Meibomian gland dysfunction (MGD) is a common eyelid disorder that occurs when the meibomian glands in the eyelid are dysfunctional. The meibomian glands are sebaceous glands located in the upper and lower eyelids and they primarily secrete an oily substance called meibum. Meibum forms the outermost layer of the tear film and helps prevent evaporation of tears. When the meibomian glands are blocked or do not function properly, they are unable to secrete adequate meibum into the tear film leading to tear film instability and increased evaporation of tears. This results in dry eye symptoms like eye irritation, red eyes, blurred vision, and sensitivity to light.
Causes and U.S. Meibomian Gland Dysfunction
The most common causes of MGD are age-related changes in the glands, genetics, medical conditions like rosacea and thyroid disease, and topical medications used long term like antihistamines. Other risk factors include a lifestyle that involves long hours spent working in front of digital screens, extended contact lens wear, LASIK eye surgery, changes in hormones due to menopause or medication, allergy flare ups, and poor eyelid hygiene. An aging population, and increased use of digital devices puts more individuals at risk for developing MGD.
Prevalence and Impact
It is estimated that U.S. Meibomian Gland Dysfunction affects over 20 million Americans annually and is the major cause of dry eyes in the U.S. According to recent studies, the prevalence of MGD has increased significantly over the past few decades from 5% to 16.7% due to changing population demographics and lifestyle factors. If left untreated, MGD can lead to significant ocular surface damage, tear film instability, inflammation, secondary infections, and vision threatening corneal complications like ulcers and scarring over long periods of time. This impacts quality of life and productivity at work or school. The total annual cost associated with treating dry eye disease in the U.S. is estimated to be over $55 billion.
Diagnosis and Assessment
To diagnose MGD, an eye care professional will conduct an evaluation of tear film and ocular surface, assess for symptoms, perform meibomian gland expression/prolapse and grading of meibum quality, and may use imaging techniques like infrared and non-contact meibography. This helps characterize the signs and symptoms as well as grade the severity based on degree of gland capping, plugging, and dropout. Tear osmolarity test, tear breakup time, corneal and conjunctival staining with fluorescein and lissamine green, and meibum quality and expressibility provide important objective parameters for diagnosis. Symptom questionnaires help correlate signs with symptoms for treatment planning.
Treatment Options
The goal of treatment is to unclog and flush meibomian glands as well as maintain tears. Warm compress is a basic home therapy that softens and liquefies meibum. In-office intense pulsed light therapy utilizes specific wavelengths of light energy that target bacteria and clear debris from glands. Manual gland expression helps flush glands. Anti-inflammatory eyelid scrubs and washes are used for hygiene. Lubricating tears, ointments, and punctal plugs augment tear volume and stability. When symptoms persist, prescription medications like topical cyclosporine, corticosteroids, and oral doxycycline or azithromycin alongside comprehensive treatment provides better outcomes. Dietary modifications and supplements can also help some individuals. Surgical options are rarely needed and reserved for advanced disease. Treatment should continue long-term to keep glands clear and functioning well.
Impact of Digital Devices
Prolonged screen time has become a routine part of modern life and work. Looking at digital devices involves less blink rate and incomplete blinks increasing tear film instability. Blue light exposure from devices has been suggested to have an inflammatory effect on ocular surfaces, exacerbate dry eye symptoms and likely worsen blepharitis and MGD over time. Studies show direct correlation between screen time and increased risk as well as severity of MGD and dry eye syndrome according to time spent per day. Limiting screen time, frequent breaks, use of blue light filters and artificial tears help reduce impact. Educational programs to increase awareness about practicing proper eyelid and digital device hygiene are crucial considering the extensive device usage.
Rise in Prevalence
According to cross-sectional studies, self-reported MGD increased from 5.6% in 2003 to 10.1% in 2020 while objective MGD by gland evaluation criteria increased from 16.4% to 25.3% during the same time period. This rise closely parallels increased life expectancies, aging populations, more time spent digitally due to online work and entertainment, higher allergen, pollutant and stress levels. MGD prevalence is also expected to rise due to increasing obesity rates as excess weight contributes to inflammation and meibomian gland dysfunction. Without proper meibomian gland care, MGD burden will likely continue escalating rapidly in the U.S. making its management a public health priority for ophthalmologists.
MGD has emerged as one of the most common eyelid disorders in the United States due to changes in demographics, lifestyle, and environment. Its prevalence has significantly increased over the past two decades. Prompt diagnosis and well-structured treatment approaches targeted at treating underlying inflammation and restoring gland function could help curb the growing MGD epidemic and rising costs of dry eye care in America. With better public education and awareness, simple daily eyelid cleansing measures and limiting excessive digital device usage, many individuals may be able to reduce their risk long-term. More research is still needed to better understand MGD pathophysiology and develop new treatments. Overall vigilance towards complete ocular surface health will be crucial going forward.
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Ravina Pandya, Content Writer, has a strong foothold in the research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. (https://www.linkedin.com/in/ravina-pandya-1a3984191)
