Pharmacological, Natural and Emerging Therapies for Meibomian Gland Dysfunction: A Review

Meibomian gland dysfunction (MGD) is a leading cause of non-aqueous deficient dry eye disease. Meibomian glands are responsible for the production of meibum, a lipid-rich secretion that coats the surface of the tear film, inhibiting evaporation of the underlying aqueous tear fluid. MGD can arise due to numerous extrinsic and intrinsic factors that drive changes in meibum quality or obstruction of gland orifices and can result in tear film instability, hyperosmolarity, epithelial damage and downstream ocular surface inflammation. Despite the high disease prevalence, management is not standardised, with a wide range of pharmacological and naturally derived therapies available. Potential pharmacological agents include anti-inflammatories (antibiotics, immunosuppressants and topical integrin antagonists), perfluorohexyloctane and topical aqueous secretagogues. Natural therapies that may offer suitable long-term solutions include oral dietary supplements (polyunsaturated fatty acids, astaxanthin, bilberry, Chinese herbal formulations and Korean red ginseng) and naturally derived topical formulations (castor oil, manuka honey, tea tree oil, coenzyme Q10 and green tea extract). The rising prevalence of MGD has led to the development of several novel therapeutic strategies, expanding the range of management options available to clinicians. A thorough examination should precede the initiation of treatment to identify underlying pathophysiology and guide targeted interventions. Treatment efficacy, duration and safety profiles must also be considered.