Meibomianitis - Causes, Symptoms, and Treatment

Introduction

Meibomian glands are oil-secreting glands in the eyes, and when these glands do not function properly, the glands become inflamed. It results in poor moisture and lubrication in the eyes. It can also cause excess oil secretion that stagnates in the corner of the eyelids and causes bacteria usually present in the skin to multiply.

It is due to hormonal imbalances during puberty, a few allergies, contaminated contact lens solutions, or infected eye makeup. First, it can be observed by inspecting the eyes and thorough questioning. Then, a few tests, like a swab test, will be performed. Finally, it is treated by prescribing antibiotics and steroids in a drop or pills form.

What Is the Meibomian Gland?

The meibomian glands are huge sebaceous glands in the upper and lower eyelids. They are oil-secreting glands that lubricate or keep the eyes moist and form the outer covering of the tear film. The upper eyelid has around 25 to 40 meibomian glands, and the lower eyelid has about 20 to 30 glands. Each meibomian gland has a group of about 10 to 15 acini in the upper eyelid and drains through the smaller ductules into the central duct. They open into the margin of the upper eyelid and secrete oil that forms the tear layer. These glands are kept active by the action of the muscles around the eyelids.

What Are the Causes of Meibomianitis?

• Hormonal Changes During Puberty: Hormonal imbalances during adolescence can cause meibomian gland malfunctioning.

• Allergies: Certain allergies caused by pollen and other airborne allergies also cause meibomianitis.

• Acne: A skin condition caused by blockage of the hair follicles due to the build-up of excess oil and dead skin cells.

• Rosacea: It is a skin condition that causes flushing or blushing and prominently visible blood vessels.

• Eyelash Lice: A small wingless insect that feeds on human blood.

• Acne Medications: Certain medications used to treat acne, like Isotretinoin, creates a ground to breed bacterias and cause infection.

• Contact Lens Solution: Certain contact lens solutions also cause infection.

• Infected Eye Makeup: Eye brushes used for makeup, when not cleaned for a long time, attract bacteria and can lead to infections.

What Are the Symptoms of Meibomianitis?

• Swelling and redness of the eyes.

• Watery eyes.

• Burning sensation in the eyes.

• Sensitivity to light.

• Crust formation in the eyelash.

• Dry eyes.

• Flaky skin around the eyes.

• Itchy eyes.

• Frequent bumps or stye formation in the eyelids.

• Too much blinking.

• Loss of eyelashes.

• Abnormal growth of eyelashes.

• Blurry vision.

What Are the Tests to Find Meibomianitis?

• Eye Examination: Thorough eye examination by the ophthalmologist (eye specialist) will be done. The doctor will look deeply into the eyelids for signs of gland obstruction with a bright light and the eyeballs for dryness.

• Swab Test: A speck of the crust will be collected in a swab for examination. A sample of the oil from the eyelid will also be tested. If the results are positive, further medications will be prescribed.

How Is Meibomianitis Treated?

Depending on the cause of the meibomianitis, the treatment will be planned.

• Cleaning Eyes With Water: The ophthalmologist will recommend cleaning the eyes with fresh warm water to remove the debris and keep the area clean.

• Artificial Tear: Artificial tears will be recommended if the eyes are dry.

• Antibiotic: Oral antibiotics like Azithromycin and Oflox eye drops will be recommended. Antibiotics in paste form will also be recommended to apply directly to the eye.

• Steroids: Prednisolone is a steroid medication given in an eye drop form to treat meibomianitis.

• Treating Rosacea: If the underlying cause is due to a skin condition like rosacea. Medications will be prescribed to treat the disease.

• Temporary Lifestyle Modifications:

  • Restrictions to eye makeup should be followed for a few days.

  • Acne treatments should be stopped until the doctor directs.

  • Restrictions to stop using contact lenses will be recommended until the infection clears.

• Meibomian Gland Expression Procedure: The doctor will perform a meibomian gland expression procedure to clear the oil and the crust formed in the meibomian gland. The doctor will then massage the eyelids while this unblocks the gland.

• Lipiflow: A device that warms the eyelids and clears the stagnant oil.

• Fish Oil: Consuming fish oil to improve oil secretion.

• Using Cannula: A tiny tube called a cannula is used to clear the oil that has thickened by pushing the cannula into the opening of each gland.

What Can Trigger Meibomianitis?

• Allergic reactions.

• Contaminated eye makeup.

• Unclean contact lens solution.

• Isotretinoin is used in the treatment of acne.

• Certain skin conditions like acne and rosacea.

• Hormonal imbalance during adolescence.

What Are the Risk Factors That Cause Meibomianitis?

• Aging.

• Deficiency in sex hormones, specifically androgens.

• Sjogren's syndrome.

• Steven Johnson syndrome.

• Psoriasis.

• Atopy.

• Polycystic ovarian disease.

• Hypertension.

• Aniridia.

• Chronic blepharitis.

• Wearing contact lenses

• Eyelid tattooing.

• Trachoma.

• Certain medications like Isotretinoin, antidepressants, antihistamine, and hormone replacement therapy.

How to Prevent Meibomianitis?

• Meibomianitis cannot be prevented. However, maintaining proper eye hygiene will prevent clogging the oil-secreting glands.

• Treating skin conditions like acne and rosacea before it causes complications.

• Certain foods like chocolates can trigger or worsen meibomianitis. Therefore, these foods should be avoided.

What Is the Prognosis of Meibomianitis?

The prognosis is good and does not cause any vision loss. However, there is a recurrence in some cases, and the treatment is long-term.

Will Meibomianitis Cause Emergency Situations?

Meibomianitis does not cause emergencies, but if the symptoms do not reduce and stye develops, one should visit a doctor immediately.

Conclusion

Meibomianitis is a dysfunction of the oil-secreting gland called the meibomian. It is caused by certain skin conditions like acne and rosacea, some allergies, contaminated lens solution, and contaminated eye makeup. It causes excess oil secretion and stagnates in the corner of the eyelids, causing a rapid increase in bacterial growth. This causes symptoms like redness or swelling of the eyes, watery or dry eyes, crust formation in the eyelids, loss of eyelashes, etc. However, it can be ruled out by an eye examination performed by the doctor and a swab test. The treatment includes treating the underlying cause like resolving the skin conditions rosacea and acne and avoiding using contact lenses and eye makeup, and antibiotic therapy to terminate bacterial growth. Though this is not a severe condition that causes vision loss, proper eye hygiene will reduce the risk of getting meibomianitis and improve the patient's lifespan.