How To Treat Mgd
Meibomian gland dysfunction is a common contributor to dry eye disease
. It is sometimes called MGD, meibomitis, and posterior blepharitis. MGD is multifaceted, but it generally includes swelling in the meibomian glands of the eyelid, which produce the lipids (meibome) that comprise the outer layer of the tear film. The swelling may be caused by a blockage on the gland outlet at the eyelid margin.
The clog, in turn, may be due to an eyelid inflamed from allergies or anterior blepharitis (in the front of the eyelid). The condition may also come from hormonal changes, or dietary habits that affect the consistency of the lipids. Sometimes, the extrusions may look tawny and thick, or even toothpaste-like; at other times, a firm fatty ball may congeal at the entrance, blocking it. Another manifestation of the dysfunction may involve heavy extrusions of lipids irritating the eyes, although no obstruction of the glands happens.
The bottom line is that as a result of the disorder, the fatty extrusions of the gland become abnormal. There may be an excess of or too little; the oil may be too viscous or too light. The overall effect is that there is greater instability in the tear film and evaporation happens at more rapid rates.
Symptoms and Associated Conditions
The signs of the disorder typically are similar to symptoms linked with dry eye in general: burning sensation in the eye, grittiness, foreign object sensation, a mild fear of light because of high sensitivity, and concretion along the lid margins. The lid margins present as enlarged and irritated and the inner margin of the eyelid may be dented as a result of scarring.
MGD often occurs in association with insufficiency of aqueous tears. In such instances, you are likely to suffer very pronounced dry eye sensations. Approximately six of ten Sjgren's syndrome patients (who exhibit aqueous tear insufficiency) have been reported to also be burdened by MGD. Other skin conditions like rosacea and seborrheic dermatitis - which generally inflict blepharitis - are also contributory to meibomitis. These associated diseases should also be addressed during the treatment of MGD.
The probability of developing meibomian gland dysfunction is observed to increase with age. It may be that the meibomian glands progressively deteriorate in their functioning, or that age-related adaptations in the eyelids may result in impaired blink mechanisms. What has been noted is that normal eyelids in elderly patients present many of the adaptations in structure and form noted in meibomitis.
meibomitis is also associated with long-term contact lens use. Contact lenses raise the tear evaporation rate. Rapid evaporation can promote contact lens intolerance and worsen the adverse reaction in people whose tear films are already sub-standard to begin with. Similarly, meibomitis is also nearly always noted in patients with giant papillary conjunctivitis (GPC) and chalazion (plural, chalazia; a lump that remains after a sty on the eyelid heals).
Treatment
meibomitis, being a rather complicated disease, has many possible causes. In any person, the disorder may start from one or more of these causes. Your doctor will have to keep these in mind as the treatment program continues.
The first item on the list in treatment is to control inflammation on the eye surface, in order to reduce the damage from bacterial activity on the eyelid rim, enhance lipid function, and relieve the accompanying dry eye symptoms.
Topical steroids may be used to control inflammation, although this is not normally resorted to because of the high risk of side effects. But more recent compounds, such as loteprednol, do not carry such risk and are acceptably effective at controlling inflammation. Specially compounded topical cyclosporine, such as cyclosporine emulsion in a castor oil base, has also been tried with great success to minimise eye surface inflammation.
Essential fatty acids, particularly omega-3 fatty acids, have been credited in many informal reports with the power to reduce dry eye symptoms, probably because of their proven anti-inflammatory properties. Their anti-inflammatory action has also been noted to mitigate meibomian gland disease.
Lid scrubs can be effective. Cleaning the eyelid margin helps remove bacteria and their toxins, as well as decongests meibomian gland ducts. Overzealous cleansing can cause irritation, however, and should be avoided. Punctal plugs, artificial tears (without preservatives), and tear stimulants also deliver relief.
by: Mervin Folts
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