A new study is providing hard data for a claim optometrists have been making for years: meibomian gland dysfunction (MGD) contributes substantially to the burden of ocular discomfort. The research, published in the May edition of the Icelandic journal Acta Ophthalmologica looked at the experiences of 1,372 dry eye patients and found that a whopping 70.3% of them had signs of MGD.1

This study retrospectively used medical records from an Austrian clinic to evaluate symptoms and objective tear film and ocular surface parameters. The researchers classified patients into categories of pure MGD, pure aqueous tear deficiency (ATD), MGD combined with ATD, pure anterior blepharitis (AB), Sjogren's syndrome (SS) without MGD and SS together with MGD. “Although the intensity of subjective complaints was similar to all other subgroups, pure MGD exhibited the lowest severity of signs of ocular surface damage and also affected younger people,” the study says.

“The results of this study demonstrate the importance of thorough evaluation of the meibomian glands in all of our patients. We are fortunate today to have diagnostic tools from the simple meibomian gland expression to the meibography which are tremendously useful in MGD detection,” says Chandra Mickles, OD, the Dry Eye Service coordinator at Nova Southeastern University.

Optometrists can identify MGD by looking for notching—particularly in the lower eyelid, which is responsible for the majority of oil in the tear film—that is a sign of gland atrophy. Additionally, an OD can use a wet cotton-tip applicator or one of several devices on the market to aid in the expression of the nasal to central lower eyelid glands, and observe both how many glands express and the quality of the meibum. According to Paul Karpecki, OD, “healthy meibum is clear like olive oil and easily expresses, barely noticeable when rolling off the eyelid. A turbid expression or paste-like or non-expressive glands are indicative of further progression of the disease.”2,3

“Careful assessment of MGD in the mindset of clinicians should lead to appropriate clinical management and ultimately improve patient outcomes,” Dr. Mickles says.

1. Rabensteiner D, Aminfar H, Boldin I, et al. The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population. Acta Ophthalmologica. 2018. onlinelibrary.wiley.com/doi/abs/10.1111/aos.13732. Accessed May 22, 2018.
2. Karpecki P. Finding MGD in DED. Rev Optom. 2015;152(7):24-8.
3. Hom MM, Silverman MW. Displacement technique and meibomian gland expression. J Am Optom Assoc. 1987 Mar;58(3):223-6.