Meibomian gland | |
---|---|
Details | |
System | Integumentary |
Identifiers | |
Latin | glandula tarsalis |
MeSH | D008537 |
TA98 | A15.2.07.042 |
TA2 | 6833 |
FMA | 71872 |
Anatomical terminology |
Meibomian glands (also called tarsal glands, palpebral glands, and tarsoconjunctival glands) are sebaceous glands along the rims of the eyelid inside the tarsal plate. They produce meibum, an oily substance that prevents evaporation of the eye's tear film. Meibum prevents tears from spilling onto the cheek, traps them between the oiled edge and the eyeball, and makes the closed lids airtight. [1] There are about 25 such glands on the upper eyelid, and 20 on the lower eyelid.
Dysfunctional meibomian glands is believed to be the most often cause of dry eyes. They are also the cause of posterior blepharitis. [2]
The glands were mentioned by Galen in 200 AD [3] and were described in more detail by Heinrich Meibom (1638–1700), a German physician, in his work De Vasis Palpebrarum Novis Epistola in 1666. This work included a drawing with the basic characteristics of the glands. [4] [5]
Although the upper lid have greater number and volume of meibomian glands than the lower lid, there is no consensus whether it contributes more to the tearfilm stability. The glands do not have direct contact with eyelash follicles. The process of blinking releases meibum into the lid margin. [2]
Lipids are the major components of meibum (also known as "meibomian gland secretions"). The term "meibum" was originally introduced by Nicolaides et al. in 1981. [6]
The biochemical composition of meibum is extremely complex and very different from that of sebum. Lipids are universally recognized as major components of human and animal meibum. An update[ clarification needed ] was published in 2009 on the composition of human meibum and on the structures of various positively identified meibomian lipids. [7]
Currently, the most sensitive and informative approach to lipidomic analysis of meibum is mass spectrometry, either with direct infusion [8] [9] or in combination with liquid chromatography. [10]
The lipids are the main component of the lipid layer of the tear film, preventing rapid evaporation and it is believed they lower the surface tension which helps to stabilize the tear film. [3]
In humans, more than 90 different proteins have been identified in meibomian gland secretions. [11]
Dysfunctional meibomian glands often cause dry eyes, one of the more common eye conditions. They may also contribute to blepharitis. Inflammation of the meibomian glands (also known as meibomitis, meibomian gland dysfunction, or posterior blepharitis) causes the glands to be obstructed by thick, cloudy-to-yellow, more opaque and viscous-like, oily and waxy secretions, a change from the glands' normal clear secretions. [12] [13] Besides leading to dry eyes, the obstructions can be degraded by bacterial lipases, resulting in the formation of free fatty acids, which irritate the eyes and sometimes cause punctate keratopathy.
Meibomian gland dysfunction is more often seen in women and is regarded as the main cause of dry eye disease. [14] [15] Factors that contribute to meibomian gland dysfunction can include things such as a person's age and/or hormones, [16] or severe infestation of Demodex brevis mite.
Treatment can include warm compresses to thin the secretions and eyelid scrubs with a commercial eyelid cleanser or baby shampoo, [17] [13] or emptying ("expression") of the gland by a professional. Lifitegrast and ciclosporin are topical medication commonly used to control the inflammation and improve the oil quality. In some cases, topical steroids and topical (drops or ointment)/oral antibiotics (to reduce bacteria on the lid margin) are also prescribed to reduce inflammation. [13] Intense pulsed light (IPL) treatments have also been shown to reduce inflammation and improve gland function. Meibomian gland probing is also used on patients who experience deep clogging of the glands.
Meibomian gland dysfunction may be caused by some prescription medications, notably isotretinoin. A blocked meibomian gland can cause a chalazion (or "meibomian cyst") to form in the eyelid.
Tears are a clear liquid secreted by the lacrimal glands found in the eyes of all land mammals. Tears are made up of water, electrolytes, proteins, lipids, and mucins that form layers on the surface of eyes. The different types of tears—basal, reflex, and emotional—vary significantly in composition.
Intense pulsed light (IPL) is a technology used by cosmetic and medical practitioners to perform various skin treatments for aesthetic and therapeutic purposes, including hair removal, photorejuvenation as well as to alleviate dermatologic diseases such as acne. IPL is increasingly used in optometry and ophthalmology as well, to treat evaporative dry eye disease due to meibomian gland dysfunction.
A sebaceous gland or oil gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest number on the face and scalp, but also on all parts of the skin except the palms of the hands and soles of the feet. In the eyelids, meibomian glands, also called tarsal glands, are a type of sebaceous gland that secrete a special type of sebum into tears. Surrounding the female nipple, areolar glands are specialized sebaceous glands for lubricating the nipple. Fordyce spots are benign, visible, sebaceous glands found usually on the lips, gums and inner cheeks, and genitals.
Blepharitis, sometimes known as granulated eyelids, is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis by itself is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The primary cause is bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.
An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. "Palpebral" means relating to the eyelids. Its key function is to regularly spread the tears and other secretions on the eye surface to keep it moist, since the cornea must be continuously moist. They keep the eyes from drying out when asleep. Moreover, the blink reflex protects the eye from foreign bodies. A set of specialized hairs known as lashes grow from the upper and lower eyelid margins to further protect the eye from dust and debris.
Dry eye syndrome, also known as keratoconjunctivitis sicca, is the condition of having dry eyes. Symptoms include dryness in the eye, irritation, redness, discharge, blurred vision, and easily fatigued eyes. Symptoms range from mild and occasional to severe and continuous. Dry eye syndrome can lead to blurred vision, instability of the tear film, increased risk of damage to the ocular surface such as scarring of the cornea, and changes in the eye including the neurosensory system.
An eyelash is one of the hairs that grows at the edges of the top and bottom eyelids, spanning outwards and away from the eyes. The lashes grow in up to six layers on each of the upper and lower eyelids. Eyelashes serve to protect the eye from debris, dust, and small particles, and are highly sensitive to touch, thus providing a warning that an object is near the eye, which then reflexively closes or flutters to rid the area of the object. The eyelid margin from which lashes grow is among the most sensitive parts of the human body, with many nerve endings enveloping the roots of the lashes, giving it sensitivity to very light tactile input even at the tips of the lashes, enabling it to trigger the blink reflex when touched. Eyelashes are also an important component of physical attractiveness, with long prominent lashes giving the illusion of large, gazing eyes, and drawing attention to the eyes.
A chalazion or meibomian cyst is not a cyst but a granuloma in the eyelid that results from a blocked meibomian gland. It typically occurs in the middle of the eyelid, red, and not painful. They tend to come on gradually over a few weeks.
Lacritin is a 12.3 kDa glycoprotein encoded in humans by the LACRT gene. Lacritin's discovery emerged from a screen for factors that stimulate tear protein secretion. Lacritin is a secreted protein found in tears and saliva. Lacritin also promotes tear secretion, the proliferation and survival of epithelial cells, and corneal wound healing Lacritin is thus a multifunctional prosecretory mitogen with cell survival activity. Natural or bacterial cleavage of lacritin releases a C-terminal fragment that is bactericidal.
Visual system homeobox 1 is a protein that in humans is encoded by the VSX1 gene.
Madarosis is a condition that results in the loss of eyelashes, and sometimes eyebrows. The term "madarosis" is derived from the ancient Greek "madaros", meaning "bald". It originally was a disease of only losing eyelashes but it currently is the loss of both eyelashes and eyebrows. Eyebrows and eyelashes are both important in the prevention of bacteria and other foreign objects from entering the eye. A majority of patients with madarosis have leprosy, and it was reported that 76% of patients with varying types of leprosy had madarosis.
Pedram Hamrah is a German-American ophthalmologist and immunologist. He obtained his M.D. from the University of Cologne, Germany.
Conjunctivochalasis, also known as mechanical dry eye (MDE), is a common eye surface condition characterized by the presence of excess folds of the conjunctiva located between the globe of the eye and the eyelid margin.
Gerd Geerling is a German consultant ophthalmic surgeon, Professor of Ophthalmology and since 2011 head of the Universitäts-Augenklinik Düsseldorf of the University of Düsseldorf, Germany.
Meibomian gland dysfunction is a chronic disease of the meibomian glands, which is commonly characterized by obstruction of the end of the duct that delivers the secretion produced by the glands to the eye surface, which prevents the glandular secretion from reaching the ocular surface. The dysfunction could be that the amount of secretion produced may be abnormal. Dysfunction could also be related to the quality of the meibum produced. MGD may result in evaporative dry eye, blepharitis, chalazion, unsealed lid during sleep, and meibomian gland atrophy.
BlephEx is a medical device used in the fields of ophthalmology and optometry to treat blepharitis and dry eye disease. The handheld device is used by a doctor to exfoliate the eyelid at the lash line and remove the inflammatory biofilm that leads to chronic lid disease and discomfort.
Lifitegrast, sold under the brand name Xiidra, is a medication for the treatment of signs and symptoms of dry eye, a syndrome called keratoconjunctivitis sicca. Lifitegrast reduces inflammation by inhibiting inflammatory cell binding. It is often used in conjunction with ciclosporin for dry eye treatment including meibomian gland dysfunction and inflammatory dry eye.
A warm compress is a method of applying heat to the body. Heating sources can include warm water, microwaveable pads, wheat packs and electrical or chemical pads. Some unorthodox methods can include warmed potatoes, uncooked rice, and hard-boiled eggs. The most common warm compress is a warm, wet washcloth.
Evaporimetry is medical test to measure the rate of the evaporation of the eye. Individuals with meibomian gland dysfunction will have an increased rate of evaporation because the glands release lower quality meibum. This impacts the tear film increasing the evaporation rate and can cause dry eye. The device used to perform an evaporimetry is called evaporimeter.
Jennifer P. Craig is a Scottish–New Zealand academic optometrist, and is a full professor at the University of Auckland, specialising in ocular surface disease.