Meibomian gland dysfunction is a well recognised cause of dry eyes. Over the years, there has been a great deal of confusion regarding classification of this condition but recently, a detailed document has been produced that describes various aspects of this disease. This report was drafted by a panel of experts for the Tear, Film and Ocular Surface Society (TFOS) and provides a detailed guideline on classification and treatment of meibomian gland dysfunction.
It is an unfortunate fact that this condition is a rather under-recognised one. These new guidelines however have shed some interesting light on this condition. There are certain aspects of meibomian gland dysfunction that have an impact on the outcomes following anterior segment surgery. It is believed that the final result with regards to a patient’s vision depends primarily on the status of the film of tears from the eyeball. It is essential to have a good ocular surface in order for any surgery to be successful.
Another aspect that has been noticed with regards to surgical outcomes is the status of the tear film and its irregularities. This can cause inaccurate readings of the power of the eye which can in turn result in an error in prescription of intraocular lenses. In adds to, patients who have meibomian gland dysfunction are at higher risk of developing infections and inflammation of the eye following cataract surgery.
There are certain aspects of meibomian gland dysfunction that one needs to be aware of. These are closely related to the pathogenesis and pathophysiology of this condition. Below is a list of some of the commonly mentioned terms in the genesis of MGD.
The meibomian glands are specialised glands that are present at the removal of the eyelids. They are sebaceous glands that are responsible for the secretion of meibum, and oily substance that allows the tear film to stay on the eyeball and prevents it from getting evaporated. In adds to, meibum prevents tears from pouring out of the eyeball onto the cheeks by forming a barrier between the eyelids and the eyeball.
The meibomian glands are located within the castle plates of the eyelids. Anatomically, there are around 50 glands in the upper eyelid and around 25 meibomian glands in the lower eyelids. The secretions from the meibomian glands are sebaceous and typically rich in lipids. Overall, research has shown that the meibomian gland secretions contain over 90 different kinds of proteins.
Meibomian gland dysfunction results from reduced secretion of meibum from the meibomian glands or from excessive secretions as well. The former is called a low delivery state while the latter is called a high delivery state.
As is evident from the discussion above, meibomian glands are essential to keep the eyes healthy. Unfortunately, in the event that these glands become dysfunctional, the eyes can become dry. Furthermore, inflammation of the meibomian glands, frequently called meibomitis, can result in obstruction of the glands by its own secretions. This results in bacterial overgrowth, increased formation of free fatty acids, irritation of the eyes and the development of dry eyes and keratopathy.
There are certain ways through which meibomian gland dysfunction can be identified. A slit lamp examination or simple meibum analysis might be sufficient. Once meibomian gland dysfunction has been detected, patients might require some form of surgery once this has been controlled through medical measures.
There is concern that MGD can affect a patient’s quality of life rather substantially. Patients can struggle to wear contact lenses and might even find that their eyes look rather unsightly and puffy. This can have an impact on their personal and professional lives.
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