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Meibomian Gland Dysfunction – Regaining good Meibomian function

I saw a young woman as a patient last week who had blepharitis and meibomian gland dysfunction, and she immediately pricked up her ears and said: “well, if I have got meibomian gland dysfunction, what can I do to make my eyelids function well again?” It has taken me several years to realise that that is the main message I should have for patients with blepharitis and problems with their oily glands resulting in dry eyes and chalazion. All treatment and lid hygiene has to be directed at improving the function of the eyelids.
What are the functions of the eyelids? The role of the eyelids is to cover the eyes and protect them through blinking and by being closed when asleep. Also, the eyelids help spread the tears over the surface of the eye with every blink. The tears consist of a watery component, an oily component and a small mucous component, approximately in layers, with the oily layer more superficial, the main bulk of aqueous sandwiched in between the oily and mucin layers. The oily component is produced by the Meibomian glands in the eyelids and helps keep the tears on the eye surface moist by reducing the tear evaporation.
In particular, improving the function of the oil glands which get inflamed and blocked with blepharitis, meibomian gland dysfunction (MGD) and chalazion will help improve the eyelid function. Often in patients with MGD the meibum, which is oil from the meibomian glands, is quite yellow and solid like butter or lighter and creamy white like toothpaste, and this is completely abnormal, and of course, the eyelid function of helping to produce and spread good quality tears is affected.
The primary role of the oily Meibomian glands is to stop the tears evaporating, and our main aim of treating meibomian gland dysfunction is to help the patient to get the best possible oil secreted from their glands to stop their tears from evaporating and provide them with a healthy external eye environment.
Ways of improving eyelid meibomian gland function include heating the eyelids, massaging and cleaning the lash roots; all of which can be done twice a day long term. Also, trying to improve the diet so as to include more oily fish such as sardine, mackerel or salmon, can help improve the quality of the meibum. I heard today that the price of salmon has unfortunately gone up by about 14% to 20% in some areas. Therefore, we should be looking at the slightly cheaper oily fish like smoked mackerel, fresh sardine, tinned sardines all of which help to provide excellent sources of Omega 3. Other good sources of Omega 3 include flaxseed oil and nuts.


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