Management of Meibomian Gland Dysfunction: A Review

MGD is the main cause of evaporative dry eye, characterized by meibomian gland duct obstruction and/or glandular secretion changes, which affect tear film stability and reduce quality of life. The treatment goal is to improve meibomian gland secretion and restore tear film stability.

Pharmacological Treatment:

Antibiotics: Tetracyclines regulate immune cell function and treat MGD by inhibiting bacterial lipases and inflammatory molecules. Minocycline is effective but has photosensitivity and gastrointestinal side effects, and is contraindicated for pregnant women and children. Azithromycin can reduce bacterial growth and inhibit inflammation, effective both topically and orally, although oral administration may lead to cardiac side effects.

Anti-inflammatory Drugs: Cyclosporine A inhibits T-cell proliferation and improves MGD symptoms but may cause stinging. Lifitegrast blocks T-cell binding, alleviating dry eye symptoms, but its efficacy in MGD requires further study. Corticosteroids are effective for acute MGD inflammation but should be used cautiously due to potential risks. Anakinra, an IL-1 receptor antagonist, has no research on its effect on MGD and is not available in the U.S.

Hormones: Androgens promote meibomian gland lipid secretion, while estrogens have the opposite effect. There is limited research on hormone therapy for MGD, and current evidence is insufficient to support widespread use.

Essential Fatty Acids: Omega-3 fatty acids have anti-inflammatory effects, and some studies suggest that oral supplementation can improve MGD symptoms, though results are inconsistent.

Demodex Treatment: Tea tree oil effectively treats blepharitis associated with Demodex mites and other treatments such as mercury oxide and ivermectin may also be used for Demodex infection.

Surgical Treatment:

Meibomian Gland Expression: Meibomian gland duct probing can mechanically open obstructed ducts, improving symptoms and signs. Dynamic probing techniques have shown good results. Devices like LipiFlow® use heat and pulsatile pressure to promote meibomian gland secretion, while studies on MiBo Thermoflo® are limited.

Intense Pulsed Light Therapy: Intense pulsed light improves MGD symptoms through various mechanisms, including reducing vascular abnormalities, promoting meibomian secretion, and anti-inflammatory effects. Most studies show it is effective with minimal side effects.

Neurostimulation: Nasal tear neurostimulation increases tear secretion and lipid production through the nasolacrimal reflex, improving MGD symptoms.

Conclusion:

There are various treatment options for MGD, but high-quality research is scarce. Clinical treatment should consider individual patient conditions when selecting the appropriate therapy. Future randomized controlled trials are needed to clarify the efficacy of each treatment and establish the order of their application.

journal homepage: https://www.surveyophthalmol.com/article/S0039-6257(19)30253-X/abstract