IU Dry Eye Clinic – Dry Eye Disease Information, Treatments, And More

Understanding Meibomian Gland Dysfunction: Causes, Symptoms, and Treatments

Posted on March 3, 2025 by Dr. Tichenor

If you’ve experienced dry, irritated eyes with intermittent blurry vision that clears temporarily when you blink, you might be dealing with Meibomian Gland Dysfunction (MGD) – a condition that can often lead to the type of dry eye disease known as evaporative dry eye. It is quite common for patients to have both MGD and dry eye disease.

What are meibomian glands and what do they do?

The meibomian glands are oil-producing glands found in the upper and lower eyelids. Every time you blink and your upper and lower eyelids meet, the glands secrete an oil called meibum that forms a layer on top of the tear film to slow the evaporation of the tear film. When the glands become blocked or produce a poor-quality oil, the tear film becomes unstable, leading to fast evaporation of the tears and results in dry, irritated eyes. This condition is known as Meibomian Gland Dysfunction (MGD).

How does MGD develop?

Inflammation in the eyelids and around the meibomian glands causes the meibum (oil) to change consistency from something like olive oil (nearly clear, free flowing) to hard butter (thick, toothpaste-like). This change in consistency can lead to blockages in the glands, preventing the oil from releasing onto the tear film. Prolonged blockage can lead to loss of meibomian glands, or what is known as meibomian gland atrophy where they can no longer produce meibum (see meibography image below where the glands-white rows-do not reach all the way to the eyelid fold). It’s important to treat MGD before we start to see meibomian gland atrophy if possible.

What are some risk factors for MGD?

Aging – the function of the meibomian glands naturally declines over time
Prolonged screen time – reduced and incomplete blinking when using computers and digital devices can lead to less meibum being secreted and lead to MGD
Contact lens wear – long-term use may alter meibomian gland functioning
Hormonal changes – conditions like menopause can affect meibum/oil production
Underlying health issues– rosacea, blepharitis, and autoimmune diseases can contribute to MGD
Environmental factors– dry climates, air condition, and pollution can exacerbate symptoms

How is MGD diagnosed?

Eye doctors can use special tools like meibography (imaging of the meibomian glands) and tear film analysis to diagnose MGD. Meibography can show whether the meibomian glands are beginning to atrophy or if there are early signs of blockages within the meibomian glands. Some devices can even measure the thickness of the oil layer which can help determine if the oil layer is thick enough to slow the evaporation of the tears or if it is too thin. A slit lamp microscope, however, is essential for a diagnosis of MGD. It can be used to closely examine the eyelids and look at how well the meibomian glands are functioning. The eye doctor can apply pressure on the eyelids and evaluate how easily meibum comes out of the glands and look at the consistency of the oil to determine if MGD is present.

Treatment and Management Options for MGD

The good news is that there are many treatments available to help manage MGD and improve eye comfort. The best treatment plan will 1) target the underlying inflammation, and 2) improve functioning of the meibomian glands.

At Home Remedies:

Warm compresses and eyelid massage
Eyelid hygiene
Omega-3 supplements
Blinking exercises

In Office Treatments:

Heat devices: Meibothermoflo, LipiFow, iLux, TearCare – These devices can deliver heat at the temperature needed to melt the thicker meibum in the meibomian glands. Typically a heat treatment is followed by meibomian gland expression where the eye doctor will squeeze on the eyelids to remove blockages within the glands.
Radio Frequency – This technology liquefies meibum within the eyelids and provides eyelid benefits such as stimulating collagen and skin tightening.
Intense Pulsed Light Therapy (IPL)– This technology targets inflammation which contributes to the development of MGD. It reduces inflammation and improves the quality of meibum -changing the consistency from toothpaste (thicker) to olive oil (freely flowing). It works very well in combination with radio frequency treatment since IPL reduces the inflammation and radio frequency helps unblock the glands.

Final Thoughts

MGD is a chronic but manageable condition. By understanding the causes, you can protect your eye health and take proactive steps for treatment. If you suspect you have MGD, don’t wait- schedule a dry eye exam and discuss personalized treatment options with your eye doctor.

Introduction to Dry Eye Disease

Posted on April 19, 2022 by Dr. Tichenor

There’s a lot to talk about when it comes to dry eye disease. Over the next few posts, we will go into understanding what’s going on behind the eyelids of those red, burning, blurry, and gritty eyes, and then get into ways we can treat and manage it. Let’s start with an introduction.

Awareness and understanding of dry eye disease (DED) has grown extensively over the past few decades, and with it a plethora of treatment options, but it is important to keep in mind that the inherent multifactorial nature can make it a challenging and frustrating condition to experience as well as treat and manage. While it is estimated that more than 30 million Americans have symptoms of DED, it is likely that many more suffer from this often-debilitating disease.

Speaking of symptoms, what are some symptoms of DED?

Dryness, itching, feels like something is in your eye, burning, light sensitivity, eye pain, and watering – I know what you’re thinking, how can my eyes be dry if they’re watering? Well, if your eyes are dry, they first try to compensate by making more and more tears, but because these tears don’t have the right components, they just run down your face instead of moisturizing your eyes!
Blurry vision that is sporadic and intermittent – Our tear film not only keeps our eyes hydrated for comfort, but it also creates a smooth surface so we can see clearly.
Eye strain and computer discomfort — Blinking is important because it helps to spread the tear film over the surface of your eyes. If you don’t blink as often, like when using our laptops or smart phones, it can lead to discomfort.
Crusting or red eyelids – It is important that we keep our eyelids clean so our eyelid glands (Meibomian glands) can release their oils and coat the surface of our eyes.
Red eyes – This is a key sign of inflammation! We will talk about inflammation a lot, because it is a key mechanism in DED.

The wide variety of symptoms you can experience with dry eye disease is because there can be many causes and contributing factors. Some examples are:

· Oral medications	· Eye surgeries	· Eyelid irregularities
· Contact lenses	· Environment	· Topical drugs and preservatives
· Autoimmune conditions	· Computer use	· Allergies
· Systemic diseases	· Blepharitis/Meibomian Gland Dysfunction	· Sjogren’s Syndrome

The most common treatment that many patients will start with are artificial tears. These drops can add moisture to the eye and help alleviate some discomfort. However, there are so many artificial tears in the “Eye” aisle at the store, it can be overwhelming to figure out which one to pick! Here are some of my favorites:

Refresh Mega-3 Many patients have evaporative dry eye where the tears evaporate very quickly because of meibomian gland dysfunction (we will talk more about this in the next post!). This means that the tear film has an abnormally thin oil layer. Refresh Mega-3 contains flaxseed oil, which helps to boost the oil layer to keep the tears on the eyes longer.

Refresh Relieva & Optase Hydrate These are both nice, refreshing preservative free drops that contain hyaluronic acid. This agent is excellent at retaining moisture, which makes it a great ingredient for an eye drop!

Siccasan You can only find this drop available for purchase online at the moment, but it is a thicker drop that provides long term hydration on the eye. It does not have mineral oil or petroleum, and can be used during the day or at night time for healing the surface of the eye overnight.

Keep in mind that while these drops can help your eyes feel better short term, they don’t treat the underlying cause of dry eye disease. If you find yourself using artificial tears more than four times a day for relief, it is certainly time to see an eye doctor and consider another treatment method!

Welcome to the IU Dry Eye Clinic Blog!

Posted on March 31, 2020 by Dr. Tichenor

About the IU Dry Eye Clinic

Indiana University School of Optometry (IUSO) is a world-class research and teaching facility, and our Bloomington Atwater Eye Care Center is a leader in outstanding eye and vision care for all types of patients. Doctors recognized for their expertise in dry eye combine that knowledge with leading edge technology available in our clinic. With these tools, our doctors can determine the underlying causes of your symptoms while also looking for signs of damage to the front surface of your eye from inflammation that is often associated with dry eye and other ocular surface diseases. A personalized treatment plan can then be created for dry eye sufferers targeting the underlying cause in order to best increase comfort and visual function.

Meet: Dr. Tichenor

Dr. Tichenor joined the IUSO faculty in October 2019 to diagnose and treat patients in the Dry Eye Clinic and to investigate dry eye disease through research and clinical studies. She graduated from Southern College of Optometry with a Doctor of Optometry degree, and then completed a PhD in Vision Science from the University of Alabama at Birmingham. With her PhD, she is uniquely trained to use and interpret diagnostic measures of the eye’s surface in order to understand the mechanisms of dry eye disease. This allows Dr. Tichenor to tailor a treatment plan that directly targets the root cause dry eye disease in her patients. She uses evidence-based medicine in her treatment strategies; that is, she integrates her clinical experience with the best available research information to create effective treatment plans for her patients.

About this Blog

This blog was created to provide a place for patients to go to learn more about our Dry Eye Clinic, the services and treatments we offer, and to provide patient-friendly education about dry eye disease. Dr. Tichenor or other invited doctors will periodically make posts here about various topics. Please let us know if there is something that you would like to learn more about!