Meibomian gland dysfunction

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Meibomian gland dysfunction
Other namesmeibomitis
Specialty Ophthalmology, optometry
TypesLow delivery (hyposecretory or obstructive) and High delivery.
Risk factors Aging, rosacea, Sjögren syndrome [1]
Meibomian glands in the lower eyelid imaged under amber light to show vasculature support and the gland structure. Meibomian-glands.png
Meibomian glands in the lower eyelid imaged under amber light to show vasculature support and the gland structure.

Meibomian gland dysfunction (MGD, also meibomitis) 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 (called meibum) 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 (either too little or too much meibum produced). 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. [2]

Contents

MGD 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. [3] [4] 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. MGD has been described as "the most underrecognized, underappreciated and undertreated disease in ophthalmic care [...] so common as to be taken as ‘normal’ in many clinical practices". [5]

The dysfunction is more often seen in women, and is regarded as the main cause of dry eye syndrome. [6] [7] Factors that contribute to the dysfunction can include things such as a person's age and/or hormones, [8] or severe infestation of Demodex brevis mites.

Treatment can include warm compresses to thin the secretions and eyelid scrubs with baby shampoo or eyelid cleanser, [9] [4] or emptying ("expression") of the gland by a professional. Lifitegrast and Restasis 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. [4] 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.

The dysfunction may be caused by some prescription medications, notably isotretinoin. A blocked meibomian gland can cause a meibomian cyst known as a chalazion to form in the eyelid.

Untreated blepharitis or MGD makes the eyes look red and puffy as if the person have been drinking or have a substance abuse problem. [5]

Classification

Classification of MGD Mgd-classification.png
Classification of MGD

MGD can be classified based on gland secretion. MGD can be low delivery and high delivery. Low delivery is the most common form [5] and is classified in hyposecretory and obstructive. Hyposecretory implies low meibum secretion without terminal duct obstruction. This is associated with gland atrophy. Contact lens wear can lead to a decreased number of functional meibomian glands. [2] Obstructive MGD, where the terminal duct is obstructed, is the most common type of MGD. Obstructive MGD has been associated with age and acne treatment products with retinoids. [2] Obstructive MGD can be classified into noncicatricial and cicatricial. In noncicatricial, the terminal duct of meibomian glands are in their normal anatomic position. In cicatricial, they are dragged posteriorly into the mucosa. [2]

High delivery implies an increased release of meibum into the tear surface. This has been associated with seborrheic dermatitis. [2]

See also

Related Research Articles

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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.

<span class="mw-page-title-main">Blepharitis</span> Medical condition of the eyelid

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.

<span class="mw-page-title-main">Eyelid</span> Thin fold of skin that covers and protects the eye

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<span class="mw-page-title-main">Dry eye syndrome</span> Medical condition

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<span class="mw-page-title-main">Chalazion</span> Medical condition

A chalazion or meibomian cyst is a cyst in the eyelid usually due to a blocked meibomian gland, typically in the middle of the eyelid, red, and not painful. They tend to come on gradually over a few weeks.

<span class="mw-page-title-main">Stye</span> Medical condition

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<span class="mw-page-title-main">Lacrimal gland</span> Exocrine gland, one for each eye, that secrete tears

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<span class="mw-page-title-main">Lacritin</span>

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<span class="mw-page-title-main">Conjunctivochalasis</span> Medical condition

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<span class="mw-page-title-main">Lifitegrast</span> Chemical compound

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<span class="mw-page-title-main">Warm compress</span> Method of applying heat to the body

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References

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