Simply Dry Eye or is it MGD?



Over the past 15 years, research has revealed that the leading cause of eye discomfort for more than 86% of patients with dry eye is MGD. MGD is a disease best detected in its earliest stages and then managed to limit progression.

MGD occurs when the protective oil that normally flows from the eyelid (meibomian) glands slows or stops. Over time, blockage and structural damage of the glands occurs. The oil acts as the front line of protection for the tears and lubricates the surface of the eyes when you blink. When these glands are not healthy, it causes the tear film to rapidly evaporate, leaving the eye’s surface exposed. This exposure can cause discomfort that increases over time and impacts quality of vision. This can result in irritating dry eye symptoms. A routine check for MGD as a part of any eye exam is recommended.


Both function and structure of the meibomian glands are evaluated to properly assess gland health and identify MGD. To determine function, your doctor will check to see if the glands are releasing oil during the blinking process. Structure can be observed with Dynamic Meibomian Imaging (DMI), providing an accurate image of your meibomian glands. If either function or structure is compromised, it is highly likely that MGD is present and your eye discomfort could become progressively worse if left untreated.

To determine if you may have MGD, take the simple online MGD SPEED test and contact an MGD expert, like Dr. Jack Abrams, with your results.


The top layer of the tear film requires oil, or lipid, produced by the meibomian glands. Blocked glands and slowed oil production can cause discomfort, fluctuating vision, reduced contact lens comfort, and the potential for worse symptoms following ocular surgery.


If left untreated, meibomian gland blockage causes structural damage and gland loss. Once glands are lost, there is no known way to regenerate the glands.

MGD and dry eye progress or worsen over time as changes to the gland function and structure occur. With precisely directed treatment, gland function can be restored and maintained. Treatment done by Abrams Eye Institute is intended for the treatment of chronic cystic conditions of the eyelids, including meibomian gland dysfunction, also known as evaporative dry eye or lipid deficiency dry eye. The safety and effectiveness of treatment has been shown in clinical studies and are supported by years of scientific research.


Eye care professionals are seeing MGD present in people of all ages. Modern lifestyles, dry environments and excessive use of display technologies can lead to infrequent blinking, called “evaporative stress”. The lack of blinking creates a demand for more lubrication on the eye, stimulating more oil production. Over time, this leads to thickening of the oil, blockage of the gland opening and shutdown of oil production in the gland.

If you have MGD, there are many factors that can increase likelihood of developing dry eye symptoms:

  • Lifestyle – Smoking, diet and activities that cause eyestrain can contribute to dry eye symptoms. For example, frequent use of computers and digital devices can cause to evaporative stress by infrequent blinking. This inhibits the function of the meibomian glands, which can ultimately lead to permanent damage of the gland structure. Reading or watching TV for long periods of time without taking breaks has been proven to deter a healthy blink rate. If MGD is present, dry eye symptoms can increase.
  • Infrequent or Incomplete Blinking – Blinking naturally activates the meibomian glands. A low blink rate or incomplete blinking can cause MGD and dry eye symptoms.
  • Contact Lens Wear – The simple presence of a contact lens on the eye disrupts the tears, accelerates progression of MGD, and aggravates dry eye symptoms.
  • Eye Surgery – After eye surgery, the surface of the eye is compromised and dry eye symptoms can occur. Untreated MGD can exacerbate a compromised eye surface.
  • Glaucoma and Medications – Over 40% of patients with Glaucoma have dry eye symptoms. Daily use of certain glaucoma medications can disrupt the tears, exacerbate MGD and worsen dry eye symptoms. Antihistamines, decongestants and blood pressure medications can also worsen dry eye symptoms.
  • Climate and Environment – Conditions such as wind, smoke or dry climates are known to increase dry eye symptoms for those with MGD. Air-conditioning or dry heat can also contribute to eye discomfort indoors.


Some treatments for alleviating dry eye symptoms provide temporary relief but do not treat the root cause of the problem. MGD, a chronic and progressive disease, is best managed by treating the root cause using our treatment. In an in-office  procedure, an eye care professional applies precise vectored thermal pulsation (heat to the inside of the lids with simultaneous external pressure to the outside of the lids) to remove the gland blockage to restore gland function.

Your eye care professional may provide various options for the treatment of Dry Eye and MGD. Select the plus icon to learn more about some of the commonly prescribed treatments for Dry Eye and MGD. (graphics for each below with + icon for pop up to learn more):

  • Ocular Lubricants are used to provide temporary relief of dry eye symptoms by adding fluid to the eye.
  • Punctal Plugs are inserted into the tear ducts to block the outflow of tears. The goal is to hold the tears on the eye.
  • Eye Lid Scrubs are used to remove debris from the eyelashes and the lid margins. Lid hygiene is key to maintaining health of the meibomian glands and surface of the eye. Good lid hygiene requires that both the lashes and lid margins be cleaned regularly. The importance of good lid hygiene is similar to good oral hygiene, like brushing and flossing teeth regularly.
  • Warm/Hot Compresses heat the eyelids from the front surface. However, it is difficult to achieve and sustain the level of heat needed to treat MGD using front surface heating. Compliance with daily use of compresses is an essential part of this therapy.
  • Omega 3 Oils suppress systemic inflammation, which contributes to dry eye symptoms.


While it is essential to seek treatment from an eye care professional if you experience any symptoms of MGD or dry eye, you can also adopt simple lid hygiene practices. For the same reasons it is important to brush your teeth to prevent plaque build-up, you need to periodically clean your lids to ensure they are free from debris and excess oils that, over time, can clog the meibomian glands and lead to eye discomfort and MGD.

Lid hygiene may include:

  • Eyelid scrubs for lids and lashes
  • In-office debridement/scaling performed by an eye care professional
  • Blink evaluation, training and exercises

Let’s Get Started

Call 702-304-9494, or click here, to schedule a consultation or exam and see how our dry eye treatment may be able to help you.