All About Dry Eye Blog

Meibomian Gland Dysfunction Continues as a Leading Cause of Dry Eye Disease

rautioIn 2011, the Tear Film & Ocular Surface Society published a defining study indicating that Meibomian Gland Dysfunction (MGD) is a major cause of dry eye disease. The study, which involved more than 50 global experts over the course of two years, explored the structure and function of the meibomian glands in our eyelids and discovered that decreased function, due to an excessive amount of Staphylococcal bacteria, has been highly underestimated as one of the primary causes of dry eye disease.

As an optometrist specializing in the treatment of dry eye disease, I come across MGD in patients every day. After my early success treating the eye lids in dry eye disease, which was supported the MGD study, there has been a significant shift in the way I treat my dry eye/MGD patients. Here’s a look at my experience with MGD and dry eye disease.

Most patients today have learned to accept their “dry eyes” as normal. On average, they try at least three different tear supplements before giving up with little relief. Even though we have an eye drop called Restasis that stimulates tearing, it doesn’t treat the main underlying cause of the problem, and that is MGD.

I literally started pushing on patient eyelids about 5 years ago and found a tremendous number of patients with either a frothy tear film or completely plugged meibomian gland openings. This leads to a marked decrease in the lipid (oily) layer of the tear film, leading to increased tear evaporation and overall dryness.

restasis“I believe that MGD is one of the most over-looked conditions diagnosed today”. I have also seen first-hand, how 90% of my patients with “dry eyes” benefit from a simple treatment regimen of heat, massage and an antibiotic. I will still use Restasis in conjunction with these lid treatments on patients with systemic illnesses such as rheumatoid arthritis and diabetes, which are known to cause decreased tear production. Glaucoma patients are also great candidates for treatment since they are more likely to experience dry eye due to their topical glaucoma medications.

My stated mission is to help educate both my patients and my peers as to the success I have had treating dry eye disease by better managing eyelid health and hygiene through simple tests and techniques. Unfortunately there is no cost-effective magic bullet, but with a simple-to-follow protocol and time, you will be on your way to healthy, happy eyes and eyelids!

About the Author

Jeffrey Rautio, OD is the founder of the Dry Eye Institute of Michigan and an optometrist practicing at Dr. Jeffrey Rautio- CVC in Ann Arbor, Michigan. A graduate of the Michigan College of Optometry, Dr. Rautio specializes in the diagnosis and treatment of dry eye. Dr. Rautio is a member of the American Optometric Association and the Michigan Optometric Association. Learn more about Dr. Rautio and his practice here.


  1. Thanks for your article Dr. Rautio. I have increasing difficulty with severe dry eye as part of an unknown autoimmune condition affecting the elastic tissues. I have a provisional diagnosis of secondary Sjogren’s Syndrome. I am interested in more information on how to care for the meibomian gland as it appears the oily components of my tears are almost absent. I produce almost no mucous anywhere in my body and even with nighttime ointment my eyelids stick together and sometimes to my eyeball every morning. This occasionally results in damage – I call it “eyeball peeling”. I have less nerve pain as my cornea worsens but this is not good. I wear six different pairs of glasses depending on conditions in spite of underlying excellent vision. Any advice would be welcome.

  2. Hilda Luiz says:

    I have severe dry eye syndrome and my eyes are extremely light sensitive. Some days I can hardly open my eyes. On the bad days, I mostly wake up with a dry crust in the corner of my eyes and I just know that I am going to have an awful day with burning eyes and great discomfort. Most days, my eyes are really bad and I have few good days. Could this be Meibomina Gland Dysfuntion? I live in Johannesburg, South Africa. Do you know of any Opthalmologists in my country that can treat this? I am in agony with this problem and I do not have quality of life.

  3. Melissa says:

    I use night time eye ointment and a sleep mask to keep my eyes covered and that has helped some. I also have a pair of sunglasses that a motorcyclist would wear and a pair of night time motorcycle glasses that have helped some as well. For indoor issues worsening my dry eyes though, I haven’t found anything. Suggestions?

    • Do you use preservative free artificial tears frequently during the day? This is very helpful. On a bad day i can use a whole box. This is better than a trip to the emergency department with peeled off cornea cells. I also wear clear glasses indoors and slightly tinted sunglasses indoors on more sensitive days or in brightly lit environments like shopping centres to minimise the photophobia that comes with dry eye. I find a grey tint best but you would need to experiment with tint colour for yourself as everybody is different. The colour of your light source is also important. I don’t like blue or yellow based lighting. I am saving for a special light that can be adjusted from warm to cool light, depending on my needs and level of sensitivity on any given day. I also press a warm face cloth onto my eyelids . The damp and the warmth is soothing, particularly on bad days. I try not to heat my home very often, preferring to rug up, and I don’t use air conditioning at all. Fan heaters are diabolical. I don’t use a hair dryer. I use a sonic humidifier to ensure the indoor air is not too dry. It can be set to the level of humidity that suits you. I hope something here is useful for you.

  4. Cynthia says:

    I have MGD and a treatment that has been a Godsend to me is “LipiFlow”. The positive effects are still lasting now into the 9th month…and this is after having eyes that sting and burn so badly, I’ve had to come home in the middle of errands to get a hot compress on them.
    The only drawbacks are the high cost of treatment that is not covered by most insurers, and the fact the treatment is not permanent (lasts 12-18 months)
    It is completely painless and lasts only 10-15 minutes in office, but the outcome is terrific.
    (From Ontario, Canada)

  5. BMW says:

    I also have very bad MGD glands where the doc said they were clogged. I tried LipiFlow back in January and helped me greatly! But now I see some of the dry eye symptoms coming back which is unfortunate. I hope INSURANCE COMPANIES would cover this procedure in the very near future! Dry Eyes is a disease!!

    • Yes, I totally agree! The cost is too high to repeat the procedure each year. Although my eyes are drier than normal and require drops, I have not had the terrible burning and stinging that I was experiencing prior to the lipiflow procedure.

  6. Dry Eye Treatment – Here are some tips on how to reduce your dry eye symptoms and improve your quality of life

  7. Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun’s ultraviolet rays. Dry Eye Sunglasses are even more important for dry eye sufferers since they will add extra protection for you sensitive eyes.

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