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What is Meibomian Gland Dysfunction

Dry Eye Inflammation & Dark or Puffy Eyelids
Jaundice Yellow Sclera

Inflammation & Dark or Puffy Eyelids


Jaundice Yellow Sclera


Meibomian gland dysfunction (MGD) is a common eye condition characterized by dysfunction of the meibomian glands, which are specialized oil-producing glands located in the eyelids. These glands play a crucial role in producing the oily component of tears, known as meibum, which is essential for maintaining a stable tear film and preventing excessive tear evaporation. When these glands do not function properly, it can lead to a range of ocular symptoms and impact the quality of life of individuals.


The primary functions of meibomian glands include:

Production of Meibum: Meibomian glands produce meibum, an oil that forms the outermost layer of the tear film. Meibum helps prevent rapid tear evaporation, ensuring the tear film remains stable and the eyes stay adequately moist.


Lubrication: Meibum contributes to the lubrication of the ocular surface, preventing friction between the eyelids and the cornea during blinking.


Preventing Tear Overflow: By reducing tear evaporation, meibum helps maintain a proper balance of tears on the eye's surface, preventing excessive tearing or the overflow of tears onto the cheeks.


Maintaining Ocular Comfort: Adequate meibum production contributes to ocular comfort, preventing sensations of dryness, grittiness, and discomfort.


Meibomian gland dysfunction can occur due to various factors, including age, hormonal changes, inflammation, and certain medical conditions. When the meibomian glands become dysfunctional, the quality and quantity of meibum may be compromised, leading to a range of symptoms:


 Dryness: Insufficient meibum can result in tear evaporation, leading to dry and uncomfortable eyes.
 Grittiness: Lack of proper lubrication can cause sensations of grittiness or a foreign body sensation.
 Burning or Stinging: Inadequate tear stability can lead to sensations of burning or stinging in the eyes.
 Blurry Vision: An unstable tear film can cause fluctuations in vision quality.
 Light Sensitivity: Dryness and irritation can lead to heightened sensitivity to light (photophobia).


The impact of meibomian gland dysfunction on quality of life can be significant:
    Daily Discomfort: Chronic discomfort and irritation can affect daily activities such as reading, using digital devices, and working.
    Reduced Productivity: Eye discomfort may lead to decreased productivity at work or in daily tasks.
    Impaired Vision: Blurred or fluctuating vision can impact one's ability to drive or perform tasks requiring clear vision.
    Social and Recreational Limitations: Ocular discomfort can limit participation in social activities, hobbies, or outdoor pursuits.
    Psychological Well-being: Persistent eye discomfort can lead to frustration, anxiety, and overall reduced psychological well-being and depression.

The multifaceted impact of meibomian gland dysfunction on quality of life underscores the importance of early diagnosis and management. Treatments for MGD may include warm compresses, lid hygiene, lubricating eye drops, and in some cases, prescription medications or procedures to improve meibum flow. Many patients are seeking Dry Eye Spa clinics because their current treatment plans are falling short or taking to long to resolve the persistent chronic inflammatory issues. If you suspect you have MGD or are experiencing dry eye symptoms, consulting an eye care professional can help determine the appropriate steps to manage the condition and improve your quality of life.

Meibomian Gland Dysfunction affects 90% of dry eye sufferers

Meibomian Gland Dysfunction affects 90% of dry eye sufferers

Meibomian Gland Dysfunction (MGD) emerges as a prevalent concern, impacting a substantial 90% of individuals dealing with dry eyes. This condition doesn't discriminate by age, affecting everyone from children to grandparents. The underlying causes behind MGD's widespread occurrence are multifaceted and diverse. Factors such as environmental conditions, prolonged digital device usage, aging, hormonal changes, and certain medical conditions contribute to the dysfunction of these crucial glands. As a result, the proper secretion of meibum, the lipid-rich substance responsible for maintaining the tear film's stability, becomes disrupted. This disruption further exacerbates dry eye symptoms, creating a cycle of discomfort and irritation for a broad demographic range.

What are Meibomian Glands? 

Meibomian Glands are specialized structures located within the eyelids that play a crucial role in maintaining the health and stability of the tear film on the surface of the eye. These glands produce an oily substance called meibum, which is a key component of the tear film's lipid (oil) layer. The meibomian glands contribute to several important functions:

Meibomian Glands
Lower Meibomian  Gland
Lubrication and Tear Stability

Lubrication and Tear Stability

The meibum produced by the meibomian glands forms the outermost layer of the tear film. This oily layer helps to reduce evaporation of tears from the eye's surface, ensuring that the tear film remains stable and maintains its hydration. Without this lipid layer, tears would evaporate too quickly, leading to dryness and discomfort.

It's essential to highlight that our lipid layer ideally resembles the consistency of extra virgin olive oil. Unfortunately, due to a lack of thorough eyelid cleaning, many individuals have accumulated oils that now have a texture akin to lard.

Preventing Tear Overflow:

The meibum's role in slowing down tear evaporation also helps prevent excessive tearing or the overflow of tears onto the cheeks. By maintaining a stable tear film, the meibum ensures that tears are distributed evenly across the eye's surface with each blink.

Preventing Tear Overflow:

Preventing Tear Film Breakup:

The meibum's lipid layer contributes to the smooth spread of tears during blinking, preventing the tear film from breaking up into patches or developing irregularities. This helps maintain a clear optical surface for proper vision.

Protecting Against Bacterial Infections:

The meibum produced by the meibomian glands contains lipids with antimicrobial properties. These lipids can help protect the ocular surface from bacterial growth and potential infections.

Lower Lid inflammation
Goblet Cell Dry Eye

Supporting Goblet Cells:

The meibum assists in stabilizing the mucin layer produced by conjunctival goblet cells. The mucin layer allows tears to adhere to the ocular surface, ensuring even distribution and promoting tear film stability.

Dysfunction of the meibomian glands, often referred to as meibomian gland dysfunction (MGD), can lead to an inadequate or altered lipid layer in the tear film. This can result in evaporative dry eye and other ocular discomfort symptoms. MGD is a common condition that can be caused by factors such as age, hormonal changes, inflammation, and certain medical conditions.

Managing meibomian gland dysfunction involves various approaches, including warm compresses to soften the meibum, lid hygiene, and in some cases, the use of therapeutic eye drops or medications.  However, our approach is unique because we offer the Trifecta (Sea, Land, Air) If you suspect you have meibomian gland dysfunction or are experiencing symptoms of dry eye, it's recommended to consult an eye care professional for a proper evaluation and personalized treatment plan.

B.I.O.® (Bacteria+Blepharitis), Inflammation, Oils,  Inflammation Oils)


Blepharitis is a common eye condition that causes inflammation of the eyelids. It can develop in both adults and children, and it can be caused by a variety of factors. Some common causes of blepharitis include:

  1. Bacterial infection: Bacteria, such as staphylococcus, can accumulate on the skin, lashes and around the eyes, leading to inflammation  of the eyelids.

  2. Seborrheic dermatitis: This is a skin condition that can cause redness, flaking, and scaling on the scalp, face, and other parts of the body. Seborrheic dermatitis can also affect the eyelids and lead to blepharitis.

  3. Allergies: People who have allergies may be more prone to developing blepharitis. Allergies can cause inflammation of the eyes and eyelids, leading to blepharitis.

  4. Meibomian Gland Dysfunction: The meibomian glands are located in the eyelids and produce the oil that keeps tears from evaporating too quickly. If these glands become blocked or dysfunctional, it can lead to blepharitis.

  5. Eyelash mites: Demodex folliculorum is a type of mite that can live in the eyelash follicles. In some cases, an overgrowth of these mites can lead to blepharitis.


Overall, blepharitis can develop due to a combination of factors, including poor hygiene, skin conditions, allergies, and other underlying medical conditions. If you suspect you have blepharitis, it's important to see an eye doctor for proper diagnosis and treatment.

Demodex Mites

Demodex mites are microscopic arachnids that inhabit the hair follicles and sebaceous glands of mammals, including humans. There are two main species of Demodex mites that commonly affect humans: Demodex folliculorum and Demodex brevis. These mites are a natural part of the human skin microbiome and are generally considered harmless in moderate numbers. However, an overpopulation of these mites can lead to certain skin and ocular issues.

Demodex mites can negatively impact the meibomian glands and periocular skin in the following ways:

Demodex Mites

Demodex Mites


Crusty Eyelids

Demodex Upper Lid

Stye Bacteria



How does Demodex affect MGD?

Meibomian glands are located in the eyelids and produce the oily component of tears, which helps prevent tear evaporation and keeps the eyes lubricated. An overgrowth of Demodex mites can block the openings of these glands, leading to a condition known as Meibomian Gland Dysfunction (MGD). MGD can result in decreased oil production, leading to evaporative dry eye and potentially causing discomfort, irritation, and blurry vision.

Blepharitis: Demodex mites can contribute to a type of eyelid inflammation called blepharitis. When the mites reproduce excessively and die, their remains can clog the hair follicles and meibomian gland ducts. This can lead to irritation, redness, swelling, and a gritty or burning sensation in the eyes.

Rosacea and Skin Issues: Demodex mites have been associated with certain skin conditions, such as rosacea. Rosacea is a chronic inflammatory skin disorder characterized by facial redness, flushing, and sometimes the development of pustules. Some studies suggest that an overgrowth of Demodex mites on the facial skin may contribute to the development and worsening of rosacea symptoms.

Acne and Folliculitis: Demodex mites can also be linked to acne and folliculitis, which are conditions involving inflammation of hair follicles. An overpopulation of mites can potentially trigger or exacerbate these conditions by clogging the follicles and contributing to inflammation.

To manage Demodex-related issues, healthcare professionals may recommend treatments such as:
Eyelid Hygiene: Regular eyelid cleansing with mild, non-irritating cleansers can help control the mite population and prevent associated issues.
Topical Medications: Certain topical medications, such as tea tree oil-based formulations, may help reduce the number of mites and alleviate symptoms.
Prescription Medications: In severe cases, doctors may prescribe medicated ointments, gels, or oral medications to control the mite population and manage associated skin and ocular conditions.
Helm Ivermectin Protocol for Demodex Mites

Dry Eye Guys recommends Helm Ivermectin Protocol developed by Dr. Craig Helm, MD a cornea, refractive and cataract surgeon. Dr. Craig Helm, a specialist in cornea, refractive, and cataract surgery, is leading an innovative treatment approach for demodex mites. He has developed a highly effective protocol that involves using Ivermectin Cream. Applying either one or two doses of ivermectin 1% cream is both well-tolerated and remarkably successful in diminishing or even eliminating the characteristic symptoms associated with Demodex blepharitis. To summarize, Dr. Helm's collection of cases provides compelling firsthand evidence of the efficacy of applying topical ivermectin 1% cream once or twice, resulting in a lasting reduction of clinical indications of Demodex infestation that can last for several months. However, seek an optometrist or ophthalmologist to tailor a treatment plan for your specific condition.

What is Inflammation?
We look at 4 structures on the Face
Sclera | Anterior Eyelid  | Skin |Eyelid Margin

Inflammation can play a significant role in MGD, and treating both skin and eye inflammation can help improve this condition.


Here's how treating skin and eye inflammation can improve meibomian gland dysfunction:


 Skin Inflammation: The skin around the eyelids is closely connected to the meibomian glands. Inflammation of the skin or eyelids can lead to blockage of the meibomian gland openings, hindering the secretion of meibum (the oily substance produced by the glands). This can result in the thickening and alteration of healthy meibum, which in turn affects the stability of the tear film and contributes to dry eye symptoms.


MGD dry eye


inflamed eyelids
Lower Lid inflammation


Eyelid Margin

Anterior EyeLids

Treating skin inflammation can involve gentle lid hygiene practices like WEYE, such as warm compresses and lid scrubs, which help to remove debris, bacteria, and excess oils from the eyelid margins. In more severe cases, topical or oral antibiotics might be prescribed to control bacterial overgrowth associated with inflammation.


Eye Inflammation: Inflammation of the ocular surface, including the conjunctiva and cornea, can exacerbate meibomian gland dysfunction. This inflammation can disrupt the normal functioning of the glands and lead to reduced meibum secretion.


Artificial tears and lubricating eye drops can help alleviate symptoms by providing additional moisture to the eyes and reducing friction. However, treating the underlying inflammation is essential for long-term improvement. In cases of more severe inflammation, topical anti-inflammatory medications (such as corticosteroids or cyclosporine) may be prescribed to reduce inflammation and promote healing of the ocular surface.


Holistic Approach: Treating MGD often requires a holistic approach that addresses both skin and eye inflammation. Managing any underlying conditions contributing to inflammation, such as rosacea or seborrheic dermatitis, can have a positive impact on meibomian gland function.


It's important to note that treatment should be tailored to the individual's specific situation and should be guided by a qualified eye care professional, such as an ophthalmologist or optometrist. These professionals can assess the severity of the condition, identify underlying causes, and recommend appropriate treatments to effectively manage meibomian gland dysfunction and associated inflammation.

What is chronic dry eye?

Chronic dry eye, also known as dry eye disease or dry eye syndrome, is a common ocular condition characterized by insufficient lubrication and moisture on the surface of the eyes. This occurs when the eyes either do not produce enough tears to maintain proper hydration or when the tears evaporate too quickly, leading to discomfort and potential damage to the eye's surface.


Tears play a vital role in maintaining the health and clarity of the eyes. They provide lubrication, nourishment, and protection to the outer layer of the eye, known as the cornea, as well as help to flush away debris and prevent infections.

Chronic dry eye can result from various factors, including:

Aging: As people get older, tear production can decrease, leading to drier eyes.


Environmental Factors: Exposure to dry, windy, or air-conditioned environments can contribute to evaporation of tears.


Digital Device Usage: Prolonged use of computers, smartphones, and other digital screens can lead to decreased blinking, reducing tear distribution.


Medical Conditions: Conditions like autoimmune diseases (e.g., Sjögren's syndrome), diabetes, and certain types of arthritis can impact tear production.


Medications: Some medications, such as antihistamines, decongestants, and antidepressants, can reduce tear production.


Hormonal Changes: Hormonal fluctuations, such as those during pregnancy or menopause, can lead to dry eye symptoms.


Eyelid Problems: Conditions like eyelid inflammation (blepharitis) can disrupt the natural balance of tears.


Contact Lens Wear: Contact lenses can contribute to dry eye symptoms by affecting tear distribution and increasing evaporation.


Common symptoms of chronic dry eye include: Eye Pain, Blurry Vision, Itch, Sting, Burn, Puffy Eyelids, Crusty, Eye Lash in Eye

Chronic Dry Eye
Chronic Dry Eye
Chronic Dry Eye

Eye Pain

Blurry Vision

Itch, Sting, Puffy Eyelids


    Grittiness or a foreign body sensation

    Burning or stinging


    Blurred vision

    Light sensitivity

    Excessive tearing (as a response to the irritation)


Management and treatment of chronic dry eye may involve various approaches, including artificial tear drops, prescription medications, lifestyle adjustments (such as blinking exercises and taking breaks from digital screens), and punctal plugs (tiny devices that help retain tears). Many people are seeking more advanced treatments that offer immediate relief like, MiBoFlo, LLLT, IPL or intense pulsed light therapy. It's important to consult an eye care professional if you suspect you have chronic dry eye, as they can provide a tailored treatment plan based on the underlying cause and severity of your symptoms.

Why do my eyes water with dry eye?

If you have dry eyes, your eyes may water due to the irritation and discomfort caused by the dryness. This paradoxical watering is a reflex action triggered by your eyes' attempt to alleviate the irritation by producing more tears. However, in cases of dry eye, the meibomian glands responsible for producing lipids may be clogged. These lipids, or meibum, are essential for stabilizing the tear film and preventing rapid evaporation of tears. When these lipids don't properly mix with the tear film due to clogged glands, the tear film's integrity is compromised, leading to increased dryness and watery eyes as your body's response to provide relief.

Tearing iStock-153388297.jpg
Tearing Asian iStock-1593583134.jpg

Why are healthy lipids (oils) important?
Healthy Lipids  = Optimal Microbiome = Happy Eyes

Lipids, specifically meibum, play a crucial role in maintaining the health of the eye's microbiome and overall ocular health. The meibum is a complex mixture of lipids, proteins, and other compounds produced by the meibomian glands located in the eyelids. Its primary function is to form the outermost layer of the tear film, which covers the surface of the eye and helps maintain a stable ocular environment. Here's why healthy lipids, like meibum, are important for the eye's microbiome and overall health:

Healthy Asian Eye iStock-1035887274.jpg
Healthy Eye iStock-1398811731.jpg

Tear Film Stability: The tear film is composed of three layers: the lipid (meibum) layer, the aqueous (watery) layer, and the mucin (mucus) layer. The lipid layer produced by meibum helps to prevent evaporation of tears from the eye's surface. This is crucial for maintaining a stable tear film, which is essential for clear vision and preventing discomfort or dryness.


Microbial Balance: The eye, like other parts of the body, has its own microbiome, which consists of various microorganisms that inhabit the ocular surface. These microorganisms help maintain a healthy ocular environment and play a role in protecting against potentially harmful pathogens. The lipid layer of the tear film serves as a physical barrier that helps to prevent the colonization of harmful bacteria and maintains a balanced microbial community on the eye's surface.


Nutrient Supply: Meibum contains essential nutrients that provide nourishment to the cells of the ocular surface. These nutrients are important for maintaining the health of the cornea and conjunctiva, the tissues that make up the outermost layer of the eye.


Protection Against Environmental Insults: The eye is exposed to various environmental factors, such as pollutants, allergens, and pathogens. The lipid layer of the tear film helps to protect the ocular surface from these external insults by preventing direct contact and reducing their potential impact.


Preventing Dry Eye: Insufficient meibum production or poor quality meibum can lead to a condition known as dry eye. Dry eye occurs when there is an imbalance in tear production and/or tear evaporation, leading to discomfort, irritation, and potential damage to the ocular surface. Healthy meibum helps prevent dry eye by maintaining an adequate and stable tear film.


Optimal Visual Clarity: The smooth and uniform distribution of meibum across the ocular surface helps to create a smooth optical surface, contributing to optimal visual clarity.


In summary, healthy lipids, particularly meibum, are essential for maintaining the health of the eye's microbiome, preventing dry eye, ensuring tear film stability, protecting the ocular surface from environmental insults, and supporting overall ocular health. Proper meibum production and function contribute to clear vision and comfortable eyes.

Why are healthy tears important?

Tears are a complex and essential fluid produced by the eyes to maintain optimal lubrication, nourishment, and protection of the delicate ocular surface. Tear composition consists of a balance of water, oils, mucus, and special proteins, all of which work together to ensure the health and clarity of the eyes. Specifically, the lubricating role of tears involves several components:


Aqueous Layer: This is the watery part of tears, comprising the majority of the tear film. It provides hydration to the cornea, the clear front surface of the eye. The aqueous layer is essential for maintaining a smooth optical surface for clear vision and for flushing away debris and foreign particles.

Lipid (Oil) Layer: The outermost layer of the tear film is composed of oils produced by the meibomian glands in the eyelids. This layer helps prevent the evaporation of tears, keeping the ocular surface adequately moist. The lipid layer also contributes to preventing tears from overflowing onto the cheeks and stabilizing the tear film.


Mucus Layer: The innermost layer of tears is a mucous gel secreted by the conjunctival goblet cells. The mucus layer helps ensure an even spread of tears across the ocular surface by allowing them to adhere to the eye.


Blinking Action: Blinking is a natural reflex that spreads tears across the eye's surface, distributing the different layers and ensuring consistent lubrication. Blinking also helps in removing irritants and debris from the eye.


Lubricating tears play a crucial role in maintaining the health and function of the eyes. When the tear film is compromised, such as in cases of chronic dry eye, the lack of proper lubrication can lead to discomfort, irritation, and potentially even damage to the cornea. Adequate tear production and balance are necessary for clear vision and overall eye comfort.


If you're experiencing persistent dryness, irritation, or discomfort in your eyes, it's recommended to consult an eye care professional and seek a Dry Eye Spa by Dry Eye Guys. They can assess your tear film quality, diagnose any underlying issues, and recommend appropriate treatments to restore proper lubrication and alleviate your symptoms. We also recommend taking the DEG Garcia DEACS Survey.

Rubbing your eyes can be harmful to the overall health of your eyes.
STOP Rubbing your eyes and you are 50% of the journey towards recovery.

Eye rubbing may seem like a harmless action, but it can actually have negative effects on our eyes and overall eye health. Here are some reasons why eye rubbing is not good for us:


Worsening Allergies: If you have allergies, rubbing your eyes can exacerbate the symptoms. Rubbing releases histamines, which are chemicals produced by the body in response to allergens. This can lead to increased itching, redness, and inflammation in the eyes.

Asian Man Rubbing Eyes iStock-1005466862.jpg
Woman Rubbing Eyes Vigorously.jpeg

Risk of Infections and increased bacteria: Our hands come into contact with various surfaces throughout the day, and they can carry bacteria and viruses. When we rub our eyes with dirty hands, we increase the risk of introducing harmful microorganisms(Blepharitis) into the sensitive tissues of the eye, leading to infections such as conjunctivitis (pink eye).


Corneal Abrasions: The cornea is the clear outermost layer of the eye. Rubbing the eyes vigorously can cause small scratches or abrasions on the cornea, which can be painful and may lead to discomfort, redness, and even more serious issues if left untreated.


Increased Eye Pressure: Rubbing the eyes forcefully can temporarily increase intraocular pressure (pressure within the eye). This is especially concerning for individuals with conditions like glaucoma, where elevated eye pressure can cause damage to the optic nerve and lead to vision loss over time.


Eye Fatigue: Rubbing your eyes can contribute to eye strain and fatigue. Instead of alleviating discomfort, rubbing may actually make your eyes feel more tired and irritated.


Potential for Eye Shape Changes: In children, excessive eye rubbing, especially if it's consistent over time, could potentially contribute to changes in the shape of the cornea. This could lead to refractive errors like astigmatism.


Broken Blood Vessels: Vigorous eye rubbing can cause tiny blood vessels on the surface of the eye to break, resulting in a condition called subconjunctival hemorrhage. This can lead to a bloodshot appearance in the eye.


To maintain good eye health, it's important to avoid rubbing your eyes. If you're experiencing discomfort, itching, or any other eye-related issues, it's better to consult an eye care professional. They can provide appropriate guidance and treatment to address the underlying causes of your symptoms without risking potential harm to your eyes.

DEACS Survey Modified from OSDI

Dry Eye Associated Conditions Survey (Download here) <­­­­­click to download survey

The OSDI survey, or the Ocular Surface Disease Index, is a standardized questionnaire used to assess the symptoms and impact of ocular surface diseases, particularly dry eye disease, on an individual's quality of life. It's a widely recognized tool used in clinical practice and research to quantify the severity of dry eye symptoms and their effects on daily activities.

The OSDI survey consists of a series of questions that ask individuals to rate the frequency and severity of their symptoms related to dry eye disease over the past week. The questions cover a range of symptoms, including eye dryness, grittiness, stinging or burning sensations, fluctuating vision, light sensitivity, and the impact of these symptoms on daily activities such as reading, using a computer, and driving.

The survey typically consists of 12 to 15 questions, and respondents are asked to rate the severity of each symptom on a numerical scale (0 to 4 or 1 to 4), where higher numbers correspond to more severe symptoms. The scores from each question are then combined to calculate an overall OSDI score, which can range from 0 to 100. Higher scores indicate greater symptom severity and a more significant impact on daily activities and quality of life.

The OSDI survey is useful for several reasons:

  1. Diagnosis and Assessment: Eye care professionals can use the OSDI survey to assess the severity of dry eye symptoms and monitor changes over time. It helps in diagnosing dry eye disease and evaluating treatment effectiveness.

  2. Research: The OSDI is frequently used in clinical trials and research studies to evaluate the impact of interventions, medications, or therapies on dry eye symptoms and quality of life.

  3. Communication: The survey helps patients communicate their symptoms and how these symptoms affect their daily activities to their eye care provider.

  4. Treatment Planning: OSDI scores can guide treatment decisions, helping providers tailor interventions based on the individual's symptom severity and specific needs.


Overall, the OSDI survey provides a standardized and quantitative way to assess the impact of dry eye disease on an individual's life, enabling better understanding, diagnosis, and management of the condition. If you're experiencing symptoms of dry eye, discussing the OSDI survey with your eye care professional can help provide valuable insights into your condition and guide appropriate treatment strategies.

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