Are you at risk of meibomian gland dysfunction (MGD) and dry eyes syndrome as you age?
Ageing is the best-known risk factor for meibomian gland dysfunction (MGD). Alas yes, with increasing age, the meibomian gland acinar epithelial cells atrophy and so they produce less lipid. The lipid they do produce or the meibum they produce has a different composition regarding its non-polar and polar lipid profiles.
Ageing meibomian glands have
- decreased meibocyte differentiation,
- a slower turnover of meibocyte cells,
- a decreased meibomian gland size and
- increasing inflammatory cell infiltrate
These factors lead to a change in the expression of various enzymes and proteins which are regulatory from meibocyte differentiation and lipid formation necessary for the formation and function of the meibomian glands. I do not want to make this blog post too scientific, but there is something called PPAR gamma peroxisome proliferator-activated receptor gamma.
PPAR is a nuclear receptor protein which helps to regulate the meibocyte growth and lipid production important for the formation and function of meibomian glands. There is what is called down-regulation of PPAR gamma with age, and this causes fewer meibocytes to form and less lipid synthesis with age, leading to the gland atrophy and the hypersecretory state.
If with ageing the meibomian glands are atrophying and secreting less lipid, you will get dry eyes, and the sensations you may get can be grittiness, burning, tiredness, reflex watering and blurred vision amongst the most common symptoms.
So, if you do not have enough meibum lipid in front of the tear film, your tears will evaporate more quickly, and this is called evaporative dry eye (EDI). Evaporative dry eye leads to disruption of the smooth and healthy ocular surface tear film to cornea and conjunctiva and leads to the dry eye symptoms in many individuals.
The role of ageing in the development of dry eyes is the most known and most prevalent cause of evaporative dry eye. Hence, ageing is called a risk factor for meibomian gland dysfunction and subsequent evaporative dry eye.
However, all is not lost. There is a lot you can do to prevent, reduce and improve your MGD as you age.
Similar to how we can look after our bodies and keep fit as we get old, we can also include in this looking after our eyelids.