Meibomian Gland Dysfunction & Evaporative Dry Eye

mgd percentage

Diagnosis and Treatment

The meibomian glands produce the protective oil that makes up the outermost lipid layer of the tear film. This creates a barrier for our tears and helps prevent tear evaporation. If the meibomian glands are underfunctioning or obstructed this can lead to chronic dry eye and ocular surface inflammation.

Meibomian Gland Dysfunction (MGD) is a condition where the glands in your eyelids cannot produce the necessary quality and/or quantity of protective oils (meibum) to keep your eyes healthy and moist. Evaporative Dry Eye is the secondary condition that results from not having enough lipids in the tear film to protect the eye.

Symptoms of MGD include:

  • Grittiness
  • Tearing
  • Burning
  • Redness
  • Discharge worse in the mornings
  • Tired, Puffy Eyes
  • Blurry Vision

How is MGD diagnosed?

MGD is diagnosed by evaluating the function of the meibomian glands under magnification and special imaging of the glands. Our doctors use LipiScan™ to assess the structure of your meibomian glands. With this new technology, the cause of dry eye can be identified with high accuracy. Consequently, your eye doctor can now prescribe the most appropriate treatment possible to alleviate your painful dry eye symptoms.

How does LipiScan work?

Using dynamic surface illumination and adaptive transillumination technologies, LipiScan™ quickly generates a multidimensional view of the meibomian glands that is clear and easy for your doctor to analyze for structural changes. 

Long-term effects of untreated MGD

Structural changes to the glands are irreversible.  

If left untreated, reduced function of obstructed glands leads to permanent structural changes to the glands including twisting, truncation and atrophy. Once a gland has atrophied completely, function is lost permanently, which leads to chronic discomfort and potentially sight-threatening damage to the ocular surface.
Meibomian-Gland-Structural-Changes

Treatment for MGD:

Lipiflow® Treatment (in-office treatment)

LipiFlow®, by Johnson & Johnson, is a 12 minute in-office medical device that uses optimal heat application and gentle pulsing massage to effectively unblock and improve the function of the meibomian glands after just a single treatment. LipiFlow is the only device that can heat the meibomian glands from both the inside and outer surface of the eyelids effectively clearing meibomian gland blockages.  Your doctor will determine if the LipiFlow® System is an appropriate treatment option for you based on a complete exam of your eye health, including evaluation for blocked glands and associated dry eye symptoms.

For more information on the Lipiflow procedure click the link below:
Lipiflow® Treatment

Additional Treatments for MGD:

Manual Lid Margin Resurfacing & Meibomian Gland Expression by your doctor

This is an in-office technique used by your eye doctor to gently debride the lid margin of any solid material that may be blocking the gland openings, followed by targeted pressure to expel stagnant oil from clogged meibomian glands. The procedure is painless and can improve meibomian gland function in mild cases. This procedure is recommended in conjunction with Lipiflow for more severe cases.

Warm compress therapy

Moist heat is a simple home remedy that can be applied multiple times a day and at your convenience in the comfort of your own home. Like flossing, you must be consistent for this treatment to be effective. 

We recommend the Bruder Moist Heat Eye Compresses.

Simply microwave the mask for 20-25 seconds and apply to the eyes for a minimum of 10 minutes, 1-2x daily or as recommended by your eye doctor.

Eyelid hygiene 

Overgrowth of bacteria surrounding the eyes and lash follicles can contribute to inflammation of the eyelid margin and subsequent meibomian gland dysfunction. Daily eyelid hygiene can help to prevent irritation, infection and recurrent styes. Talk to your doctor about which eyelid cleansing products are appropriate for your condition.

Topical prescription medications 

Prescription eye drops may be prescribed by your doctor to calm down inflammation associated with MGD and dry eye. These drops often work synergistically with other treatments and/or can help improve the outcome of Lipiflow treatment.

Over-the-counter lubricating eye drops

To help restore an insufficient tear film, you may need to use OTC artificial tear drops. Ask your doctor which brand is recommended for your condition.

Nutritional Supplements

Several studies have shown that increasing dietary intake of Omega-3 fatty acids (when taken in the correct form and dosage) can improve dry eye symptoms as well as reduce inflammation. Therapeutic dosing for dry eye treatment is 2000 mg daily of two specific omega-3s (DHA & EPA combined) found in fish oil.

Foods naturally rich in Omega-3 fatty acids:
Fatty fish including Salmon, Mackerel, Sardines and Anchovies (preferably wild caught)
Plant based sources include Flax Seeds, Chia Seeds, Hemp Seeds, Walnuts, Pecans

Brands of Supplements we recommend:
Nordic Naturals ProOmega 2000
   EPA 1125 mg & DHA 875 mg per 2 softgels
PRN Omega Eye /De (Dry Eye)
   EPA 1680 mg & DHA 560 mg per 4 softgels
   Vitamin D3 - 25 mcg (1000 IU) per 4 softgels)
PRN DE Dry Eye Omega Liquid with vitamin D3
   EPA 1680 mg & DHA 560 mg per teaspoon
   Vitamin D3 - 25 mcg (1000 IU) per teaspoon


Resources: 1 Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous deficient and evaporative dry eye in a clinic based patient cohort: a retrospective study. Cornea. 2012; 31(5):472-478
 

 

Millennium Eye Care

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