What is meibomian gland dysfunction and how can it be treated?
What is meibomian and how does it differ from dry eye?
Meibomian gland dysfunction is a form of dry eye, but it’s slightly confusing to think of this condition as dryness. In meibomian gland dysfunction, you have all the symptoms of dry eye, you have grittiness, discomfort, pain typically at the end of the day or during the night, all symptoms of dryness. But actually, when we look at the tears of these people, they have plenty of tears. The issue in these patients is the quality of the tears. So what we find is that the meibom, which is the oil in the tears, is of very poor quality or is lacking, and that’s because the oil glands that make this meibom, are not functioning correctly, and they’re called the meibomian glands. And that’s where meibomian gland dysfunction, the term, comes from. It’s the oil glands in the eyelids that make the oil component of the tears are not functioning properly, and they’re making poor quality oil, which is causing a feeling of discomfort or tiredness or heaviness in the eyes.
How can meibomian be treated?
So how can it be treated? Well, treatment for meibomian gland dysfunction is… Really, there are two components. There’s addressing the consequences and there’s treating the cause. In terms of treating the cause, the single best treatment for Meibomian gland dysfunction is consistent heat therapy. So simply delivering constant heat for ten minutes or more to the meibomian glands stimulates them to produce more oil and better quality oil.
Heat therapy treatment for meibomian.
So there are various different ways of doing this, everything from machines that deliver heat to very basic eye bags which are microwaveable devices, or sometimes they can be self-heating devices that are placed on the eyelids. But the key component of heat therapy for meibomian gland dysfunction is consistent heat for ten minutes or longer at high enough temperature.
Treating the consequences of meibomian gland dysfunction.
The second component, then, of treating meibomian gland dysfunction is treating the consequences. So if a patient has had poor quality oil for a prolonged period, meibomian gland dysfunction for a prolonged period, they’ll start to develop damage on the surface of the eye as a consequence. And that damage will manifest as unhealthy cells, cells on the surface of the eye that are stressed and dying. They stimulate inflammation, and these patients typically have a slight, mild redness on the surface of the eye due to low-grade inflammation. So very often a course of anti-inflammatory eye drops are required. And, of course, that’s only something that can be provided by a consultant ophthalmologist. So a combination of anti-inflammatory treatment.
The last component of treating the consequences is addressing the concentration of the tears, the hyperosmolarity, we call it. And hyperosmolarity is when you have this dysfunctional oil, it interferes with the concentration of the tears, and the tears become too concentrated, too salty. And this actually hurts. This irritates and hurts the eyes. That can be addressed by using either hyperosmolar eye drops or eye drops that are designed specifically to correct this imbalance in the concentration of the tears.
So there’s no one single treatment for meibomian gland dysfunction. It’s a combination of encouraging better meibomian oil production with treating the consequences in terms of anti-inflammatory and lubricant drops which correct the osmolarity of the tears.