American Academy of Optometry
American Academy of Optometry
November 13, 2019
2 min read

Consider underlying conditions with MGD

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Kelly K. Nichols

ORLANDO, Fla. – Clinicians should consider rosacea in patients with meibomian gland dysfunction, according to a speaker here at the American Academy of Optometry meeting.

The OCEAN group (Geerling et al.) showed that 90% of patients with ocular rosacea have eyelid changes similar to those observed in patients with meibomian gland dysfunction (MGD), Kelly K. Nichols, OD, MPH, PhD, FAAO, said during the Anterior Segment Section Symposium, which was sponsored by Primary Care Optometry News.

“They also reported that when rosacea was associated with MGD, the MGD had a poorer prognosis,” she said.

“We should be thinking about underlying conditions more when we see a patient with MGD,” Nichols said. “Why are younger people having MGD? Are we seeing more of it? I hear yes. Why? There are some instances of rosacea in kids. Is there a juvenile form of rosacea?”

Risk factors for MGD include contact lens wear, chronic blepharitis, giant papillary conjunctivitis, Demodex, aging, androgen deficiency, rosacea, Sjögren’s syndrome and menopause, Nichols said.

Clinicians should ask patients about symptoms they may have, although she recommends the use of a survey in addition to a screening test, tear break-up time, osmolarity and ocular surface staining.

“Evaluate the meibomian gland at the slit lamp with your finger,” Nichols said. “If you can do meibography, do it to decide if it’s mild, moderate or severe MGD. Look at the tear film prism for aqueous.”

Nichols said it has been 10 years since the MGD report (Nichols et al.) came out, but, “we still need to learn more about physiology. We don’t know how long it takes to result in gland loss, but we’re fairly sure you can’t get glands to come back. Can you halt that process through treatments? We’d love to know that.”

It is not known what is the most important part of the lipid layer.

“There are 500 unique proteins in the tear film and in the lipid layer, and any one of those can be leading to irregularities,” Nichols said.

“If you can’t manage this, look for someone who can manage it with you,” she said. “Try not to miss or underdiagnose rosacea or other systemic conditions.” – by Nancy Hemphill, ELS, FAAO


Geerling G, et al. The Ocular Surface. 2017;doi:org/10.1016/j.jtos.2017.01.006.

Han S, et al. Anterior Segment Section symposium: Rosacea, ocular rosacea and MGD. Presented at: American Academy of Optometry meeting; Orlando, Fla.; October 22-27, 2019.

Nichols KK, et al. Invest Ophthalmol Vis Sci. 2011;doi:org/10.1167/iovs.10-6997a.

Disclosure: Nichols reports she is a consultant/speaker/advisor for: Alcon, Allergan, Bruder, Eleven Biotherapeutics, Insite/Sun, Kala, Oyster Point, Parion, ScienceBased Health, Shire/Sarcode, Sight Sciences, Silk Tech, Tear Solutions and TopiVert. She has had research contracts with: Alcon, Allergan, Bruder, Johnson & Johnson, Kala, National Eye Institute, Oculus, Shire, Sight Sciences, TearScience and Tear Solutions.