Meibomian gland dysfunction (MGD) is a common eye disease that occurs when the meibomian glands in the eyelids do not function properly. The meibomian glands are sebaceous glands located in the upper and lower eyelids that secrete an oily substance called meibum. Meibum forms the outer layer of the tear film and helps prevent evaporation of tears.
When the meibomian glands are obstructed or inflamed and unable to properly secrete meibum, the quality and stability of the tear film is disrupted, causing dry eye symptoms. MGD is one of the leading causes of evaporative dry eye disease in the United States. However, it often goes undiagnosed due to a lack of awareness.
Symptoms of U.S. Meibomian Gland Dysfunction
Some common symptoms of MGD include eye dryness, itching, burning, soreness, scaling, redness, discharge from the eyelids, blurry vision during reading or computer use, and sensitivity to light. The symptoms can fluctuate throughout the day and may worsen at the end of the day. Contact lens wearers are also prone to developing MGD, which can interfere with comfortable lens wear.
In severe cases, plugging of many meibomian gland orifices and loss of glandular tissue may occur, leading to thickening and shortening of the outer edges of the eyelids called lid margin changes. These structural changes can impair proper drainage and secretion of meibum.
Prevalence of MGD in the U.S.
According to various epidemiological studies, U.S. Meibomian Gland Dysfunction is an extremely common disorder in the United States, affecting approximately 20-30% of the adult population. The prevalence increases with age, and over 50% of people between ages 60-80 have signs of MGD.
Women are also more likely to be affected than men, with studies showing nearly two-thirds of women seeking treatment for dry eye actually have MGD. The high prevalence of MGD in the U.S. can be attributed to aging population, widespread digital device usage, environmental factors, and lifestyle habits that place added stress on the meibomian glands.
Causes and Risk Factors
Some of the major causes and risk factors for developing MGD include:
- Aging: Declining function of the meibomian glands is natural with aging.
- Genetics: Certain genetic factors have been linked to increased risk of MGD.
- Medications: Many prescription and over-the-counter medications like antihistamines, antidepressants, isotretinoin can cause dry eye and MGD.
- Digital device use: Frequent use of computers, phones, tablets impacts blink rate and exposes eyes to dry indoor air which stresses meibomian glands.
- Environmental factors: Air conditioning, heating systems lower humidity levels, increasing tear film evaporation.
- Systemic diseases: Rosacea, thyroid disorders, vitamin A deficiency are associated with MGD.
- Lifestyle: Smoking, poor diet, lack of omega-3 fatty acids, infrequent blinking while reading or using devices.
Diagnosis of MGD
Diagnosing MGD requires a comprehensive eye examination by an ophthalmologist or optometrist. Signs of MGD on examination include plugged or collapsed meibomian gland orifices, thickened opaque meibum secretions, and characteristic changes to the lid margins. A diagnostic tool called meibography uses infrared light to visualize and assess meibomian glands through the eyelid.
Additionally, tests are done to evaluate tear film parameters like tear osmolarity testing and tear breakup time (TBUT) testing. These objective tests help distinguish between aqueous deficient dry eye versus evaporative dry eye caused by MGD. It is also important to rule out other conditions that mimic dry eye like eyelid malpositions, chalazion, allergies, vitamin deficiencies etc.
Treatment Options for MGD
Treatment focuses on restoring normal meibomian gland function and tear film stability. Warm compress therapy applied over closed eyelids helps soften concretions within meibomian glands and facilitates their expression. Digital expression techniques may be used to manually clear glands underVision care practitioners can also prescribe products containing heat, which can penetrate and warm the tissues deeper to help unplug glands. Prescription eyelid cleansers and warm soaks also help clear debris from lid margins.
In moderate to severe MGD, doctors may recommend in-office procedures such as intense pulsed light therapy (IPL), which uses selective light waves to unclog and restore glands. Intraductal probing breaks up dense secretions located deep within meibomian glands. Immunosuppressive or antiproliferative topical eyedrops and ointments targeting inflammation associated with MGD may provide additional relief. Newer minimally invasive procedures like LipiFlow aim to physically melt and remove obstructions within glands.
Managing tear deficiency is also critical and prescription artificial tears, gels and ointments are used to supplement natural tears and reduce signs and symptoms. Omega-3 fatty acid supplements aid tear film stability. Eyelid hygiene including lid scrubbing and warm compresses help prevent recurrences. With tailored treatment plans and good lid hygiene habits, MGD can usually be effectively managed. However persistent or recurring cases may require multiple in-office procedures or even surgical interventions in rare cases.
Burden of Disease
MGD imposes a huge economic and societal burden in terms of both direct medical costs and indirect costs in lost productivity. On average, patients with dry eye disease visit multiple practitioners, undergo repeat examinations, and use numerous prescription and OTC eye drops, ointments and supplements. Indirect costs arise from days taken off work due to doctor visits, impairment caused by visual disturbances, need for lighting accommodations while working, and limitations on daily activities.
All of this underscores the importance of early diagnosis and treatment of underlying MGD to halt progression of disease and avoid long-term complications. Public awareness and education about this common yet under-recognized eye disease is crucial to help reduce the burden. More research is also warranted into pathophysiology, advanced diagnostic techniques and new treatment modalities for MGD management.
Meibomian gland dysfunction is a very prevalent cause of dry eye disease in the United States. By improving understanding of risk factors, tailoring treatment regimens and developing new therapies, vision care practitioners aim to optimize outcomes for those afflicted with this chronic disease long-term. Coordinated efforts are needed for screening, diagnosis and proactive management of MGD in our aging population.
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Ravina Pandya, Content Writer, has a strong foothold in the research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. (https://www.linkedin.com/in/ravina-pandya-1a3984191)
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