Meibomian gland dysfunction
✍️✍️✍️✍️
Clinical stages of MGD with therapeutic options
✅ Stage 1 criteria and management
✍️ no symptoms
✍️ Minimally altered secretions
✍️ no ocular surface staining
✍️ Inform patient about MGD
✍️ management
• Alter diet
• reduce environmental stress
• Consider lid hygiene
• warm compresses and expressions
✅ Stage 2 criteria and management
✍️ Minimal to mild symptoms of discomfort, itching, and photophobia
✍️ Minimal to mild altered secretions
✍️ none or limited ocular surface staining and TFBUT( tear film break up time ) <10s
✍️ management
• Improve ambient humidity
• increase dietary omega-3 intake
• Lid hygiene and warm expression (minimum of 4min twice daily)
• Lubricants
• topical azithromycin
• liposomal spray
• Consider tetracycline derivatives
✅ Stage 3 criteria and management
✍️ Moderate symptoms with defnite limitation of activity
✍️ Moderately altered secretions
✍️ increased lid margin vascularity
✍️ telangiectasia
✍️ orifice plugging
✍️ Mild to moderate conjunctival and peripheral corneal staining
✍️ TFBUT around 5s
✍️ management as stage 2 Plus
• oral tetracycline derivatives
• Lubricant ointment
• Consider anti-inflammatory therapy for dry eye
✅ Stage 4 criteria and management
✍️ Marked symptoms with definite limitation of activity
✍️ Severely altered secretions with MG dropout
✍️ displacement Central corneal staining
✍️ conjunctival inflammation and hyperaemia
✍️ TFBUT < 5s
✍️ management the same As stage 3 treatment Plus
• anti-inflammatory therapy for dry eye
✅ MGD Plus-disease
✍️ Exacerbated inflammatory ocular disease surface disease
✍️ Mucosal keratinization
✍️ Phlyctenular keratitis
✍️ trichiasis
✍️ MG cysts or chalazion
✍️ Anterior blepharitis
✍️ management by all previously mentioned options with
• Pulsed steroid therapy
• therapeutic CL/scleral CL
• Epilation
• cryotherapy
• Intralesional steroid or excision
• topical antibiotic or antibiotic-steroid combination
• tea tree oil scrubs
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