Meibomian Gland Dysfunction is the leading cause of Dry Eye, but its significance remained unrecognized until recent years. This conclusion was unambiguously stated in a landmark compendium of the opinions of 50 of the world’s leading experts who gathered to evaluate the role of Meibomian Gland Dysfunction (MGD) in dry eye.1
Due to lack of awareness and a deficit of metrics for its identification and monitoring, MGD has been overlooked and under-diagnosed.2 More recently, we have come to realize that functional Meibomian Glands are essential to ocular wellness and vision. MGD has a significant detrimental effect on vision, general eye comfort, contact lens wearing comfort, ocular surface appearance, refractive surgery outcomes, and lifestyle in general. MGD can potentially negatively affect all aspects of ocular surface health.3,4
Failure to diagnose MGD in its earliest and most treatable stages has led to many patients experiencing the effects of chronic and severe MGD.5,6,7 These patients present with a decompensated tear film and significantly compromised ocular surface. Further, patients who are already experiencing evaporative stress due to contact lens wear, ocular surgery, or various topical medications are at increased risk for MGD.8,9 Failure to proactively diagnose and manage MGD in these large and overlapping patient populations places them at great and unnecessary risk. As with any treatable disease, early diagnosis and treatment is the most effective way to prevent long-term structural change due to loss of function.10
The tear film is a highly integrated and complex structure. The lipid layer is the frontline of protection for the tear film and ocular surface. If there is any compromise to the lipid layer, the rest of the tear film will experience homeostatic stress. A healthy ocular surface simply cannot be maintained in the absence of healthy meibomian gland function.11,12 By embracing the metrics that are currently available and incorporating a thorough and standardized approach to meibomian gland evaluation in routine eye care we can offer our patients the best chance at ocular surface health maintenance. This approach will optimize the outcomes of any and all aspects of the anterior segment care.13,14,15,16
When MGD is identified, the primary treatment target must be rehabilitating meibomian gland function.17 Adjunct therapy may additionally target controlling inflammation, vision compromise, or any other measurable component of a dry eye state. Eye care professionals need a way to improve clinical outcomes and patient satisfaction by identifying, diagnosing, and treating MGD – aside from the dry eye complexity. With this new understanding, eye care professionals are now rethinking their approach to ocular surface health in general.