Meibomian gland (
MG) dysfunction (MGD) is a multifactorial,
chronic condition of the eyelids, leading to eye irritation,
inflammation and ocular surface disease. Initial
conservative therapy often includes a combination of warm compresses in addition to baby shampoo or eyelid wipes. The practice of lid hygiene dates back to the 1950s, when
selenium sulfide-based shampoo was first used to treat seborrhoeic
dermatitis of the eyelids. Today, tear-free baby shampoo has replaced
dandruff shampoo for MGD treatment and offers symptom relief in selected patients. However, many will not achieve significant improvement on this
therapy alone; some may even develop an
allergy to the added
dyes and fragrances in these products. Other manual and mechanical techniques to treat MGD include MG expression and
massage, MG probing and LipiFlow(®). While potentially effective in patients with moderate MGD, these procedures are more invasive and may be cost prohibitive. Pharmacological treatments are another course of action. Supplements rich in
omega-3 fatty acids have been shown to improve both MGD and
dry eye symptoms.
Tea tree oil, specifically the terpenin-4-ol component, is especially effective in treating MGD associated with Demodex mites. Topical
antibiotics, such as
azithromycin, or systemic
antibiotics, such as
doxycycline or
azithromycin, can improve MGD symptoms both by altering the ocular flora and through anti-inflammatory mechanisms. Addressing and treating concurrent ocular
allergy is integral to symptom management. Topical
N-acetylcysteine and topical
cyclosporine can both be effective therapeutic adjuncts in patients with concurrent
dry eye. A short course of topical
steroid may be used in some severe cases, with monitoring for
steroid-induced
glaucoma and
cataracts. While the standard method to treat MGD is simply warm compresses and baby shampoo, a more tailored approach to address the multiple aetiologies of the disease is suggested.