Meibomianitis
👁️🗨️ Meibomianitis
(Also known as Meibomian Gland Dysfunction - MGD)
🔍 Definition
Meibomianitis is a chronic inflammation and dysfunction of the meibomian glands, which are sebaceous glands located in the eyelids that secrete the lipid layer of the tear film.
😮 If these glands get blocked or inflamed, the oily layer of the tear film is reduced → leading to evaporative dry eye and irritation.
🧬 Anatomy Refresher
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Meibomian glands are vertically aligned glands in both upper and lower eyelids.
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They secrete meibum, an oily substance that prevents tear evaporation.
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Opening of each gland is located just behind the lash line.
🧪 Causes / Risk Factors
| Cause or Factor | Notes |
|---|---|
| Chronic blepharitis | Especially posterior blepharitis |
| Rosacea | Very commonly associated |
| Aging | Gland atrophy or dysfunction |
| Hormonal changes | Especially androgens |
| Contact lens use | Alters gland secretion |
| Environmental factors | Screen time, dry air, allergens |
| Poor eyelid hygiene | Allows debris, bacteria, and Demodex buildup |
👀 Symptoms
| Symptom | Description |
|---|---|
| Burning or stinging | Especially near the lid margins |
| Foreign body sensation | Gritty or sandy feeling |
| Tearing (paradoxical) | Due to reflex tearing |
| Blurry vision | Intermittent, improves with blinking |
| Eyelid redness or heaviness | Especially toward the end of the day |
| Crusting or oily discharge | Along lash line |
🔬 Signs on Examination
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Thickened or capped meibomian gland orifices
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Pressing on lid margin shows cloudy or toothpaste-like meibum
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Redness and telangiectasia along the eyelid margin
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Foamy tear film on slit lamp
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Associated chalazion or posterior blepharitis
💊 Management of Meibomianitis
🔹 Mainstay: Eyelid Hygiene
| Step | Description |
|---|---|
| Warm compresses | Loosens thick meibum (5–10 min, twice daily) |
| Lid massage | Helps express glands after compress |
| Lid scrubs | Removes debris, dead skin, bacteria (baby shampoo or wipes) |
🔹 Medications (Moderate to Severe Cases)
| Medication | Role |
|---|---|
| Oral doxycycline/minocycline | ↓ inflammation, ↑ meibum quality (6–12 weeks) |
| Topical azithromycin gel | Anti-inflammatory, helps lipid secretion |
| Topical steroids (short course) | For inflammation (e.g., loteprednol) |
| Omega-3 fatty acids (oral) | Improves meibum quality (diet or supplements) |
🔹 Advanced Options (If Refractory)
| Treatment Option | Description |
|---|---|
| LipiFlow | Thermal pulsation device to unclog glands |
| Intense Pulsed Light (IPL) | Treats rosacea-related meibomianitis |
| Meibomian gland probing | Physically opens blocked ducts |
⚠️ Complications
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Evaporative Dry Eye Disease
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Recurrent chalazia
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Ocular surface inflammation
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Visual fluctuations
🧠 Mnemonic: “MEIBO” for Meibomianitis
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M: Margins inflamed
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E: Evaporative dry eye
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I: Incomplete or thick meibum
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B: Blepharitis association
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O: Oral doxycycline helps
📋 Quick Comparison Table
| Feature | Meibomianitis | Anterior Blepharitis |
|---|---|---|
| Glands involved | Meibomian (posterior lid) | Base of eyelashes (anterior lid) |
| Discharge | Thick, oily meibum | Dry scales or crusts |
| Key associated disease | Rosacea | Seborrheic dermatitis or staph |
| Main therapy | Warm compress + oral doxycycline | Lid hygiene + topical antibiotics |
🔄 Long-term Management Tips
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Consistency is key — daily hygiene matters more than short-term meds.
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Avoid eye makeup if symptoms are flaring.
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Blink fully during screen time (take breaks).
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Stay hydrated, and consider humidifiers in dry climates.
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