Meibomian gland dysfunction: when the eyelid oil glands clog

On this page

1. What the glands do and what goes wrong
2. How common it is
3. Symptoms and signs
4. What’s linked with MGD
5. How it’s diagnosed
6. Treatment at home
7. Prescription treatments
8. In-office treatments
9. What doesn’t help as much
10. When to see a specialist
11. Common questions

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What the glands do and what goes wrong

Meibomian glands sit in the firm plate inside each eyelid, and their openings line the back of the lid edge. The oil they make spreads over your tears, helps keep the tear film stable and slows its evaporation. It’s squeezed onto the lid edge by muscle contraction as your lids move11 Nichols et al., Investigative Ophthalmology & Visual Science, 2011 (opens in a new tab). The International Workshop on Meibomian Gland Dysfunction: Executive Summary..

In a 2011 report, an international workshop of more than 50 experts defined MGD as a chronic problem affecting most of the meibomian glands, commonly with blockage at the ends of the gland ducts, changes in the amount or quality of the oil, or both¹.

Most MGD starts with blockage. Thickened, cloudy oil mixed with shed cells plugs the openings and the ducts behind them. A blocked gland may then swell, waste away and drop out. The result may be faster evaporation, a less stable and saltier tear film, more bacteria on the lid edge, and inflammation and damage on the eye’s surface¹. Less often, the glands make too little oil without being blocked, or release too much¹.

When MGD is bad enough, it may lead to evaporative dry eye, the type explained on our main dry eye page. Evaporative dry eye and low tear production can occur together¹.

You may also hear MGD called posterior blepharitis. The workshop says the two terms aren’t interchangeable: posterior blepharitis means inflammation of the back edge of the lid, MGD is only one of its possible causes, and early MGD may show no signs of lid inflammation¹.

How common it is

Nobody knows exactly, because studies have defined MGD in different ways. In the population studies of middle-aged and older adults reviewed by the 2011 workshop, it was found in 3.5% to almost 70% of people. Rates were much higher in studies from Asia, often above 60%, than in mostly white populations, where they ranged from 3.5% to 19.9%. The authors cautioned against comparing the studies directly, since their definitions differed22 Schaumberg et al., Investigative Ophthalmology & Visual Science, 2011 (opens in a new tab). The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on the Epidemiology of, and Associated Risk Factors for, MGD..

Among people who already have dry eye, MGD is common. The 2011 workshop called it very likely the most frequent cause of dry eye¹. In a clinic study across 10 sites in Europe and the US, 86% of the dry eye patients whose type could be identified had signs of MGD, on its own or with low tear production. Only 23 of those 159 patients had low tear production alone33 Lemp et al., Cornea, 2012 (opens in a new tab). Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort..

MGD can also be there before it causes symptoms. In its earliest stages, the workshop noted, people may have no symptoms at all, and it reported that most eye care practitioners agree underdiagnosis is common¹.

Symptoms and signs

As of the 2011 workshop, no symptoms had been found that are specific to MGD. The ones linked with it are the same as, or very close to, those of dry eye in general and of blepharitis along the lash line². They include:

• Burning, itching, dryness or a general irritated feeling
• Heavy or puffy eyelids
• Watery eyes
• Crusts on the lashes, or eyelids stuck together, especially in the morning
• Red eyes or red eyelids

Vision that fluctuates is another symptom MGD shares with dry eye caused by low tear production¹. Our guide to dry eyes and blurry vision explains why it comes and goes.

An eye doctor looks for signs on the lid edge: gland openings that are capped or plugged, tiny dilated blood vessels and redness, and oil that comes out cloudy, thick or not at all when the lid is pressed².

A single lump on the lid is usually something different. A chalazion forms when one oil gland clogs, and an internal stye is usually an infection in one of those glands. Blepharitis, a problem with the edge of the eyelid, makes both more likely. Don’t squeeze either one, and see an eye doctor if a lump affects your vision or doesn’t go away44 American Academy of Ophthalmology, 2026 (opens in a new tab). What Is the Difference Between a Stye and a Chalazion?.

Because MGD affects most of the glands at once, the 2011 workshop treats a single chalazion as a separate problem, though it lists chalazion among the conditions that can occur alongside MGD¹.

What’s linked with MGD

Research on causes was thin when the 2011 workshop reviewed it. The workshop listed factors that may go along with MGD or contribute to it, and noted that the studies behind them were few, small or looked at people at a single point in time, so they show links rather than proven causes².

• Age. In one study of 177 people, few aged 50 or younger had notable changes in their lid edges or oil glands, while such changes became far more common after 50².
• Hormones. Androgens, estrogens and progestins all help regulate the glands. Androgen deficiency and menopause are on the workshop’s list of factors that may promote MGD¹. Our guide to dry eyes and menopause covers what’s known about hormones and hormone therapy.
• Skin conditions. Eyelid changes, including MGD, have been reported in up to 90% of people whose rosacea affects their eyes, although that figure isn’t conclusive, since population studies find similarly high rates of gland changes². Psoriasis and allergic conditions (atopy) are on the list too¹.
• Sjögren’s. This autoimmune disease affects the tear and saliva glands. In a small clinic study of 46 dry eye patients, severe gland blockage was more common in those with Sjögren’s (38.9%) than in those without it (11.1%)².
• Eyelid mites. The link with Demodex mites is unclear: one small study found MGD in five of six people with mites, but other studies found little or no connection². Our guide to eyelid mites covers them.
• Contact lenses. The evidence is mixed. Pooling four studies, the workshop found MGD in 37.7% of lens wearers and 32.1% of non-wearers, a difference that wasn’t statistically significant. A study that imaged the glands did find more gland loss in lens wearers². More in our guide to dry eyes with contacts.
• Medicines. Medicines linked with MGD include antiandrogens, medicines for an enlarged prostate, postmenopausal hormone therapy, antihistamines, antidepressants and retinoids¹. The only one the workshop knew to have been studied specifically for its effects on the glands was the retinoid acne drug isotretinoin, and those studies were small. For several of the others, the evidence comes from studies of dry eye in general². Never stop a prescribed medicine because of your eyes. Ask the doctor who prescribed it whether it could be playing a part.
• Screens and reading. In one study of 70 people who worked at computer screens, 52 had MGD, and those who spent more hours on screen work tended to report more discomfort. It’s unclear whether screen work helps cause MGD or makes existing MGD feel worse². Reading also slows blinking: in a study of 150 healthy volunteers, the average fell from 17 blinks a minute at rest to 4.5 while reading55 Bentivoglio et al., Movement Disorders, 1997 (opens in a new tab). Analysis of blink rate patterns in normal subjects..

How it’s diagnosed

There’s no single test. For people with symptoms, the 2011 workshop suggested a sequence: a symptom questionnaire, then tests of the tears such as tear saltiness (osmolarity), tear break-up time, dye staining of the eye’s surface and a measure of tear production, and then a look at the glands themselves¹.

• The lid edge. Under a slit lamp microscope, the doctor checks the gland openings and the lid margin for plugging, redness and dilated blood vessels².
• Gland expression. The doctor presses on the lid and watches what comes out. The workshop’s scale runs from clear oil, through cloudy and grainy, to oil as thick as toothpaste, and a second score counts how many glands release anything at all¹.
• Meibography. Photos of the lids taken with infrared light show the glands themselves, so the doctor can see whether any have wasted away or gone².

The workshop also said that in adults without symptoms, it’s appropriate to add gland expression, for example moderate finger pressure on the middle of the lower lid, to a routine exam, to catch MGD that isn’t obvious yet¹.

Treatment at home

Treatment works in steps. In the 2011 workshop’s plan, the first steps are home care and advice, and each next step is added when the one before isn’t enough¹.

Daily heat, then massage

Good evidence The thickened oil in MGD often melts only above body temperature, which is why heat is used66 Lee, Ophthalmology and Therapy, 2024 (opens in a new tab). Evidence-Based Strategies for Warm Compress Therapy in Meibomian Gland Dysfunction.. The workshop’s plan called for warming the lids for at least four minutes, once or twice a day, followed by moderate to firm massage to express the oil¹. A 2024 review of 20 studies is more specific: the target is an eyelid temperature of 40°C (104°F) or more, and it advises a moist-heat eye mask, microwavable or self-heating, on each eye for at least 10 minutes once a day⁶.

Why once a day? In the studies it reviewed, people kept to their routine less well when asked to do it more often. In one, once-daily and twice-daily use of the same mask improved gland measures about equally, and the once-daily group kept it up a little better⁶.

All nine trials of repeated warm compresses in the review, lasting from two weeks to six months, found that symptoms eased. The review also calls warm compresses a way to relieve MGD rather than cure it, so think of heat as a habit you keep⁶.

Microwavable masks have been linked with skin burns, so heat yours as its instructions say, don’t overheat it, and test it on your wrist first⁶. Step-by-step instructions, including how to massage safely, are in our warm compress guide.

Lid hygiene

Good evidence Cleaning along the lash line each day is easy to add after a compress. A Cochrane review of 34 trials found that lid hygiene may ease the symptoms of blepharitis, including the kind at the back edge of the lid caused by MGD, though it found no strong evidence that any treatment cures chronic blepharitis77 Lindsley et al., Cochrane Database of Systematic Reviews, 2012 (opens in a new tab). Interventions for chronic blepharitis..

Drops, air and screens

The workshop listed artificial tears (preservative-free preferred for frequent use) and oily (emollient) drops or sprays as options with limited or emerging evidence. Its first steps also included advice on more humid air and a better workstation setup, and explaining that some medicines can dry the eyes¹. Our eye drop guide sorts drops by type, the Eye Break Timer reminds you to look away from the screen, and the Blink Test shows how often you blink while reading.

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Prescription treatments

If home care isn’t enough, an eye doctor can add prescription treatment. Our evidence board grades 20 dry eye treatments, including several below.

Perfluorohexyloctane (Miebo)

Strong evidence Miebo is a prescription drop approved for the signs and symptoms of dry eye. It forms a single layer of molecules on the surface of the tear film, which is expected to slow evaporation, though its exact mechanism in dry eye isn’t known88 FDA prescribing information: Miebo, via DailyMed (opens in a new tab). MIEBO (perfluorohexyloctane ophthalmic solution)..

Its two main trials randomly assigned 1,217 people with dry eye and signs of MGD to Miebo or a saline drop, four times a day for 57 days. Compared with saline, Miebo reduced staining of the cornea, a sign of surface damage, and eased dryness, with significant differences at day 15 and day 57. Blurred vision, the most common side effect in the eye, was reported by under 4%⁸.

A pooled analysis of four trials with 1,814 patients found consistent results, though all of them were short term99 Guedes et al., Cureus, 2024 (opens in a new tab). Efficacy and Safety of Perfluorohexyloctane in Evaporative Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.. Our prescription drops guide has the details.

Antibiotics

Doctors may prescribe azithromycin eye drops or a tetracycline-family antibiotic by mouth. The workshop’s plan listed azithromycin drops for mild MGD, with limited evidence, and rated oral tetracyclines as supported for moderate MGD. It suggested antibiotics may work partly by blocking bacterial enzymes that break down the lid oils, and flagged that oral tetracyclines can make skin more sensitive to sunlight¹. A Cochrane review a year later found the evidence on oral antibiotics for chronic blepharitis inconclusive⁷.

Anti-inflammatory and steroid drops

For moderate to severe MGD, the workshop’s plan adds anti-inflammatory treatment for dry eye. The workshop advised keeping steroid drops for flare-ups, because long-term use can cause cataract and raise eye pressure, and eye pressure needs regular checks while you use them¹. If your exam shows eyelid mites, our eyelid mite guide covers the treatment made for them.

In-office treatments

Clinic treatments can be limited by cost and access. A 2024 review suggests treatments such as IPL for people who find a daily home routine hard to keep up, and for MGD that doesn’t respond to it⁶.

Intense pulsed light (IPL)

Good evidence Pulses of light are applied to the skin of the cheeks, from in front of one ear to the other, while the eyes are fully covered. In 2021 the FDA authorized an IPL device to improve signs of dry eye due to MGD in adults 22 and older with moderate to severe signs and symptoms and Fitzpatrick skin types I to IV, used alongside treatments such as gland expression, artificial tears and warm compresses1010 US FDA, De Novo decision DEN200028, 2021 (opens in a new tab). Intense pulsed light device for managing dry eye (Lumenis Stellar M22), granted February 2021..

In the trial behind that decision, four sessions two weeks apart improved tear break-up time a little more than a sham treatment (by about 1.25 seconds on average), but symptoms improved about as much in both groups, and both groups had their glands expressed at every session¹⁰.

A 2025 review of 13 randomized trials found that IPL probably reduces symptoms compared with a sham. Whether it makes a worthwhile difference when added to standard care, which is how it’s usually used, is still unclear, and the evidence on side effects is very uncertain1111 Peira et al., Acta Ophthalmologica, 2025 (opens in a new tab). Effectiveness and safety of intense pulsed light therapy for dry eye symptoms due to meibomian gland dysfunction: a systematic review and meta-analysis.. Because the authorization covers skin types I to IV, ask whether IPL suits your skin.

Thermal pulsation (LipiFlow and similar devices)

Good evidence LipiFlow is an office device that applies controlled heat and pressure to the eyelids, with the aim of emptying and unclogging the glands1212 Pucker et al., Cochrane Database of Systematic Reviews, 2024 (opens in a new tab). LipiFlow for the treatment of dry eye disease.. In a small randomized trial (31 people completed it), a single 12-minute treatment worked at least as well as three months of twice-daily lid warming and massage. Only the examiners were masked, so a placebo effect may have played a part1313 Finis et al., The Ocular Surface, 2014 (opens in a new tab). Evaluation of an automated thermodynamic treatment (LipiFlow) system for meibomian gland dysfunction: a prospective, randomized, observer-masked trial..

The broadest look at the evidence is a 2024 Cochrane review of 13 trials with 1,155 people. LipiFlow performed about as well as other common treatments, including basic warm compresses, lid hygiene products and prescription drops, and no trial reported a side effect that threatened vision. The evidence was low or very low certainty, largely because the people in the trials knew which treatment they were getting and the studies differed from each other¹². So one treatment may do about as well as months of home care, but the evidence is weak, and it hasn’t been shown to do better than basic warm compresses.

For typical prices and how to check your coverage, see what dry eye treatments cost.

What doesn’t help as much

Omega-3 supplements. Mixed evidence The 2011 workshop listed eating more omega-3 as an option with limited evidence¹. Then the DREAM trial gave 535 people with moderate to severe dry eye either 3,000 mg of omega-3 a day or an olive oil placebo for a year. The trial wasn’t limited to MGD. Both groups improved by about the same amount, and the result held in every subgroup the researchers had planned to check1414 DREAM Study Research Group, New England Journal of Medicine, 2018 (opens in a new tab). n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease..

The workshop also flagged the blood-thinning effect of these supplements, so ask your doctor before starting one if you take a blood thinner¹.

A hot washcloth. It needs re-warming about every two minutes to stay at the target temperature, and in studies where towels weren’t re-warmed, they didn’t improve results. Microwavable masks held their heat well across 10 minutes⁶.

When to see a specialist

See an eye doctor if your symptoms last more than a few weeks despite daily heat and lid care, if you need drops many times a day, or if your lids are often red, crusty or swollen. Get prompt care for eye pain, a sudden change in vision, or a red, painful eye with discharge.

A dry eye specialist can image your glands, check for mites and inflammation, and offer the clinic treatments above. Our clinic directory lists practices whose own websites show dry eye care beyond drops, starting in Florida.

Common questions

Sources

1. The International Workshop on Meibomian Gland Dysfunction: Executive Summary (opens in a new tab). Nichols et al., Investigative Ophthalmology & Visual Science, 2011.
2. The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on the Epidemiology of, and Associated Risk Factors for, MGD (opens in a new tab). Schaumberg et al., Investigative Ophthalmology & Visual Science, 2011.
3. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort (opens in a new tab). Lemp et al., Cornea, 2012.
4. What Is the Difference Between a Stye and a Chalazion? (opens in a new tab) American Academy of Ophthalmology, 2026.
5. Analysis of blink rate patterns in normal subjects (opens in a new tab). Bentivoglio et al., Movement Disorders, 1997.
6. Evidence-Based Strategies for Warm Compress Therapy in Meibomian Gland Dysfunction (opens in a new tab). Lee, Ophthalmology and Therapy, 2024.
7. Interventions for chronic blepharitis (opens in a new tab). Lindsley et al., Cochrane Database of Systematic Reviews, 2012.
8. MIEBO (perfluorohexyloctane ophthalmic solution) (opens in a new tab). FDA prescribing information: Miebo, via DailyMed.
9. Efficacy and Safety of Perfluorohexyloctane in Evaporative Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (opens in a new tab). Guedes et al., Cureus, 2024.
10. Intense pulsed light device for managing dry eye (Lumenis Stellar M22), granted February 2021 (opens in a new tab). US FDA, De Novo decision DEN200028, 2021.
11. Effectiveness and safety of intense pulsed light therapy for dry eye symptoms due to meibomian gland dysfunction: a systematic review and meta-analysis (opens in a new tab). Peira et al., Acta Ophthalmologica, 2025.
12. LipiFlow for the treatment of dry eye disease (opens in a new tab). Pucker et al., Cochrane Database of Systematic Reviews, 2024.
13. Evaluation of an automated thermodynamic treatment (LipiFlow) system for meibomian gland dysfunction: a prospective, randomized, observer-masked trial (opens in a new tab). Finis et al., The Ocular Surface, 2014.
14. n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease (opens in a new tab). DREAM Study Research Group, New England Journal of Medicine, 2018.

Symvana guides are researched from primary sources and updated when the evidence changes. They’re for education and don’t replace an eye exam. Never stop or change a prescribed medicine without talking to the doctor who prescribed it.