💡 Overview: Meibomian Glands & Ocular Surface Health

Author: FeliciaPauk | info@fellysaas.com

Retinoids and Dry EYES

Meibomian glands are modified sebaceous glands located in the tarsal plates of the eyelids. They secrete meibum, a lipid-rich substance that:

• Prevents evaporation of the tear film

• Maintains a smooth optical surface

• Reduces shear forces on the conjunctiva and cornea

Dysfunction of these glands—termed Meibomian Gland Dysfunction (MGD)—is one of the leading causes of dry eye disease, particularly evaporative dry eye.

We often blame screen time, allergies, or poor sleep for our dry, irritated eyes. But what if the real culprit lies within your skincare routine or more specifically, in the tiny oil glands along your eyelids?

Welcome to the world of Meibomian Gland Dysfunction (MGD)- an under-recognized condition that affects millions and is closely linked to both our ocular surface health and skincare habits, including the use of retinoids.

🔬 Retinoids & Meibomian Gland Atrophy: The Link

Retinoids (like isotretinoin or topical tretinoin) are derivatives of Vitamin A and are widely used in dermatology for acne, anti-aging, and pigmentation.

Key Effects of Retinoids on Meibomian Glands:

1. Induce acinar atrophy: Retinoids reduce the size and function of meibomian acinar cells.

2. Cause ductal keratinization: This leads to duct blockage, inflammation, and ultimately gland dropout.

3. Reduce lipid synthesis: Leading to an unstable tear film and increased evaporation.

4. Alter ocular surface immunity: Retinoids can dysregulate local cytokines and mucins, compounding dry eye.

   
   

📚 Studies:

• Stern ME et al. (2004): Highlighted the inflammatory cycle in dry eye, which can be aggravated by retinoid-induced gland changes.

• Draelos ZD (2006): Found that topical retinoids can penetrate periocular tissues and affect gland function, even when not applied directly to eyelids.

• Donnenfeld et al. (2003): Demonstrated meibomian gland dysfunction as a dose-dependent side effect of systemic isotretinoin therapy.

• Harvard Medical School (2025): Research led by Dr. David A. Sullivan demonstrated that exposure to 13-cis retinoic acid (isotretinoin) can disrupt meibomian gland function. The study found that retinoids promote inflammatory mediator and protease expression in meibomian gland epithelial cells, inhibit their proliferation, and induce cell death, leading to gland dysfunction and dry eye symptoms.

• Medical News Today (2024): A 2023 study highlighted that oral isotretinoin affects the meibomian glands, leading to decreased oil production in the tear film and resulting in dry eyes. The study emphasized that both topical and oral retinoids can contribute to dry eye disease by impacting these glands. 

UK-Based Insights

• John Rose Eyecare (2025): This UK-based optometry practice reported that retinoids commonly found in anti-aging eye creams can negatively affect meibomian gland function. The article advises caution when using retinoid-containing products near the eyes and recommends consulting with eye care professionals.

• Dry Eye Zone UK (2025): An article from this UK resource emphasized that even over-the-counter retinol products might pose risks for dry eye when applied near the ocular area. It underscores the importance of being aware of product ingredients and their potential ocular effects. 

  
  

Additional Research

• Scientific Reports (2025): A study investigating the relationship between tear function changes and meibomian gland dysfunction across various phenotypes of polycystic ovary syndrome (PCOS) found that tear film instability attributed to MGD was significantly different in all PCOS patients compared to healthy subjects, highlighting the broader implications of gland dysfunction.

  
  

👁️ Symptoms of MGD & Retinoid-Associated Dry Eye

• Burning, stinging, or gritty sensation

• Redness or foreign body sensation

• Increased reflex tearing (paradoxical tearing)

• Blurred vision that improves with blinking-

• Discomfort with contact lens use

💊 Management Tips (Clinical & Patient Self-Care)

🔹 For Patients on Retinoids:

• Use preservative-free artificial tears (e.g., Systane®, Hylo-Forte)

• Apply warm compresses daily to support gland secretion

• Avoid applying topical retinoids near the eyelids

• Consider omega-3 fatty acid supplements to improve meibum quality

• Use lid hygiene wipes (e.g., Blephaclean® or Ocusoft®)

• Topical azithromycin or low-dose doxycycline can help in inflammatory MGD

🔹 For Aesthetics & Skincare Professionals:

• Educate clients on risks of periocular retinoid use

• Offer non-retinoid alternatives for eye-area rejuvenation (e.g., bakuchiol, peptides)

• Be cautious recommending retinoids to clients with pre-existing dry eye

📌 Clinical Takeaway

Meibomian glands are critical to maintaining ocular surface integrity. Retinoid-induced MGD is underdiagnosed, especially in patients using anti-aging skincare. Regular use of Systane or other lubricants is helpful, but identifying and managing the underlying dysfunction is key.

📌 Clinical Implications

These findings underscore the importance of cautious use of retinoid-based products, especially near the eye area. Healthcare professionals should educate patients on the potential ocular side effects of retinoids and recommend alternative treatments when appropriate.

📌 Medical Disclaimer

This content is for informational purposes only and does not substitute for professional medical advice. Please consult your GP, dermatologist, or medical aesthetician before using active skincare ingredients near the eyes or adopting management tips mentioned above.