Meibomian gland dysfunction

1. MGD Unplugged…
Rashad Ibn Muhammed
M Optom 3rd Sem

2. Meibomian Gland Dysfunction
1. Introduction
2. Anatomy
3. Physiology
4. Etiology/Pathophysiology
5. Signs
6. Symptoms
7. Treatment
8. Message

3. Introduction
• Recommended definition of MGD: 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.
Investigative Ophthalmology & Visual Science, Special Issue 2011, Vol. 52, No. 4

4. Anatomy
• First mentioned by Galenus in 200 AD
• Then decribed in detail by German physician
and anatomist Heinrich Meibom in 1666
• Present at Upper and lower tarsal plate of
eyelids
• Arranged vertically
• Length of tarsel plate
• UL longer than LL

6. • Secreates Meibum and protein
• Volume of UL glands 26(ul)are double than LL
glands 13(ul)
• No. of Glands
– UL : 25-40
– LL : 20-30
• Central duct is wider in LL
• Excretery duct has an opening called as
orifices

7. Pathway
Meibum Ductule
Orifices
Blink
OUT
Acini
Externl
ductule

8. • Melting point of Meibum 32-350C
• Recoverytime Afterfull expression - 2 hours

9. Etiology
• Obstructive (Hyposecreatory)
• Non obstructive (Hypersecreatory)
• Prevalence 60-70% in Asian population

11. Pathophysiology
• Hyperkeratinisation of the Excretory duct and
orifices = Obstruction =increased
intraglandular pressure= Degenerative dilation
of ductal system = Hyposecretion due to loss
of meibocytes = gland atrophy= cell stress
trigger inflammation

12. Symptoms
• Burning
• Itching
• Redness
• Watering
• Visual fluctuation

13. Signs
• Telangiectasia
• Capping of orifices (concretions,Plugging)
• Reduction of orifices
• Abnormal secretions
– Foamy,granular,toothpaste
– Lidmargin keratinisation

14. Telangiectasia

15. Inspissated Orifices

16. Factors associated with MGD
• Age
• Race
• Hormonal changes
• CL wear
• Acne
• Sjogrens syndrome
• SJS
• Anti histamins,Anti histamin, retinoid drugs

17. Investigations
• Slitlamp examination
Lid abnormalities
• Expression on the lids
• Meibography
• Fluorescein staining
• TBUT

19. Complications
• DES
• Acne rosacea
• Lid margin diseases

20. Treatment
• Topical
• Oral
• Lid huygene
• Thermal pulasation
• Intense pulse light
• Nutrition

21. Topical
• Topical antibiotics
Azithromycin
– Anti inflammatory
– Inhibit protein synthesis
Restasis
– Cyclosporin
– Immunosuppresent
Tear supplement

22. Oral
1. Tetracyclin
– Suppress Microbial lipase production
– Reduce free fatty acids
– Reduce inflammation

23. Lid hygiene
• Lid cleaning
• Lid massage
• Lid scrubs
• Warm compression

24. Thermal pulsation
• Using an instrument,
• Heat is applied to palpebral surface of upper
and lower eyelids over the MGs and the outer
eye lid massaged expressing the heated oils
• 12 minutes per eye
• In offie treatment

26. Intense pulse light
• Broad spectrum light has been applied over
the lids for 5 minutes
• Thus this light heats up the meibimian gland
liquifying solid meibum
• In Hospitel therapy

27. Nutrients
• Omega 3 fatty acids

28. References
1. http://www.reviewofoptometry.com/content/c/15811/
2. http://www.reviewofophthalmology.com/content/d/thera
peutic_topics/i/1302/c/25069/
3. http://www.aapos.org/terms/conditions/141
4. http://iovs.arvojournals.org/article.aspx?articleid=212629
5
5. Investigative Ophthalmology & Visual Science, Special
Issue 2011, Vol. 52, No. 4
6. http://www.aao.org/eyenet/article/rethinking-
meibomian-gland-dysfunction-how-to-spot?julyaugust-
2011
7. http://www.medscape.com/viewarticle/840051

29. Questions???
1. Opening of Meibomian gland is called as
2. Main classification of MGD
3. Treatment options of MGD