Meibomitis: Causes, Treatment, Diagnosis, Prevention, and Pictures

Meibomitis is a chronic inflammation of the tiny oil glands that line your upper and lower eyelids. The meibomian glands release meibum, the special oil that helps lubricate your eyes and keep your tears from evaporating.

When the meibomian glands are blocked, it changes the amount and composition of your meibum. Your eyes will feel uncomfortable, and your vision may be blurry. The gland blockage also creates an environment favorable for bacteria.

Your eyes have about 20 to 40 meibomian glands on each lower lid and 30 to 40 glands on each upper lid. The glands slowly release meibum all the time. Blinking allows more meibum to be released.

People of any age can get meibomitis, including babies. But it's more common among older people and people who live or work in environments that have a lot of dust or pollen particles.

The cause of meibomitis isn't known. It's one of the results of meibomian gland dysfunction (MGD), but MGD also occurs without meibomitis.

Many meibomitis treatments are available, but there's no one definitive treatment.

The symptoms of meibomitis can range from mild to severe. In general, your eyes will feel irritated and your vision may be blurry.

Your eyes may also be:

• painful
• red
• swollen
• dry
• itchy
• burning
• gritty
• sensitive to light
• tender to the touch

You may also have a stye that appears as a red, painful bump on the eyelid. This can be caused by an infection as a result of a clogged oil gland.

The exact cause of the meibomian gland blockage that gives rise to meibomitis isn't known.

Researchers believe it may be bacterial. Ongoing studies are looking at the bacteria on the eye surface and how they affect meibum.

Some factors associated with a higher risk of meibomitis are:

Aging

As you get older, you produce less meibum and meibum with different composition. The number of your meibomian glands also declines.

Environmental stress

Living or working in an environment of low humidity can change your meibum production. This includes air-conditioning and winter heating.

Contact lenses

Wearing contact lenses is associated with a reduction of meibum and other meibomian gland abnormalities. The longer you wear contact lenses, the greater the effect on the meibomian glands.

Diet

A lack of omega-3 fatty acids in your diet may contribute to meibomitis. These fatty acids are found in flaxseed oil, fish oil, and olive oil.

Hormones

Androgens and estrogens may affect the composition of your meibum. Androgens stimulate meibum secretion and suppress inflammation. Estrogens increase inflammation.

Drugs

Retinoic acid can change the volume of meibum and functioning of the meibomian glands. Topical retinoic acid is prescribed for acne.

Topical epinephrine and glaucoma medications have been found to change the meibomian gland function. More studies are needed to determine the effect of preservatives and length of use.

Rosacea

A 2017 article reported that studies of people with rosacea found more abnormalities in the meibomian glands, when compared with control groups.

Computer screen use

Computer screen use is correlated with MGD. More studies are need to determine whether computer use contributes to the development of MGD or exacerbates an already existing condition.

Other risk factors

Other risk factors under investigation include:

• smoking
• antihistamine use for allergies
• postmenopausal hormone replacement therapy
• diabetes

Diagnosis will be made by an eye specialist, either an ophthalmologist or an optometrist. The doctor will ask you about your medical history and your symptoms.

They'll physically examine your eyes and eyelids using special equipment. You may have drops to dilate your pupils. The doctor may also swab your lids to take a sample for bacterial analysis.

A slit lamp exam combines a low-power microscope with a high-intensity light to look at your eyes in detail. The doctor will use this to look for any abnormalities in your meibomian glands.

Newer versions of the slit lamp are portable pen-shaped devices with LED lights and a camera.

Other diagnostic techniques include:

• using a special tape to blot your eyelid margins to measure lipids
• applying pressure to your eyelids to measure the meibomian gland output
• using transillumination to look at the meibomian glands through your eyelids

Researchers have suggested different systems of grading the severity of MGD and meibomitis, but uniform standards haven't yet been accepted.

Meibomitis can be difficult to diagnose because it may be accompanied by dry eye or corneal swelling.

Treatment for meibomitis will depend on the severity of your symptoms. Your doctor may start with conservative treatment, and then add other kinds of treatments if your symptoms persist.

New treatments are under development, and research is ongoing.

Lid hygiene

The first treatment is lid hygiene. Your daily routine should include:

• warm compresses for your lids, for at least 1 to 2 minutes twice a day
• lid massage, as advised by your doctor
• lid scrub or lid cleanser (you can also use baby shampoo)
• eye drops, tears, gels, or ointments, as advised by your doctor for lubricating your eyes

New devices to aid in lid hygiene are on the market for lid warming and massage. New lubricants are also available, and under study.

Drugs

Your doctor may prescribe systemic antibiotics such as doxycycline, minocycline, and azithromycin. Research studies have shown that these antibiotics reduce inflammation and improve the meibum. Be sure to discuss side effects of these drugs with your doctor.

The doctor may also prescribe topical corticosteroids to reduce inflammation. Again, discuss the potential side effects with your doctor.

Another prescription drug your doctor may prescribe is cyclosporine A. It's an immunosuppressant. Studies have shown it to be effective, but there's debate about the most effective dose.

OTC supplements

Omega-3 essential fatty acid (flaxseed oil) supplements are recommended. Studies have shown that these improve symptoms of MGD and meibomitis. They're available over-the-counter (OTC).

Surgical remedies

In certain cases, surgery to open meibomian glands may be recommended to relieve symptoms.

To help prevent meibomitis and keep your eyes comfortable, there are a few things you can try:

• Practice daily eye hygiene.
• Keep the air around you humidified.
• Stay hydrated.
• Don't smoke, and avoid being around smokers.
• Lubricate your eyes, including blinking frequently.
• Wear sunglasses that protect your eyes from sun and wind.

Meibomitis can be painful and even disabling if it's severe. Many treatments exist, including for the dry eye that often accompanies it. You may have to try a few different treatments to get long-term relief.

The exact cause of meibomitis isn't yet known. But meibomitis and MGD are both being researched. New treatments and new insights into their causes are likely.

Talk to your doctor if you have the symptoms of meibomitis. They can help you find the right treatment for relief.