Management of Meibomian Gland Dysfunction in Children

First-Line Conservative Management

The American Academy of Ophthalmology recommends applying warm compresses to the eyelids for several minutes, once or twice daily, to help manage Meibomian Gland Dysfunction (MGD) in children 1, 2, 3
Vertical eyelid massage should be performed to express meibomian gland secretions after warming, as recommended by the American Academy of Ophthalmology 1, 3
The American Academy of Ophthalmology suggests cleaning eyelid margins by gently rubbing the base of eyelashes using diluted baby shampoo or commercially available eyelid cleaners on a pad, cotton ball, or cotton swab 2, 3
Hypochlorous acid eye cleaners at 0.01% have strong antimicrobial effects for anterior blepharitis, according to the American Academy of Ophthalmology 3

The American Academy of Ophthalmology recommends applying topical antibiotic ointment (bacitracin or erythromycin) to the eyelid margins one or more times daily or at bedtime for a few weeks to manage MGD in children 1, 2
Repeat treatment intermittently using different antibiotics with different mechanisms of action to prevent resistant organisms, as suggested by the American Academy of Ophthalmology 1, 2

Tetracyclines (doxycycline, minocycline, tetracycline) are contraindicated in children under 8 years of age due to tooth staining, according to the American Academy of Pediatrics and the American Academy of Ophthalmology 1
The American Academy of Ophthalmology recommends using oral erythromycin as an alternative: 30-40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4-6 weeks 2
Alternatively, the American Academy of Ophthalmology suggests using azithromycin: 5 mg/kg daily for 2 months, which has shown clinical improvement in small case series 2

Low-energy intense pulsed light (IPL) treatment has been found effective and safe for treating moderate-to-severe blepharitis in children, according to the American Academy of Ophthalmology 4, 5
IPL should be used with caution in more darkly pigmented individuals (above Fitzpatrick skin type IV) due to risk of burns and pigmentation changes, as recommended by the American Academy of Ophthalmology 4, 5

Short-term topical corticosteroids can be used to manage MGD in children, with loteprednol etabonate 0.5%/tobramycin 0.3% suspension being safer than dexamethasone due to less risk of intraocular pressure rise or cataract progression, according to the American Academy of Ophthalmology 2
The American Academy of Ophthalmology recommends limiting steroid use to short courses to avoid complications 2

Patients must understand that cure is usually not possible, and treatment focuses on symptom control, as stated by the American Academy of Ophthalmology 3
Frequent eyelid manipulation may lead to mechanically induced irritation, according to the American Academy of Ophthalmology 1, 2
The American Academy of Ophthalmology suggests considering the child's and parent's ability to safely perform home treatments when tailoring the therapeutic plan 2, 3
The optimal treatment regimen often requires persistence and a trial-and-error approach, as recommended by the American Academy of Ophthalmology 3