Mechanisms and Safety of Therapeutic Strategies in Meibomian Gland Dysfunction: A Narrative Review.

backgroundMeibomian gland dysfunction (MGD) is a chronic and widespread abnormality of the meibomian glands that often results in symptoms such as eye irritation and blurred vision, significantly affecting patients' daily activities. While conventional treatments like warm compresses and meibomian gland expression remain widely used, their limitations have driven the development of novel therapeutic technologies. SUMMARY: This review synthesizes evidence from 71 clinical and experimental studies in Medline databases on both established and emerging therapeutic strategies for MGD, including physical interventions (warm compresses, eyelid cleansing, probing and expression, thermal pulsation systems such as LipiFlow®, and intense pulsed light) and pharmacological approaches. Across these modalities, most interventions improve symptoms, tear film stability, and meibum quality primarily by enhancing glandular outflow and modulating ocular surface inflammation. Device-based physical therapies typically offer greater and more long-lasting improvements than conventional methods but are limited by cost, access, and a lack of long-term safety data. KEY MESSAGES: Though the current range of MGD treatments cannot regenerate affected glands, their secreting functions can be greatly improved. Clinicians should therefore individualize treatment options according to disease stage, meibography findings, comorbid ocular surface conditions, and patient-specific factors such as tolerance, adherence, and cost.