Meibomian gland dysfunction

1. MEIBOMIAN GLAND
DYSFUNCTION
MUHAMMAD MAGDY ABD ELRAZEQ
MSC OPHTHALMOLOGY
FICO

2. MEIBOMIAN GLANDS
• Meibomian glands are large sebaceous glands present in eyelids which secrete
lipids that form the superficial layer of tear film to protect evaporation of the
aqueous phase. There are about 25-40 glands in the upper eyelid and about 20-
30 in the lower eyelid.

4. THE INTERNATIONAL WORKSHOP ON
MEIBOMIAN GLAND DYSFUNCTION:
• Recommended definition of Meibomian gland dysfunction (MGD) : is a chronic,
diffuse abnormality of the meibomian glands, commonly characterized by terminal
duct obstruction and/or qualitative/quantitative changes in the glandular secretion.
This may result in alteration of the tear film, symptoms of eye irritation, clinically
apparent inflammation, and ocular surface disease. The International Workshop
on Meibomian Gland Dysfunction 2011

5. POSTERIOR BLEPHARITIS??!!
• Posterior blepharitis is a term used to describe inflammatory conditions of the posterior lid margin,
of which MGD is only one cause. Other causes include infectious or allergic conjunctivitis and
systemic conditions such as acne rosacea.

6. EPIDEMIOLOGY
• MGD is an underdiagnosed and undertreated disease and asymptomatic MGD is more
common than the symptomatic MGD.It is estimated that 70% of Americans over the age
of 60 have MGD.

7. RISK FACTORS
• Aging
• Sex hormone deficiency
• Contact lens wear, chronic blepharitis, eyelid tattooing, trachoma, aniridia
• Drugs : Isotretinoin , Antihistaminics ,Hormonal replacement therapy, antibiotics,
antidepressants
• Demodex blepharitis
• Atopy , Steven johnson syndrome , Polycystic Ovary syndrome , Sjogren’s
syndrome ,hypertension

8. PATHOPHYSIOLOGY
• MGD is a highly complex disease condition that is associated with or caused by several
host, microbial, hormonal, metabolic and environmental factors.

10. SYMPTOMS
• Redness.
• Tearing
• Irritation.
• Photophobia.
• Blurring of vision
• Eyelids crusting and sticking.

11. SYMPTOMS
• Symptoms commonly worsen in the morning and patients have exacerbations
and remissions.

12. DIAGNOSIS
• The diagnosis of MGD is based on examining the altered anatomical features such as
terminal duct obstruction, gland drop out, qualitative and quantitative changes in
meibum and pathological events leading to MGD.
• The International Workshop on Meibomian Gland Dysfunction recommended several
diagnostic tests for MGD and proposed two approaches for diagnosing symptomatic
MGD-related disease. For asymptomatic adults, performing gland expression with digital
pressure to the central lower lid followed by assessing ocular surface damage is
recommended. Presence of ocular surface damage or anatomical changes warrants
Meibomian gland functionality should be assessed.

14. STAGING

15. MANAGEMENT
• Blepharitis is a chronic condition with frequent exacerbation. Currently, standard therapy
is directed at control of symptoms and inflammatory signs. A Cochrane review evaluated
34 chronic blepharitis intervention studies and found no strong evidence to suggest that
any of the studied treatments resulted in a cure.
• General treatment : Eyelid hygiene , warm compresses and scrubs.
• Eyelid hygiene should be continued after acute exacerbations
resolve.

16. MEDICAL THERAPY
• Topical treatment :
Azithromycin 1.5% eye drops 2 times daily for 5 days.
Topical steroids: Short courses of topical steroids have been found beneficial for
symptomatic relief in cases with clinically significant ocular inflammation.
Lubricants (artificial tears) : lipid containing eye drops ,if more than 4 times daily
better to use preservative free eye drops.

17. MEDICAL THERAPY
• Oral antibiotics :
Doxycycline 100 mg / day.
Should be avoided during pregnancy and lactation and children.
Erithromycin can be used in children.
Azithromycin

18. OTHER LINES OF TREATMENT
• Omega 3 fatty acids.
• Intraductal meibomian gland probing to reopen MG orfices mechanically

19. OTHER LINES OF TREATMENT
• Demodex treatment :
Tea tree oil : blephademodex
Ivermectin
Blephex

20. LIPIFLOW
• LipiFlow® (TearScience®, Morrisville, NC, USA) is a thermal pulsation system that applies
heat and pressure to the eyelid tissue simultaneously to express the meibomian glands.
• Cost issues and
Efficacy limit
Access to treatment.

21. INTENSE PULSED LIGHT IPL
• Intense pulsed light (IPL) is a relatively novel treatment for DED due to MGD.
The technique has been used in dermatology for over a decade for the treatment
of rosacea, acne and skin lesions like benign cavernous hemangioma and
telangiectasia.
• The technique uses a polychromatic light with a wavelength spectrum of 500–
1200 nm which is directed to the skin and absorbed by
chromophores such as melanin, hemoglobin and water
with the development of heat, thus inducing blood vessels ablation

22. PROGNOSIS
• Blepharitis is a chronic condition that has periods of exacerbation and remission.
Patients should be informed that symptoms can frequently be improved but are rarely
eliminated.

23. TAKE HOME MESSAGE
• Don’t underestimate MGD.
• Inform patient about chronicity , remissions and exacerbations.