Meibomian gland dysfunction is an oil deficiency in the tears caused by dysfunction of the oily glands known as the Meibomian glands. It is very common condition and a feature of many dry eye syndromes.

MGD is often experienced by those with keratoconus, particularly if they wear contact lenses. MGD is also a major cause of Blepharitis (inflammation of the eye lids) sty’s and irritated eyes.

The Meibomian glands are found within the eye lids and in this condition the oil contained within the gland becomes too greasy and viscous. The secretions become semi solid blocking the gland opening and preventing expression of the oil onto the eye. There is little or no lubrication for the blink.

SOUNDS FAMILIAR?

This can cause symptoms of:

• Foreign body sensation
• Itchy, grittiness, burning sensation
• Watery eyes
• Dry eye sensation
• Contact lens discomfort
• Blurry vision
• Recurrent eye infections or styes (lump in eye lid)
• Eyes also may appear redder especially at the end of the day.

The oily layer of the tears is called the lipid layer and helps to prevent evaporation, therefore symptoms can be worse in drier environments such as air conditioning & central heating. Contact lens wear can also make the condition worse.

The oil in the tears also helps to give lubrication to the blinking action of the eye. Without sufficient oil the lids can become irritated leading to sore tired eyes. Think of a car engine without any oil…water is not enough, good quality oil is essential to protect the engine parts from grinding together & seizing up.

Crying or watery eyes are reflex tearing which are more water than oil so does not relieve the symptoms or unblock the glands.

Causes can be linked with:

• Changing hormones such as pregnancy & menopause
• Environmental factors such as prolonged screen use or close work, air conditioning, central heating, dust.
• Systemic conditions such as arthritis, acne rosacea, asthma.

• Some medications, Smoking & Alcohol are known dry eye causes.
• Age Related, Eye Lid shape & condition.
• Contact lens wear
• Diet

There is evidence to prove that increasing your intake of Omega 3 fish oil can significantly improve the tear film. There are special diet supplements available such as Hyabak Caps which are specially formulated to promote healthy tear film.

Drinking plenty of water is important, if you are dehydrated your eyes may be dehydrated too. If you have special diet requirements you may need to check with your GP first.

Contact Lenses

Wearing contact lenses makes this condition worse. Reduce contact lens wear to maximum 10 hours, do not sleep in your lenses & be very strict with your hygiene. Risks of infections are higher with drier eyes as the tear film should protect the eye from infection and keep the eye & lenses clean.

Do not wear your lenses at all if you have an active infection, redness, discomfort or irritation.

Use a Warm Compress To melt the Meibomian oils in the eye lids. This can be done using a warm face cloth pressed onto the eye twice daily for 8-10 mins. The aim is the heat should be warmer than body temperature but not uncomfortable. Contact lenses should be removed first.

Alternatively, microwaveable heat pads (such as The Eye Bag) can be purchased which stay warm for longer and are therefore more efficient.

The MGDRx EyeBag® is a patented, CE marked Class 1 medical device registered with the Medicines and Healthcare products Regulatory Agency (MHRA). The EyeBag® can be used as treatment for sore gritty eyes, dry eye syndrome, Meibomian Gland Dysfunction, Chalazion treatment, Stye treatment and Blepharitis treatment.

The EyeBag® is a silk and cotton device which can be re-heated up to 200 times in a microwave. Simply heat for 30 or 40 seconds on full power and the EyeBag® will stay warm for up to 10 minutes.

Lid massage

Stroking the lids in a circular motion to express the oil once melted.

Lid Hygiene

Possibly the most important of all, this should be done twice daily to clean away the oil & loose skin cells from the lid margin, eyelids & brows. Loose skin cells & air debris can fall into the eyes further clogging up the Meibomian gland openings. Gentle make up wipes or lotion cotton wool pads can be used or alternatively specific wipes are available to buy such as Blephaclean & Blephasol duo.

Treatments must be done twice a day for 4-6 weeks before a significant improvement will be made. It is not advised to use tap water, or baby shampoo to clean your eyelids.

Eye Drops

There are various products available on the market. it is always advisabke to seek professional advice before using any new products.

• Preservative free is recommended for long term use & contact lens wearers.
• Check dates, once bottles are open they have to be discarded between 1 & 6 months of opening, depending on the brand. Individual vials are very convenient & hygienic.
• Contact lens wearers must check for use with contact lenses fitter

• Eye sprays are very easy to use & can be sprayed over make up but may not be as effective as eye drops so only suitable for mild dryness or can be used alongside drops. Look for modern ingredients such as Hyaluronan, Sodium Hyluronate & Trehalose.

• A drop can be added to the bowl of a contact lens when applying contact lens to the eye to act as a cushion, help the lens adhere to the eye & extend comfortable wear 7mes.

• The Blink range & Hycosan Blue is excellent for mild dryness. Hycosan Red & Theoloz duo are also recommended for more symptomatic dry eye. Theoloz Duo Gel & Clinitas Hydrate are for very dry eyes and are advised to use at night as can blur vision for up to 20 minutes due to the viscous nature

if you have any concerns regarding your dry eye or MGD, please seek further help from your Optom. lens fitter or GP.

With thanks to Beth Ralph, The EyeBag Company, and the NHS.

Beth Ralph is based at Bird Opticians Sheffield & Elliott & Heath Chesterfield Derbyshire If you are in the UK and interested in the dry eye clinic,  do get in touch,  It is a private service with various related fees.

See:
https://www.birdopticians.co.uk/

https://elliottandheath.com/