Meibomian Gland Dysfunction (MGD)

What the meibomian glands do

Each eyelid contains 20 to 40 meibomian glands, which open in a row just behind the lashes. With each blink they release a thin layer of oil (meibum) that floats on top of the tear film and slows evaporation. In MGD:

• gland openings become blocked by thickened oil and keratin
• the oil turns thick, cloudy or toothpaste-like
• tears evaporate too fast, causing dryness and inflammation
• over time, glands can shrink and drop out permanently

Causes and risk factors

• age, especially over 40
• prolonged screen use, which reduces blinking
• contact lens wear
• rosacea, especially ocular rosacea
• seborrheic dermatitis and dandruff
• Demodex mites
• eye makeup, eyeliner on the inner lid margin, and makeup not removed at night
• hormonal changes, including menopause and androgen deficiency
• medicines such as isotretinoin, antihistamines and some antidepressants
• Asian ancestry (higher prevalence in several studies)

Symptoms

• burning, stinging or grittiness
• dryness, especially later in the day
• red eyes and red lid margins
• watery eyes (reflex tearing)
• blurred or fluctuating vision that clears with blinking
• crusting or frothy tears at the lid edges
• light sensitivity
• contact lens discomfort
• recurrent styes and chalazia

MGD vs aqueous-deficient dry eye

Many people have both types. See dry eye.

Diagnosis

An optometrist or ophthalmologist will:

• examine the lid margins with a slit lamp for capped or plugged gland openings and abnormal blood vessels
• press gently on the lid to see the quality and quantity of oil
• measure tear breakup time with fluorescein dye
• assess tear volume and inflammation
• image the glands (meibography) to see gland loss in some clinics

Treatment

Daily home care

1. Warm compresses: apply a heated eye mask or warm washcloth to closed eyes for 5 to 10 minutes. The oil in blocked glands melts at temperatures slightly above body temperature, so steady warmth matters. Microwavable or electric eye masks hold heat better than washcloths.
2. Lid massage: immediately after warming, gently roll a clean fingertip along each lid toward the lashes to express the oil.
3. Lid hygiene: clean the lid margins with a lid cleanser or diluted baby shampoo. See blepharitis.

Do this once or twice daily. Improvement takes several weeks, and the routine usually needs to continue long term.

Eye drops

• preservative-free artificial tears, especially lipid-containing drops
• perfluorohexyloctane drops, approved for dry eye from MGD
• anti-inflammatory drops such as cyclosporine or lifitegrast for associated inflammation
• short courses of steroid drops under supervision
• lotilaner drops when Demodex mites are present

Oral medicines

• doxycycline or minocycline at low doses for several weeks to months, which improve oil quality and reduce inflammation (avoid in pregnancy and young children)
• azithromycin, oral or topical, as an alternative
• omega-3 supplements: evidence is mixed

In-office treatments

• thermal pulsation: devices that heat and massage the lids from inside and outside
• intense pulsed light (IPL): light treatment along the cheeks and lids, especially helpful with rosacea
• gland probing and expression by a clinician

Lifestyle

• take screen breaks and blink fully
• use a humidifier and avoid direct air from vents and fans
• remove eye makeup fully every night and avoid eyeliner on the inner lid edge
• stay hydrated

Outlook

MGD is usually chronic, but symptoms can be well controlled. Early treatment helps preserve the glands, because glands that have shrunk away do not regrow.

Frequently asked questions

What is meibomian gland dysfunction?

It is a condition in which the oil glands in the eyelid margins become blocked or produce poor-quality oil. Without a healthy oil layer, tears evaporate too quickly, causing dry, gritty, burning eyes. It is the most common cause of dry eye.

What causes meibomian gland dysfunction?

Common causes and risk factors include aging, reduced blinking during screen use, contact lenses, rosacea, seborrheic dermatitis, eye makeup, Demodex mites, hormonal changes and certain medicines such as isotretinoin.

How do you unclog meibomian glands at home?

Apply a warm compress or heated eye mask for 5 to 10 minutes to melt the thickened oil, then gently massage the lids toward the lashes. Clean the lid margins afterwards. Repeat daily. Persistent blockage may need in-office treatment.

Can meibomian gland dysfunction be cured?

It is usually a long-term condition, but daily lid care, medicines and in-office treatments control symptoms well for most people. Early treatment helps protect glands from permanent loss.

Is meibomian gland dysfunction the same as blepharitis?

They overlap. MGD is often called posterior blepharitis because it affects the inner edge of the lid where the oil glands open. Anterior blepharitis affects the lash line. Many people have both.