How Meibomian Gland Dysfunction Is Diagnosed

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Your eyes feel dry and uncomfortable, and you're facing the possibility that you may have meibomian gland dysfunction. You're not sure what may lie ahead.

Could these tiny oil glands at the edges of the eyelids be clogged or just not performing as they should? From examining the glands and the secretions they release to looking at the tears themselves, here's what to expect when in the midst of a diagnosis for a meibomian gland issue.

Finger pressing on a closed eyelid near the lashes

AndreyPopov / iStock / Getty Images

Self-Checks

While there's no kit you can buy or quick checks you can make in the mirror to alert you that you may have a meibomian gland dysfunction, you can determine if what you're feeling is consistent with typical complaints.

Having irritated eyes is just the starting point. If your eyes are feeling dry, you may want to ask yourself if you are also dealing with any of the following symptoms:

  • Redness
  • Itchiness
  • Light sensitivity
  • A burning sensation
  • Transient blurry vision
  • Wateriness
  • Foreign body sensation

If these symptoms sound like what you are experiencing, it may be time to consult an eye practitioner. They can determine if you are dealing with meibomian gland dysfunction or if this is something else.

Physical Examination

To determine if you actually have meibomian gland dysfunction, a practitioner must do a thorough examination. This may involve examining the secretions produced by applying gentle pressure to the eyelids.

Also, the doctor will look closely at your tears to determine if these may be the source of your symptoms. The practitioner will look to see if you have enough of these on the surface of your eye and determine if they are staying there long enough.

With a tear breakup time test, the doctor places a drop of dye on the surface of your eye. Then they will shine a blue light in front of you, which will make the tears glow. It will then be possible to tell if your tears have good quality or if they are breaking up too quickly and aren't sticking around to keep the surface moist.

Your practitioner will also ask some questions to get a better handle on whether you have risk factors for meibomian gland dysfunction. Those questions can include the following:

  • Do you currently wear contact lenses?
  • What kinds of medications are you taking? Are you being treated for acne? Are you being treated for prostate cancer or something else with anti-androgen therapy? Or, are you using any topical glaucoma medications?
  • When did your symptoms arise? Was this after age 50?
  • Do you live or work in a particularly dry environment?

Your answers can help the practitioner gauge how likely you are to have a meibomian gland issue or something else.

Lab Tests

If it is suspected that you may have meibomian gland dysfunction, your doctor will look at both the signs you present with and your subjective symptoms. Keep in mind that you can be symptom-free and still have signs of meibomian gland disease.

It is typical for a practitioner to conduct a battery of tests to see whether your case fits the meibomian gland dysfunction pattern. They will be looking at the glands themselves, examining your gland secretions, looking at your lids for signs of gland blockage, and also testing your tears. You may expect the following to take place:

  • Being asked to answer a symptoms questionnaire or a dry eye questionnaire to see if you're a likely candidate for a meibomian gland dysfunction diagnosis
  • Tear volume testing to see if you have a sufficient quantity of tears
  • Meibometry testing to determine the quantity of lipids at the lid margins noninvasively
  • Staining the surface of the eye to gauge the severity of dryness there
  • Schirmer tear testing with a paper strip to see if the quantity of tears is sufficient

Together, these tests can help determine if you have meibomian gland dysfunction and help monitor how you're faring over time and responding to treatment.

Imaging

It's important to image the meibomian glands themselves in making any meibomian gland dysfunction diagnosis. Meibography, which shows images of the meibomian glands and can indicate changes, once involved a probe but now is a noninvasive test.

Practitioners are looking to see how your meibomian glands appear. This can also allow you to see for yourself how your glands are being impacted. Under normal circumstances, these resemble piano keys. But with meibomian gland dysfunction, they may instead appear twisted or thickened or may be absent altogether.

Differential Diagnoses

Keep in mind that it may not be apparent initially whether you have meibomian gland dysfunction or aqueous deficient dry eye, in which you aren't producing enough tears, or actually have a combination of the two conditions.

If the practitioner has stained the surface of your eye and looked at the oil coming from the meibomian gland and found an issue, it may not yet be clear what the correct diagnosis should be.

The reason is that the inflammation caused by both of these conditions can create symptoms that look very similar. Because the treatment for each of these can take months, it can be important to find out which condition you have.

To help determine this, the doctor may prescribe steroid drops initially. This can reduce inflammation around the meibomian glands. If this allows the oil to flow freely once again, then it is likely that you don't have meibomian gland dysfunction.

If the meibomian gland remains blocked, the doctor will know that further work is needed to improve your lipid production.

Summary

Meibomian gland dysfunction diagnosis relies on a history, physical examination, and tear breakup time test. A practitioner may further do imaging with meibography and other testing of the quality and quantity of tears. It is important to distinguish between meibomian gland dysfunction and other causes of dry eye.

A Word From Verywell

It can be frustrating to be dealing with red, burning eyes and know that something is amiss. Ultimately, determining whether these symptoms are indeed linked to meibomian gland dysfunction, as you may suspect, can clear the way for setting up a treatment plan to tackle this condition successfully.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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