What is MGD (Meibomian Gland Dysfunction) and What Are MGD Treatments?
By Drs Jenna and Travis Zigler
What is MGD? What is Meibomian Gland Dysfunction?
The meibomian glands in your upper and lower eyelids help to produce tears, and this is where MGD begins. This disease is a progressive, obstructive disease that advances from the production of normal, healthy oils of the tear film into thicker secretions that cause stagnation and blurry vision. If left untreated, the glands can become completely obstructed and eventually atrophy.
Symptoms of MGD include blurred vision, red eyes and eyelids, dry, scratchy eyes, and overall irritation. Unfortunately, this disease currently has no cure, but there are ways to effectively treat it and reverse some of the issues.
What are Meibomian Glands?
There are approximately 31 meibomian glands in your upper eyelid and about 26 glands in the lower eyelid. The glands in the upper eyelid are longer and produce more oil, or meibum, than the ones in the lower eyelid. Each gland contains little pockets called acini that act like an oil factory, producing the meibum. These pockets produce the oil and push it out into the duct to exit the eyelid. A muscle (the orbicularis oculi) inside your eyelid assists in “milking” the glands during a blink and pushing the oil to the opening and out into your eye. Upon exiting the duct and being pushed onto your eye, the oil then forms the outer layer of your tears called the lipid layer. So what do these tear layers help with? They’re so important!
The oily outer layer, produced by special glands (meibomian glands) within the eyelid, serves to prevent evaporation of the saltwater middle layer of the tears. The inner layer against the eyeball is made of mucus secreted from cells on the front surface of the eye and is important in helping the saltwater layer spread evenly across the surface of the eye. As you can see, any dysfunction in the layers of the tears can be problematic, and we especially see this with an increase in evaporation from MGD.
What Causes Meibomian Gland Dysfunction?
Think of your eyes like your car windshield. If your windshield wipers are broken, you’re out of wiper fluid, or you have thick, dirty fluid, it’s going to be very tough to see through the window. When your tear film is disrupted, the light coming into your eye is also disrupted. This causes blur, halos, and glare just like you notice when your windshield isn’t clean. Healthy tears are so important because they provide a smooth surface for the light to pass through into your eye.
The number one cause of MGD is aging, as it's common for the morphology of the glands to change with age. Hormone fluctuations can also play a role, especially androgen deficiency. Other conditions that can contribute to MGD include demodex eyelash mites, rosacea, and other seborrheic skin conditions.
Meibomian Gland Dysfunction Treatment | How to Unblock Meibomian Glands
A warm compress eye mask is step number one because those with meibomian gland dysfunction have hardened, impacted oils within their glands. This is a problem because those hardened oils have a hard time expressing onto the eyes. Without the proper healthy oils, you end up with a disruption in your tear film which can lead to discomfort, redness, watery eyes, and overall dry eye.
A warm compress mask is easy to use. You simply place the entire mask into the microwave, heat it on high for 20 seconds, and then test the temperature of the mask on the inside of your wrist. As long as it's not too hot, you can lie back and place the mask over your closed eyelids for 15-20 minutes. Making this a part of your daily eyelid hygiene regimen is a wonderful way to ensure that you're keeping those oils flowing.
Step 2: Gently Express the Meibomian Glands
After heating the oil within your eyelids, you still may have to help those oils out onto the eyes. New procedures such as Lipiflow and MiBo Thermoflo can simultaneously heat and express the glands, and they are quite effective! However, these treatments can be pricey to have done regularly. Expression of the glands can also be manually done by your eye doctor, but sometimes it's a good idea to do this at home as well. You can use either your finger or a cotton swab, and it's easy to do.
Using a wet cotton swab on the outside of your eyelid, roll the swab from the upper eyelid crease down to the eyelashes and repeat this across the entire upper eyelid. Then, do the same on the bottom eyelid, rolling up toward the eyelashes. This process helps to break up the impacted oil and release it from the glands onto your eyes. Take care not to push too hard, but you do want to use enough pressure to be effective.
Hypochlorous acid (HOCl) has become a very popular product for eyelid cleansing in recent years. This natural substance is produced by neutrophils in the body in response to bacterial invaders and inflammation. It works to fight off microorganisms on the skin and mucous membranes, ensuring that the affected area is clean. It is well known that clean eyelids can help alleviate the signs and symptoms of blepharitis, dry eyes, and meibomian gland dysfunction.
After using a warm compress and gently expressing the glands, you'll want to use a HOCl cleaner to rid the eyelids and eyelashes of any debris left there. Simply spray the solution onto your closed eyelids. Rubbing the solution in and then letting it dry is enough, although some people prefer to spray onto a cotton ball or round before application. Either is fine and very effective at keeping the skin clean! A hypochlorous acid cleanser should be used twice per day for maintenance of clean eyelids.
Omega-3 fatty acids are so important for those with MGD. Because the meibomian gland oils of those with MGD are of poor quality, it is imperative to ensure you're ingesting a good ratio of Omega-3 to Omega-6 either through food or supplementation. A healthy Omega-6 to Omega-3 ratio is 4:1 but, sadly, our Western diet almost guarantees that yours may be closer to 20:1. To make sure your ratio is healthy, eliminate all processed and fried foods and sugars and replace them with healthy omegas like wild caught salmon, mackerel, walnuts, chia seeds, flaxseed, and avocados.
For those who wish to supplement, the Heyedrate Omega-3 for Eye Health contains high quality, triglyceride-based omegas, as well as a few other important vitamins and can help balance out your ratio. In a recent small study, 40 enrollees at Singapore Eye Research Institute and Singapore National Eye Center found that a lower lactoferrin concentration was found in eyes with reduced meibomian gland expressibility. The association was still significant after adjustment by age, and the same subjects reported greater dry eye and allergy symptoms. This formula contains lactoferrin, among other healthy nutrients. The recommended dosage is three softgels per day, which can be taken all at once or separately.
In-Office Treatments for MGD
Lipiflow is a device that works well for MGD because it applies heat and pulsation to the eyelids. This helps to liquefy meibum (oil) and express the meibomian glands at the same time. This procedure is quick and can be very beneficial if the right patients are selected.
MiBo Thermoflo treats the outer eyelids only, and it is very similar to a Lipiflow procedure. MiBo Thermoflo is also a spa-like setting that delivers consistent heat for ten minutes, which will lead to a melting of hardened oil leading to less symptoms and signs of meibomian gland dysfunction. This is usually more affordable than Lipiflow.
IPL is another great option. Originally used as a treatment for Rosacea, patients that were having IPL, or Intense Pulsed Light Therapy, on their skin condition noticed improvement in their dry eye symptoms. IPL is also used for laser hair removal. IPL is brief, powerful bursts of light that cause changes in the blood vessels near the surface of the skin, which raise the skins temperature, and eliminates problematic flora (bacteria) on the skin and eyes. For meibomian gland dysfunction, the increase in temperature acts like the world’s best warm compress and helps eliminate stagnate oil from the glands. It will also decrease inflammation from the treatment area due to changes in the blood vessels.
Meibomian Gland Dysfunction Associated With Decreased Lactoferrin
In a recent studyof 40 enrollees at Singapore Eye Research Institute and Singapore National Eye Center found that a lower lactoferrin concentration was found in eyes with reduced meibomian gland expressibility. The association was still significant after adjustment by age. The same subjects reported greater dry eye and allergy symptoms.
What is Lactoferrin's Function?
Lactoferrin is an iron-binding protein present in many bodily secretions, including breastmilk, nasal secretions, saliva, and tears. Colostrum contains the highest concentration of lactoferrin in the body (875mg per half cup!), and it's next largest concentration is in human breastmilk (125mg per half cup). This protein can be purified directly from milk (including cow's milk), or it can be created through DNA in a lab.
Lactoferrin does amazing things for the immune system of the body, including acting as an anti-inflammatory and antimicrobial. Of course, this comes into play as the lactoferrin in colostrum and breastmilk helps provide defense for human infants who do not yet have a working immune system. But that's not the only place it works. Lactoferrin is an important protein in the tear film, and it is an important part of the innate defense of the eyes.
It's main function in the body is in the binding and transport of iron ions, which removes an important substance required for bacterial growth. Lactoferrin also has the ability to cause bacterial cell lysis and phagocytosis. Amazingly, it also exhibits anti-inflammatory, antifungal, anti-allergy, and antiparasitic properties, which can all come into play when speaking of the eyes.
As stated previously, lactoferrin is present in the tear film, and levels have been shown to be decreased in those with Sjogren's syndrome, Stevens-Johnson syndrome, and meibomian gland dysfunction.
Lactoferrin Benefits and Uses
In discussing Lactoferrin's benefits, we can dive back into the fact that it is anti-inflammatory, an antioxidant, and antimicrobial. Bacteria and inflammation play a large role in various forms of dry eye disease, and especially in that of MGD. When the bacterial load of the eyelid skin and glands becomes too great, this can begin to clog the meibomian glands. Because of this, inflammation begins to present itself and the glands become unable to produce the correct quality and quantity of oil needed for the eyes to feel comfortable.
Studies have shown that oral administration of lactoferrin could potentially preserve the function of the lacrimal gland by decreasing oxidation and free radicals and therefore decreasing inflammation. These findings mean that, by taking a supplement containing lactoferrin, you could potentially decrease the inflammation of your eyes and begin to feel comfortable again. In addition to it's use in dry eye disease, lactoferrin supplementation may also be useful in treating stomach ulcers, hepatitis C, and for heightening the immune response as well as promoting healthy bacteria in the stomach and intestines.
Lactoferrin Side Effects
Lactoferrin is safe when taken as directed and when consumed through food. However, in high doses, lactoferrin may cause diarrhea, skin rashes, fatigue, loss of appetite, and chills. It is safe for use in pregnant and breastfeeding women in food amounts, although supplementation should be avoided since not much is known about potential adverse effects.
There are multiple lactoferrin supplements on the market which you could take alone, although we recommend combining it with other beneficial dry eye vitamins and minerals for optimal results. The Heyedrate Omega-3 for Eye Health not only contains omega-3 fatty acids as well as omega-7, but it also contains 10mg of lactoferrin. As with most lactoferrin supplements, this lactoferrin is derived from dairy sources, but should should cause issues if you have dairy sensitivities. However if you're lactose intolerant you may want to consult with your physician.
The Heyedrate Omega-3 contains 515mg EPA, 415mg DHA, 40mg Omega 7, 10mg Lactoferrin, Vitamin E, Vitamin C, Vitamin B-6, and Magnesium for a powerful anti-inflammatory effect. This supplement is overall a wonderful addition to your dry eye routine.
Other Considerations for Meibomian Gland Dysfunction Management
How do you massage your eyes for blepharitis?
If you're interested in doing this at home, the process is pretty simple and safe. After using your warm compress to heat up the oil in your meibomian glands, use a wet cotton swab or your clean finger. On the outside of your eyelid, roll from the upper eyelid crease down to the eyelashes and repeat this process along the entire upper eyelid. Then, do the same on the bottom eyelid, rolling up toward the eyelashes (you may have to close your eyes for this).
This process helps to break up the impacted oil and release it from the glands onto your eyes. Take care not to push too hard, but you do want to use enough pressure to be effective. If this seems too diffcult, you can simply use a circular motion to massage over your eyelids with your clean fingertips.
Can warm compresses damage eyes?
There's been a ton of controversy lately about whether or not warm compresses are safe. Some research has shown that using a warm compress heated to at least 45 degrees celsius can cause corneal changes by heating up the cornea. However, if you follow our recommendations, using a warm compress once per day for 10-20 minutes, this should not be an issue. Most warm compresses are also not going to hold heat long enough at that high of a heat setting to cause damage.
3 best eye drops for Meibomian Gland Dysfunction
1. Oasis Tears Plus PF
We love Oasis Tears Plus PF because it contains no preservatives and is an eye drop that helps keep the eyes comfortable for hours. It works to lubricate, moisten and relieve delicate eye tissue from irritation and dryness. It is also a true solution that keeps tears on the eye surface to relieve the irritation and grittiness. You can purchase Oasis eye drops through your eye doctor or by clicking here.
2. Ocusoft Retaine MGD
We've loved this artificial tear for years, especially for our patients with MGD. Their lipid-replenishing formula utilizes electrostatic attraction to help stabilize the tear film. This protects against moisture loss and keeps you feeling comfortable. This product also contains no preservatives.
3. Refresh Optive Mega-3
This artificial tear is unique because it actually incorporates omega-3 fatty acids into the formula. It's preservative free, comfortable to use, and has been a great resource of ours for years.
Best eye cream for Ocular Rosacea and MGD
We get more questions about cosmetics and skincare products than anything else. We recently did a great interview with Dr. Leslie O'Dell, which you can find here, but we'll give you a quick rundown of the top ingredients to avoid in cosmetics and skincare:
Argireline (Acetyl Hexapeptide-3)
Benzalkonium Chloride (BAK)
Sodium Laureth Sulfates
If you're looking for a gentle eye cream safe for both ocular rosacea and MGD, check out the Heyedrate Eye Cream and Face Moisturizer. This moisturizer is designed with your sensitive eyes in mind, and we've formulated this moisturizer without toxic ingredients.
Can Meibomian gland dysfunction be cured?
There is no cure for MGD, blepharitis, or dry eye disease, but there are great ways to manage these conditions and become symptom free. Depending on the cause of course, getting to the root of the inflammation is the #1 way to become symptom-free.
How do you unclog your Meibomian glands at home?
Meibomian gland dysfunction treatment can be as simple as warm compresses at home (which are shown to provide symptom relief), to diet changes and supplements, to in-office procedures such as IPL, MiBiFlo, or Lipiflow. Warm compresses are best performed with a mask that is specifically formulated for dry eye. We recommend applying warm compresses at least every night.
After using the warm compress, cleanse your eyelids with a hypochlorous acid cleanser. Simply spray the solution onto your closed eyelids, rub it in, and let it dry.
What causes Meibomian gland dysfunction?
MGD is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction, and qualitative and quantitative changes in glandular secretion resulting in alterations of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease (this all according to DEWS II). There are a multitude of causes, the most common being staph bacteria. Rosacea, demodex, hormone fluctuations, and natural aging all play a role in MGD.
How do I know if my Meibomian gland is blocked?
The best way to know if you have blocked meibomian glands is to visit your eye doctor. They can express your glands and examine not only the morphology of the glands, but also the consistency of the oils coming out of them. If the oil is healthy, it will be the consistency of olive oil. If not, it may be the consistency of toothpaste, which is going to block your glands. Your doctor may use only their slit lamp to view your glands or they may use a meibography machine.
How do you fix Meibomian gland dysfunction?
First of all, begin treatment now! When you begin treatment early on in the disease process, you have a much better chance of responding well to it. You’ll also avoid any permanent damage that can cause eye issues for a lifetime. In the mild stages of MGD, we often begin with warm compresses and making sure the eyelids are kept clean with the a hypochlorous acid cleanser.
A warm compress can be easily applied twice a day in the form of an eye mask. Many eye masks are available that can be heated in the microwave to the desired temperature (we recommend 10-20 seconds, you don’t want to burn your eyelids!) Use an eye mask for 20 minutes, twice per day to soften the oils that your meibomian glands release.
Afterward, make sure to massage your closed eyelids gently to express the oils onto the surface of your eyes. You can think of this like a relaxing spa treatment...twice per day!
After your warm compress, use a hypochlorous acid spray for dry eye and blepharitis. This effective cleaner can be safely used twice per day to kill bacteria, block bacterial toxins, and relieve symptoms of MGD and dry eye. This spray is perfect to use right after the warm compress and patients have noticed a difference in comfort in as little as 2 weeks.
Can I express my own Meibomian glands?
You definitely can. It's easy to do a little lid massage by gently pushing on your eyelids to break up any of the impacted oils. Gland expression is similar to lid massage, and this is something you can do at home. Heating up your meibomian glands helps turn the oil into more of a liquid (think of placing a stick of butter on the stove... it melts). After using a warm compress, you can milk the glands by rolling a q-tip starting away from your eyelid margin and rolling towards it (or you can use your finger). Do this over the entirety of your eyelids, both top and bottom.
Is LipiFlow a waste of money?
Lipiflow applies heat to the inside of the eyelids while simultaneously applying a pulsation to the outer eyelids. This helps to liquefy meibum (oil) and express the meibomian glands at the same time. This procedure usually lasts about 15 minutes and can provide great benefits for many people with MGD. To learn more about LipiFlow, check out this article.