Meibomitis/Meibomian Gland Dysfunction

Meibomitis refers to dysfunction and inflammation of the Meibomian glands. These are sebaceous glands that are positioned vertically in rows throughout your upper and lower eyelids. The lipid-like secretions of these glands ends up on the margin of your eyelids and, when healthy appears similar to baby oil in consistency. Upon blinking, the upper lid comes down, presses on the oil and pulls a sheet of oil upwards, coating the tear layer beneath to keep it from evaporating. That being said, dysfunction of these glands causes the tears to evaporate more rapidly and leads to symptoms of dryness, burning and irritation. There is a natural bacterial flora that thrives on the ocular surface; mostly staphylococcal, these bacteria can colonize the meibomian glands.

The number one reason for dysfunction of the glands is because they get clogged up. There are many reasons the glands become clogged. One reason they get clogged up may be hormonal changes - changes in estrogen levels can cause a thickening of the oils. It has been suggested that changes in estrogen levels also cause a proliferation of staphylococcal bacteria that normally inhabit the eyes. These bacteria invade the meibomian glands and thrive there. The double trouble caused by the thickening of the oils plus the bacteria gradually decrease the secretion of oils from the glands.

The "cycline" derivatives such as Tetracycline and Doxycycline function as enzymes that break down lipids that congeal. They are not effective in killing the staphylococcal flora, so when your doctor puts you on these compounds, they must be knowledgeable of the fact that they are not using these compounds as antibiotics, and use them in conjunction with an antibiotic that will actually keep the bacterial flora to a minimum. The first medical line of therapy usually will be Doxycycline 100 mg tabs twice a day (to break down the lipid conjugation), with Erythromycin ophthalmic ointment use at bedtime in the affected eye (to stop bacterial proliferation). A shotgun approach involved Tetracycline, 250 mg 4X a day along with the erythromycin ointment.

This is only part of the therapy and functions best in the beginning stages of meibomitis. Think of the example of a hair follicle in a bald person. When that hair was alive and thriving, it grew out of the follicle beneath the scalp. As time went on, the follicle slowly ceased to function, and the hair that grew out of the follicle got thinner and thinner, weaker and weaker, until the follicle ceased to produced the sulfur chains that grew it and the person went bald. The meibomian gland can be thought of as a follicle, and the longer it malfunctions, the less chance it will ever function well again. If you are young, you have a good chance of restoring the function of the gland, but there are two other vital things you have to do.

1. You have to keep the gland oils from solidifying by using warm, moist compresses MORE than 3 times a day - they help to melt the lipid "plug", and allow the cycline compounds and antibiotics to penetrate

2. You have to try to help them along by expressing them - this is a manual way to make the plug less solid - grab the lower eyelids between your thumb and forefinger and massage back and forth. Only do this after consulting with your doctor. There is much research to suggest that diet supplementation with omega 3 fatty acids can aid in the restoration of normal, healthy oils in the meibomian glands and this area is currently being researched. Other related terms: meibomitis, meibomian, meibomian gland dysfunction, posterior blepharitis, blepharitis, dry eyes, meibomian gland, meibomian glands