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Meibomian Gland Dysfunction / Blepharitis

What is Meibomian Gland Dysfunction (MGD)?

Meibomian glands are oil glands that line the margin of our eyelids. The purpose of these glands is to secrete oil which binds the layers of our tear film together. This keeps the water component from evaporating and causing our eyes to dry out.

MGD is a blockage or abnormality of the meibomian glands in the eyelids. As a result, they don’t secrete enough oil or the oil they do produce is of poor quality. If our natural tears become imbalanced and unhealthy, it can cause irritation and/or blurred vision.

MGD is very common. In the early stages, patients are often asymptomatic, but if left untreated, MGD can cause or exacerbate dry eye symptoms and eyelid inflammation. If chronic, these glands can become unable to secrete oil and can result in permanent changes in the tear film and dry eye.

What is Blepharitis?

Blepharitis is a common and persistent inflammation of the eyelids. This condition occurs frequently in people who have a tendency towards oily skin, dandruff, or dry eyes. It can begin in early childhood and continue throughout life as a chronic condition, or develop later in life.

In blepharitis, both the upper and lower eyelids can become coated with oily dandruff-like particles and unhealthy amounts of bacteria. Some of these particles can flake off into the eyes causing a foreign body or scratchy sensation. Sometimes patients will experience only minor irritation and itching, but some may develop redness, stinging or burning, blurred vision and tearing. In extreme instances, this can lead to a more serious complication, inflammation of the eye tissues themselves, such as corneal ulcers.

Both MGD and Blepharitis are conditions that cannot be cured but can be controlled with treatment.


Warm Compresses

Heating the eyelid margin will increase oil production and help liquefy the oil that has solidified in the glands. It will also soften the debris along the lid margins so it can be more easily cleansed away. Every day wet a clean washcloth with hot water (not too hot), wring it out and place it over closed eyelids for 3-5 minutes. It may require reheating the washcloth as it cools. This should be done twice a day with active symptoms, and once a day for maintenance.

Gel masks / Bruder masks which can be microwaved are another option.

Lid scrubs / Massage

This helps remove oil, bacteria and debris which block the oil gland openings. Using a warm wet washcloth or a Q-tip, gently scrub along the top and bottom eyelids for 30 seconds. Use a mild soap like Johnson & Johnson baby wash, Purpose, or Cetaphil, something that will not burn or irritate the eyes. There are also several other over the counter or prescription options sold in convenient pad form or foam.

Omega 3 Fatty Acid: Flaxseed and Fish Oil

Some people benefit from supplementing their diets with omega 3 fats. These fatty acids may help suppress inflammation and improve the quality and consistency of the oil produced by the meibomian glands. Recommended dosage is typically between 2,000-4,000 mg/day.

Care needs to be taken if on blood thinners.

Artificial Tears

Use over the counter artificial tears 3-4 times a day in both eyes. Systane Balance or Refresh Optive Advanced are two brands that have been shown to help supplement the lipid (oil) layer of the tear film.

Eye Ointment

Antibiotic or antibiotic-steroid ointments may be used to decrease inflammation or decrease the bacterial content on the eyelids. A small ribbon is applied at the base of the lashes before bed using a clean finger or Q-tip.

Oral antibiotics

Tetracycline and its derivatives such as doxycycline or minocycline have been shown to have a dual effect. They decrease the number of bacteria present while also having an anti-inflammatory effect on the glands. Sometimes patients may need to use them for several weeks or months.

Thermal pulsation systems—LIPIFLOW

Removes obstruction to improve gland function. For 86% of patients who

received one treatment, mean improvement in meibomian gland function and

dry eye symptoms was sustained 12 months.


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