Meibomian Gland Dysfunction (MGD)

If you suffer from dry eyes that burn toward the end of the day, blur in front of a screen and don’t respond as they should to drops — there’s a good chance the root isn’t “too few tears,” but tiny glands inside the eyelids that aren’t doing their job. This condition is called meibomian gland dysfunction, or MGD for short, and it is the most common cause of dry eye. On this page I’ll explain exactly what happens in these glands, why drops alone usually aren’t enough, and what actually helps.

What the meibomian glands are and what they do

Along the eyelid margins, right at the base of the lashes, sit dozens of tiny glands called the meibomian glands. Their job is to secrete, with every blink, a thin oily layer that coats the tear. That layer is critical: it’s what keeps the tear from evaporating too quickly and keeps the ocular surface smooth, moist and stable.

Our tear isn’t just water. It’s built from three layers — an inner mucin layer, a middle watery layer, and an outer oily layer that comes from the meibomian glands. When all the layers are intact, the tear is stable and holds on the eye’s surface. When the oily layer is missing, the whole system destabilises.

What happens in MGD

In MGD the glands gradually become blocked, or their secretion thickens and loses quality. The result is a thin or absent oily layer, so the tear evaporates within seconds instead of holding on the surface. The eye feels dry, burning and irritated — and this happens even when tear production itself is entirely normal. That’s an important point: you can produce plenty of tears and still suffer significant dry eye, simply because the tears “escape” too fast.

Over time, glands that stay blocked for a prolonged period can be permanently damaged and even disappear (a process called gland atrophy). That loss is irreversible — which is why early diagnosis and treatment matter so much: they don’t just relieve symptoms, they preserve the glands that remain.

The symptoms of MGD

The signs resemble those of dry eye in general, and often worsen toward the end of the day or after hours in front of a screen:

• burning, irritation and a gritty or foreign-body sensation in the eyes
• redness of the eye and the lid margins
• blurred vision that briefly improves after blinking
• a feeling of “heavy” or sticky eyelids, sometimes with crusting in the morning
• worsening in front of a computer, in air conditioning, in wind, or with contact lenses
• paradoxical watering — the eye is irritated and produces reflex tears, but these don’t resolve the dryness

What causes MGD and who is at risk

Many factors contribute to MGD. Age is a key one — gland function naturally declines over the years. Prolonged screen use reduces the blink rate, and it’s blinking that “expresses” the glands and spreads the oil; less blinking means less gland drainage. Contact lenses, hormonal changes, a diet low in omega-3, and a dry or air-conditioned environment also raise the risk.

MGD is also closely tied to other lid-margin conditions: blepharitis (inflammation of the eyelid margins), the presence of demodex (a microscopic mite at the base of the lashes), and skin rosacea. They often appear together and feed one another, so good MGD care addresses them too.

How MGD is diagnosed

Diagnosis isn’t made from symptoms alone, but from a focused examination of the lid margins and ocular surface. In the exam I assess the structure of the lid margin and the gland openings, gently express the glands to see the secretion quality (clear and fluid versus thickened and cloudy), measure tear-film stability, and gauge the degree of inflammation. Advanced equipment can also image the glands under infrared light — a test called meibography — to see directly which glands are blocked, shortened or gone.

This distinction matters especially because dry eye stems from different causes, each with a different appropriate treatment. Only once we understand that it’s MGD — and to what degree — can a correct treatment plan be built.

How MGD is treated

Treatment is stepwise, by severity, and aims to open the glands, restore the oily layer and reduce inflammation:

The foundation — daily care at home. Warm compresses that heat and soften the blocked oil, gentle lid hygiene, and omega-3 supplements that contribute to secretion quality. For some patients this foundation is enough to control symptoms.

In-clinic gland expression. Controlled expression of the glands drains the thickened content and lets them return to secreting normal oil.

IPL (intense pulsed light). IPL is one of the significant MGD treatments developed in recent years. It works on several levels at once — heating and opening the glands, reducing inflammation around the eyelids, and treating demodex — thereby touching the root of the problem, not just the symptom. A series of several sessions is usually needed.

Advanced heating-and-expression treatments. Dedicated devices heat and express the glands automatically or semi-automatically, and are used in suitable cases.

Treating associated conditions. Where blepharitis, demodex or rosacea are present, treating them is an integral part of controlling MGD.

Alongside all of this, quality artificial tears — preferably lipid-based — provide symptomatic relief along the way. It’s important to understand that they complement treatment but don’t replace it: they soothe, but they don’t restore the glands.

Why it’s important not to wait

MGD is a progressive and sometimes silent condition. In its early stages it’s bothersome but tolerable, and many people put off getting evaluated and make do with drops. The problem is that glands left blocked for a long time can be permanently damaged, and lost glands can’t be brought back. The earlier it’s diagnosed and treated, the more gland function can be preserved and the better the long-term control of symptoms.

When to see a cornea and ocular-surface specialist

It’s worth getting evaluated if:

• symptoms persist beyond a few weeks and interfere with daily life
• artificial tears no longer provide adequate relief
• there is persistent redness, burning or a recurring gritty sensation
• you wear contact lenses and have become less able to tolerate them
• vision blurs intermittently and improves after blinking

I perform MGD diagnosis and treatment, including meibography, IPL and long-term follow-up, at my clinic in Haifa, serving patients from across the north. If you suffer from persistent dry eye and want to find out whether MGD is the root and what treatment suits you, you’re welcome to get in touch and book an evaluation. We’ll start with an accurate diagnosis, and from there build the right plan together.