Meibomitis: Symptoms, Causes and Treatment

Meibomitis describes an inflammatory condition that affects the meibomian (oil-producing) glands in the upper and lower eyelids. These glands are oriented vertically and open at the eyelid surface. Meibomian glands have a role to secrete meibum, a substance made up primarily of oil and some protein, into the tear film.

Meibum serves as a protective layer for our tears, preventing them from evaporating. When the meibomian glands become clogged and inflamed, meibomitis results; this is also referred to as meibomian gland dysfunction (MGD).

In MGD, the lack of oil in the tear film results in increased evaporation, causing dry eyes. In fact, meibomitis is one of the primary contributing factors to dry eye syndrome. An estimated 86% of patients with dry eye symptoms have MGD.

Symptoms

The symptoms of meibomian gland dysfunction are very similar to those of dry eyes. These include burning, stinging, grittiness, irritation, a scratchy sensation, and a feeling like something is in the eye. Counterintuitively, dry eyes may water excessively as a compensatory response. With meibomitis, the eyelids may look red, tender, and irritated. The eyelashes may be matted, and fall out more easily.

Vision can be affected in meibomitis, since good vision requires a stable tear film. Some people experience a constant blur, while others experience an intermittent haze that clears up with every blink, then gradually becomes blurry again.

Causes

While meibomitis research is ongoing, an absolute cause for the condition has not been identified. However, there are several factors thought to increase the risk of developing it.

  • Aging. Age is a risk factor for MGD and dry eye. The eyelid margins change texture, as does the makeup of the oily secretions. Declining hormone levels may play a role in the increased MGD seen with age as well.
  • Hormones. Sebaceous glands throughout the body, including the meibomian glands, are affected by hormone levels. There are hormone receptors in the meibomian glands that are sensitive to estrogen and testosterone levels. The age-related decline in androgens, such as testosterone, has been found to negatively impact meibomian gland function.
  • Medical conditions. Certain medical conditions can make a person more prone to the development of meibomitis. For example, an estimated 75-86.2% of patients with rosacea have MGD. Meibomitis is also more common in people with Sjogren’s syndrome.
  • Screen time. Digital device use may also contribute to meibomitis by decreasing the blink rate.
  • Medications. Certain medications may play a role in the development of MGD. For example, isotretinoin, a medication commonly used in acne, targets sebaceous glands and therefore impacts the meibomian glands. This effect may be reversible. Topical anti-aging treatments used around the eyes often contain retinoic acid, which can contribute to MGD.
  • Contact lens wear. Wearing contact lenses also contributes to the development of MGD.

Treatments

There are several treatments known to be of benefit for the treatment of meibomitis. Depending on the severity of your condition, your doctor may recommend the following:

  • Warm compresses. The use of a warm washcloth with some gentle massage to the eyelids can promote the flow of meibum out of the glands. The heat helps to melt the oils and the massage helps to release them into the tear film. There are also electric and microwaveable heat packs available specifically for this purpose.
  • Artificial tears. Supplementing the tear film with artificial tears can help to relieve the symptoms of dryness associated with MGD. It may be more beneficial to use a lipid-containing product, which helps to make up for the deficient meibum in the tear film.
  • Oral medication. Sometimes, medications in the tetracycline family are prescribed orally to help with decreasing inflammation and promoting oil secretion.
  • Thermal pulsation. Thermal pulsation is a treatment specifically designed for the treatment of MGD. It is performed in the offices of optometrists and ophthalmologists. The treatment involves the use of a machine to deliver heat and pressure to the eyelids. The goal is to evacuate the glands of stagnant oil, to allow them to open up and flow more freely.
  • Intense pulsed light. Intense pulsed light (IPL) is another in-office treatment offered by eye doctors. It uses a lamp to deliver high-intensity light to the eyelids. IPL treats MGD by reducing inflammation and eliminating abnormal blood vessels.

Summary

Meibomitis is a common condition that affects an estimated 35.8% of the population around the world. When the meibomian glands don’t function as they should, the eyes feel dry and irritated. There are several factors that can increase the risk of developing MGD, including aging, hormones, and medications. Many treatments are available, ranging from warm compresses to prescription medications to in-office procedures. It’s important to realize that none of these treatments are able to permanently eliminate meibomitis; however, they can offer substantial help in managing the condition and its symptoms.

References

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Ding J, Sullivan DA. Aging and dry eye disease. Exp Gerontol. 2012;47(7):483-490. doi:10.1016/j.exger.2012.03.020

Galor, A. MGD: Definition Versus Dry Eye Disease, Risk Factors. Curr Ophthalmol Rep 2, 58–64 (2014). doi:10.1007/s40135-014-0040-x

Kocamiş Ö, Temel E, Aşikgarip N, Örnek K. Electronic Device Screen Time and Meibomian Gland Morphology in Children. J Ophthalmic Vis Res. 2021;16(4):531-537. Published 2021 Oct 25. doi:10.18502/jovr.v16i4.9741

Neudorfer M, Goldshtein I, Shamai-Lubovitz O, Chodick G, Dadon Y, Shalev V. Ocular Adverse Effects of Systemic Treatment With Isotretinoin. Arch Dermatol. 2012;148(7):803–808. doi:10.1001/archdermatol.2012.352

Rabensteiner DF, Aminfar H, Boldin I, Schwantzer G, Horwath-Winter J. The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population. Acta Ophthalmol. 2018;96(6):e707-e711. doi:10.1111/aos.13732

The ABCs of MGD. Aoa.org. https://www.aoa.org/news/clinical-eye-care/diseases-and-conditions/the-abcs-of-mgd?sso=y. Published 2018.

Understanding MGD. Aoa.org. https://www.aoa.org/news/clinical-eye-care/diseases-and-conditions/understanding-mgd?sso=y. Published 2018.

Viso E, Millán AC, Rodríguez-Ares MR. Rosacea-associated meibomian gland dysfunction-An epidemiological perspective. European Ophthalmic Review. 2014;8(1): 13-16.

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