Alisha Regmi, M. Optom

Postgraduate in Optometry (M.Optom), The Sankara Nethralaya Academy, Chennai, India

Meibomian Gland Dysfunction (MGD) is a chronic and diffuse abnormality of the Meibomian Glands which is commonly characterized by terminal meibomian duct obstruction and/or qualitative/quantitative changes in the glandular secretion” as defined by International Workshop on MGD. ⁽¹⁾ The prevalence of MGD ranges from 3.6% to 68.0%. ^(2-5)  Evaporative dry eye, the most common type of dry eye ⁽⁶⁾ is mainly caused due to MGD, unstable lipid layer due to changes in quality and quantity of meibomian gland secretion. ⁽⁷⁾   It can further increase the evaporation of the underlying aqueous layer too. ⁽⁸⁾  

Table 1: Conventional Diagnostic Criteria for MGD proposed by Japanese MGD working group ⁽⁹⁾

International Workshop on MGD recommended the following tests for diagnosis of MGD-related disease in the general clinical setting: symptom questionnaire, blink rate, tear meniscus height, tear osmolality, and tear breakup time, fluorescein staining, Schirmer test, and slit-lamp findings (lid changes, meibum expressibility / quality). ⁽¹⁰⁾

Table 2: Recent Diagnostic tools for MGD

    Figure-1: Lipiview-II interferometer ⁽¹¹⁾

Figure-2: Lipiscan ⁽¹²⁾

Figure-3: Vivo confocal microscopy (IVCM) showing the stage of MGD. (a) Normal meibomian glands; (b) lumen obstruction with minimal inflammation; (c)Intra-epithelial, and inter-glandular  inflammation; (d) fibrosis with epithelium destruction. ⁽¹³⁾

Management of MGD

 Table 3: Showing sequence of treatment addition algorithm proposed by International Workshop on MGD ⁽¹⁴⁾ (added based on the severity of MGD)

Table 4: Recent therapeutic modalities

Figure-4: Lipiflow thermal pulsation system ⁽¹⁵⁾

Figure-5: Intense pulsed light treatment in Meibomian gland dysfunction ⁽¹⁶⁾

References

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