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Meibomian Gland Dysfunction

Meibomian gland dysfunction is a well recognised cause of dry eyes. Over {the} years, there has been a great deal of confusion regarding classification of this condition but recently, a detailed document has been produced that describes various aspects of this disease. This report was drafted by a panel of experts for {the} Tear, Film and Ocular Surface Society (TFOS) and provides a detailed guideline on classification and treatment of meibomian gland dysfunction.

It is an unfortunate fact that this condition is a rather under-recognised one. These new guidelines however have shed some interesting light on this condition. There are certain aspects of meibomian gland dysfunction that have an impact on {the} outcomes following anterior segment surgery. It is believed that {the} final {result} with regards to a patient’s vision depends primarily on {the} status of {the} film of tears from {the} eyeball. It is essential to have a good ocular surface in order for any surgery to be successful.

Another aspect that has been noticed with regards to surgical outcomes is {the} status of {the} tear film and its irregularities. This can cause inaccurate readings of {the} power of {the} eye which can in turn {result} in an error in prescription of intraocular lenses. In {addition}, patients who have meibomian gland dysfunction are at higher risk of developing infections and inflammation of {the} eye following cataract surgery.

Essential terminology Meibomian gland dysfunction

There are certain aspects of meibomian gland dysfunction that one needs to be aware of. These are closely related to {the} pathogenesis and pathophysiology of this condition. Below is a list of some of {the} commonly mentioned terms in {the} genesis of MGD.

  1. Blepharitis - this is a clinical condition that is characterised by inflammation of {the} entire eyelid. Inflammation that only involves {the} margin of {the} island is called marginal blepharitis.
  2. Anterior blepharitis refers to inflammation of {the} eyelid that lies in front of {the} gray line. Inflammation here can extend to {the} posterior eyelid margin.
  3. Posterior blepharitis refers to inflammation of {the} posterior aspect of {the} eyelid margin.
  4. Meibomian gland dysfunction is defined as a chronic abnormality that affects meibomian glands and one that is characterised by obstruction of {the} terminal ducts and an alteration in {the} secretion of {the} glands. In essence, it results in a destruction of {the} eyelid films and can make {the} eye rather dry.

The meibomian gland

The meibomian glands are specialised glands that are present at {the} removal of {the} eyelids. They are sebaceous glands that are responsible for {the} secretion of meibum, and oily substance that allows {the} tear film to stay on {the} eyeball and prevents it from getting evaporated. In {addition}, meibum prevents tears from pouring out of {the} eyeball onto {the} cheeks by forming a barrier between {the} eyelids and {the} eyeball.

The meibomian glands are located within {the} castle plates of {the} eyelids. Anatomically, there are around 50 glands in {the} upper eyelid and around 25 meibomian glands in {the} lower eyelids. The secretions from {the} meibomian glands are sebaceous and typically rich in lipids. Overall, research has shown that {the} meibomian gland secretions contain over 90 different kinds of proteins.

Pathogenesis of Meibomian gland dysfunction

Meibomian gland dysfunction results from reduced secretion of meibum from {the} meibomian glands or from excessive secretions as well. The former is called a low delivery state while {the} latter is called a high delivery state.

As is evident from {the} discussion above, meibomian glands are essential to keep {the} eyes healthy. Unfortunately, in {the} event that these glands become dysfunctional, {the} eyes can become dry. Furthermore, inflammation of {the} meibomian glands, {sometimes} called meibomitis, can {result} in obstruction of {the} glands by its own secretions. This results in bacterial overgrowth, increased formation of free fatty acids, irritation of {the} eyes and {the} development of dry eyes and keratopathy.

Diagnosing eyelid problems of Meibomian gland dysfunction

There are certain ways through which meibomian gland dysfunction can be identified. A slit lamp examination or simple meibum analysis {may} be sufficient. Once meibomian gland dysfunction has been detected, patients {may} require some form of surgery once this has been controlled through medical measures.

Effect on quality of life related to Meibomian gland dysfunction

There is concern that MGD can affect a patient’s quality of life rather substantially. Patients can struggle to wear contact lenses and {may} even find that their eyes look rather unsightly and puffy. This can have an impact on their personal and professional lives. 

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