and patients alike. However, there’s one term that many dry eye sufferers may be unfamiliar with — meibomian gland dysfunction.

While this term isn’t quite as cut-and-dry as “dry eye disease,” it amounts to the same thing in some ways. But what does it mean if you’re diagnosed with meibomian gland dysfunction?

Let’s discuss what this condition is, how it affects your eye health, and what your options are if you have it.

Woman with red, irritated eyes due to meibomian gland dysfunction

How Your Tears Are Supposed to Work

Before we dive into meibomian gland dysfunction, we need to talk a little bit about your tears and what they’re made of.

Your tears have 3 layers.

The first layer is called the mucin layer. This mucusy substance helps your tears stick to the surface of your eye. 

The middle layer is called the aqueous layer. This section of your tear film is the liquid that helps hydrate your eyes and keep them clean.

Finally, we have the lipid layer. This outermost layer sits on the surface of the tear film to prevent your tears from evaporating too quickly. Your lipid layer is made of an oil called meibum, which is produced by your meibomian glands. You can find these tiny glands on your lid margins between the surface of your eyeball and your lash line.

If your tear film doesn’t have a healthy lipid layer, your tears will evaporate too quickly, which leaves your eyes feeling dry and irritated.

What Is Meibomian Gland Dysfunction?

Meibomian gland dysfunction is not technically just one condition–it’s a term that describes a group of conditions that impact the meibomian gland’s ability to produce meibum.

The most common form of MGD is known as obstructive MGD, which occurs when the glands are blocked and unable to excrete oil properly. These blockages can be caused by inflammation, build-up inside the gland, or a combination of these and other factors. 

When meibomian glands are out of commission, your eyes don’t receive enough meibum to prevent tears from evaporating. As a result, MGD leads to evaporative dry eye disease

Symptoms of MGD

MGD can come with a range of symptoms, including:

  • Dry, itchy, or gritty eyes
  • Swollen and sore eyelids
  • Red eyes
  • Excessive tears
  • Blurry vision
  • Foreign body sensation in the eye 

Risk Factors of MGD

Age

As we age, our meibomian glands can atrophy and stop producing meibum. Approximately 95% of MGD sufferers are over the age of 60.

Ethnicity

Meibomian gland dysfunction occurs in people of every ethnicity. However, there is evidence people of East Asian descent are more likely to develop MGD due to their eyelids’ structure.

Medications

Certain medications can increase your risk of developing MGD. These medications may include:

  • Hormone replacement therapy
  • Antidepressants
  • Testosterone blockers
  • Acne medications
  • Medicines for an enlarged prostate

Contact Lens Use

Research indicates that wearing contact lenses could lead to meibomian gland dysfunction for a few reasons. Unfortunately, there is conflicting evidence from multiple studies, so the link between contacts and MGD is still somewhat unclear.

Systemic Conditions

Several systemic conditions and autoimmune diseases can increase the likelihood of developing meibomian gland dysfunction. Some of these conditions include:

Man removing his glasses to rub his eyes because of meibomian gland dysfunction

Getting an MGD Diagnosis

You’ll most likely be able to determine whether you’re suffering from dry eye based on symptoms alone. However, your symptoms won’t tell you whether you’re suffering from aqueous deficiency dry eye or MGD (evaporative dry eye.) This distinction is important because both types of dry eye are treated differently.

You’ll need to visit an optometrist that focuses on dry eye diagnosis and treatments. They’ll most likely have special diagnostic technology that evaluates your meibomian gland health or tear volume and quality.

For example, our practice uses LipiScan. LipiScan is a special piece of imaging equipment that allows us to look closely at the state of your meibomian glands. These high-definition images make it easy for us to determine whether your dry eye symptoms result from MGD.

Treatment Options

There are several treatment options available for meibomian gland dysfunction. Perhaps one of the most promising options is a relatively non-invasive in-office treatment called LipiFlow.

LipiFlow uses precise applications of heat and pressure to eliminate blockages within your meibomian glands. 

The specially-designed activators are placed over your eyes. Once they’re in place, they will heat up to a comfortable temperature that is just high enough to liquefy some of the meibum that has hardened within your glands.

At the same time, the activators gently massage your eyes, which helps express any blockages in your meibomian glands and stimulates the flow of the meibum.

Some of the other treatment options include:

  • Anti-inflammatory medications
  • Warm compresses
  • Gland expression
  • Lid debridement
  • Lid hygiene
  • Intraductal probing
  • Intense pulsed light

Help Is Available

Meibomian gland dysfunction is a frustrating problem to have, but you are certainly not alone. Finding an optometrist who focuses on dry eye will allow you yet the appropriate diagnosis, and by extension, the best treatment option for your unique needs. 

Written by Dr. Aaron Sako

Dr. Sako, who was born in Santa Monica and raised in Cerritos, first joined the La Paz Optometric family in 2001. He graduated with a Bachelor of Science in biological sciences in 1995 from the University of California Irvine, before earning his Doctor of Optometry, graduating with honors in 2000 from Nova Southeastern University in South Florida.

Dr. Sako’s current areas of focus are primary care, surgical consultations, surgical co-management, and specialty contact lenses. He is also glaucoma certified and is licensed in the use of therapeutic and diagnostic pharmaceutical agents. Dr. Sako has extensive clinical experience and training, and spent time at the Bascom Palmer Eye Institute in Miami, Florida and the Aker Kasten Cataract and Laser Eye Institute in Boca Raton, Florida, before joining the La Paz Optometric team.

Dr. Sako is an affiliate member of a prominent Orange County laser center, allowing his patients to benefit from his unique understanding of LASIK, which he, himself, has undergone. He has also co-managed thousands of refractive procedures. A proponent of lifelong learning, Dr. Sako is also certified in Corneal Refractive Therapy (CRT), which is a non-surgical option for correcting nearsightedness, which involves patients wearing specialty contact lenses during sleep.

Dr. Sako is a member of the American Optometric Association, the California Optometric Association, the Orange County Optometric Association, the Orange County Optometrist Club, and the Asian American Optometric Society. He is currently a member of the executive board for the Asian American Optometric Society and has been since 2004. He is also a member of the prestigious Advisory Board to Vision Laser Eye Centers in Newport Beach, California.

Dr. Sako believes in the importance of community service and always striving for excellence. This former Eagle Scout is currently an active member of the Mission Viejo Rotary Club and provides charitable annual eye exams and care through this organization to children in Baja, Mexico.

Dr. Sako lives in Ladera Ranch with his wife, Mako, and their three children Skylar, Payton, and Colby. When he is not helping patients, Dr. Sako enjoys exercising, skiing, playing golf, and spending time with friends and family. He also has a keen interest in music, and enjoys playing the Tahitian drums and strumming on his ukulele.

More Articles by Dr. Aaron Sako

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