Causes and Risk Factors of Meibomian Gland Dysfunction

Having meibomian gland dysfunction is a common problem. These oil glands are at the edges of both the upper and lower eyelids. You rely on them to make meibum, an oily secretion rich in lipids that ensures that tears don’t evaporate too soon. These glands can easily become blocked or start producing poor-quality oil.

Knowing that you’re dealing with this condition is only part of the battle. It’s also important to understand why you, in particular, may have developed meibomian gland dysfunction, as well as why now.

Understanding what the causes may be can put this condition in a whole new light. This article discusses the common causes of meibomian gland dysfunction, including genetic and lifestyle factors.

Common Causes

There’s no one easy answer as to why you may be vulnerable to meibomian gland dysfunction. From aging and environmental stress to wearing contacts lenses or using certain systemic and topical medications, a variety of factors can play a role in the development of this condition.

While it is something that can affect anyone, some people are more prone to it than others. Here are some potential factors to keep in mind.

Age

If you’re over the age of 50, the possibility of developing meibomian gland dysfunction becomes more likely, particularly if you’re also female. As you age, some meibomian gland cells atrophy, which results in a decrease in lipid production.

At the heart of these changes is likely reduced cell renewal and meibomian gland size, as well as an increase in inflammatory cells in the area that affects your glands.

Environmental Stress

If your eyes are in a very dry environment, it can lead to changes in the cells that make meibum (meibocytes), changes in the ratio of lipids to proteins in meibum, and other alterations. This can cause a depletion in the number of functioning meibomian glands over the long run.

Also, the thickness of the meibum itself may increase, which may ultimately make the tear film less stable and contribute to symptoms.

Hormonal Changes

Hormones can also have an impact on this condition. Meibomian glands have both estrogen and androgen receptors, which makes these hormones important in these cases. Generally, androgen hormones both stimulate meibum secretion and reduce inflammation. Estrogen, on the other hand, increases inflammation.

Individuals with low androgen levels, including those receiving anti-androgen therapy, are at increased risk for meibomian gland dysfunction. This can include individuals with:

• Prostate cancer or benign prostatic hypertrophy who are undergoing anti-androgen therapy
• Complete androgen insensitivity syndrome, a genetic condition in which the body does not respond to androgens
• Sjogren’s syndrome, an autoimmune disease associated with dry eyes and dry mouth

Medication Usage

Some medications can affect meibomian gland function and impact the quality of the oil produced. Medications that can cause changes include:

• The acne medication Accutane (isotretinoin) has been associated with meibomian gland atrophy.
• Topical epinephrine can cause meibomian gland blockage and dilation.
• Topical glaucoma medications such as carbonic anhydrase inhibitors, prostaglandin analogues, and beta-blockers can cause meibomian gland changes.

Genetics

There can also be a genetic component to meibomian gland dysfunction, with some people born with this condition. You may have been born with meibomian glands either absent altogether or just too few. This may also involve one of the following conditions:

• Turner syndrome: This is a genetic disorder in which there is only one X chromosome rather than two X chromosomes or an X and a Y chromosome.
• Ectodermal dysplasia and cleft lip and palate: This is a rare genetic disorder that affects the limbs (including fingers and toes), hair, teeth, skin, nails, and sweat glands.
• Anhidrotic ectodermal dysplastic syndrome: This is an inherited disorder that affects sweat glands, skin, hair, and teeth.
• Distichiasis: This disorder, in which extra eyelashes replace meibomian glands, occurs congenitally.

Cardiovascular

While meibomian gland dysfunction is not a cardiovascular disease, some research shows there may be an association between severity of meibomian gland dysfunction and increasing levels of lipid components such as cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL).

These are levels that are often high for those with heart disease or at increased risk of developing it. Likewise, the severity of meibomian gland dysfunction tends to be linked to increased lipid levels.

While the connection is not clear, there is some thinking that cholesterol in the meibum and other lipid levels may play a role in developing meibomian gland disease.

Lifestyle Risk Factors

There are also some readily controllable lifestyle factors that can come into play with meibomian gland disease.

Diet

What you eat can play an important role in improving the quality of meibum produced. In particular, the amount of omega-3 fatty acid you consume can impact the lipid profile of meibomian gland secretions (more is better). Also, taking omega-3 supplements may help decrease eye surface inflammation and inflammatory substances in tears.

Foods high in omega-3 fatty acid to help enrich your diet include:

• Flaxseed oil
• Fish oil
• Olive oil

Contact Lens Wearing

Wearing contact lenses can have a negative effect on meibomian glands. This can cause more meibomian gland loss, which cannot be reversed even after contact lens use has been discontinued.

While the reason for this is not completely understood, it is thought to be linked to mechanical trauma to the gland and plugging of the gland with epithelial cells, as well as chronic inflammation.

Cosmetics

Cosmetic products used around the eyes can also have a detrimental impact. Creams and other cosmetics applied here can have ingredients that have been found to be toxic to the meibomian glands, at least in cultures. It is also believed that these can contribute to meibomian gland atrophy when used day to day.

Summary

Meibomian gland dysfunction is seen more often in people over age 50. Other risk factors include environmental stress, hormonal influences, wearing contact lenses, and some medications. Some genetic conditions are also linked to it.

A Word From Verywell

Having a fuller understanding of what may be at the root of your meibomian gland dysfunction can bring you closer to ultimately controlling it. If you have meibomian gland dysfunction or suspect you might, heading off some of these causes may allow you to improve symptoms and make the condition more manageable moving forward.