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Meibomian Gland Dysfunction

(Posterior Blepharitis)

Meibomian glands are the oil-producing glands located in both the upper and lower
eyelids. When these become chronically blocked, which occurs in about 30% of the
population, increased evaporation of the watery component of your tears occurs,
causing the symptoms of irritation and dryness. This condition is called Meibomian
Gland Dysfunction (MGD), and is also known posterior blepharitis.

What is Meibomian Gland

Dysfunction?

Meibomian glands are the oil-producing glands located in both the upper and lower
eyelids (Fig 1). They number about 25 to 30 and normally slowly release oil into the
tear lm. This oil/lipid helps to stop the watery component of the tears from
evaporating, thus helping to prevent dry eyes.

Figure 1: Meibomian Glands

Sometimes the oil becomes slightly thicker than normal which can lead to blockage of

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the narrow duct which takes the oil from the gland to the tear lm. Dry eye and
irritation occur as the stabilising oil cannot reach the tear lm. This is called
Meibomian Gland Dysfunction (MGD) and is also referred to as posterior blepharitis, as
naturally occurring bacteria can cause the oils to thicken and stagnate.
Severe blockage can lead to much enlarged glands (a cyst) or even infection. It is
therefore important to rstly unclog the blocked glands, and secondly prevent them
from blocking up again - as much as possible.

Examples of heated eye bags used for MGD compresses. They are
Bruder medibeads.

lled with wheat or

At home Meibomian Gland

Expression

The rst step in unblocking the glands is to liquefy the thickened oil in them. This is
achieved with a hot facecloth against the closed eye for a minute or so. A heated
wheat bag can be used instead for better heat transfer. These are available at
Innovative Eye Care. Some patients prefer to use the warmth of their shower to heat
up the glands.

Figure 2: Liquefying the thickened oil with a heated wheat bag

After liquefying the oils with this warming, place your index nger on your cheek and
press rmly at the edge of the lower lid, rolling your nger upwards to milk the gland
and empty its contents out of the lid (Fig 3). The picture below shows this technique.

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Figure 3: Emptying the glands

Repeat this process few times across the entire lower eyelid, then the upper
eyelid.
Repeat the entire procedure for the other eye.
Do this twice per day for two weeks. This will help to unclog the blocked glands.
After this period, repeating the procedure just once per day should help to
prevent the glands from becoming re-blocked.
If you stop hot compresses all together, MGD will recur because it is a chronic
condition this is why it is important to make the compresses part of your
daily routine.

In-Office Meibomian Gland

Expression

If the MGD is more severe, some patients glands will initially need a little more help
to become unblocked. This can be done by your optometrist with the aid of a
meibomian gland expression paddle (Mastrota paddle). Generally this will only require
a 15 minute appointment. This in-o ce expression is more e ective than just normal
hot-compresses and massage at home. Some patients prefer having this procedure
every few months due to the long-term relief it provides.

IPL treatment for MGD

An exciting new treatment for MGD is now available at Innovative Eye Care. Intense
Pulsed Light treatment shows exciting promise for patients with MGD. It involved three
treatments over the course of 6 weeks at the clinic with your optometrist. For more
information please visit our IPL treatment page here
(http://www.innovativeeyecare.com.au/what-we-do-article/VZyq_hwAAAgNQRe0
/ipl-treatment-for-meibomian-gland-dysfunction).

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Therapeutic Intervention for MGD

There are several therapeutic options which are useful in MGD management:

Systane Balance eye drops have been formulated to provide relief for MGD
patients. These drops have an oil component that helps to stabilise the lipid
layer of the tear lm and prevent evaporation. They can be used twice a day or
when required, for up to 6 months after the bottle is opened.

Optimel is an ophthalmic ointment derived from antibacterial manuka honey. In

MGD there is often an overgrowth of natural bacterial ora which a ects
meibomian gland secretions. Using this new product can decrease the
overgrowth and restore normal meibomian gland function. Recommended
dosage is a small 2mm amount placed under the bottom lid three times a day.
Due to its nature, Optimel is preservative free. Be aware that it does sting a
little on insertion! The eye drop form of optimel has a lower concentration of
the active component, but it does sting a little less! Find Optimel Antibacterial
Manuka Eye Drops at our shop. (http://eyesolutions.com.au/collections/dry-eyetreatments/products/optimel-antibacterial-manuka-eye-drops)

Oral antibiotics, such as doxycycline, used at a low dosage (50mg a day) in

conjunction with your GP have been show to have an anti-in ammatory e ect
which helps MGD patients improve their gland function. Oral antibiotics are
generally only reserved for moderate to severe forms of the conditions that do
not respond to other treatments. Ask your optometrist if you need oral
antibiotics for your MGD before commencing treatment.

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There are constant updates in the eld of MGD research and treatments. Be sure to
ask your optometrist if you have any questions about your recommended treatment.

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Woodville, SA 5011

(08) 8445 9050 (tel:0884459050)

ADELAIDE CITY
60 Hutt Street

Adelaide, SA 5000

(08) 8231 9341 (tel:0882319341)

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