Hyperkeratinization Plays Key Role in Meibomian Gland Dysfunction

The human eye
The human eye
The researchers propose a novel treatment strategy that incorporates keratolytic agents.

Meibomian gland dysfunction’s (MGD) pathogenesis may be rooted in retention hyperkeratosis, which leads to altered meibum flow and plug formation, according to a study published in Clinical Ophthalmology. With this information, researchers suggest that selenium sulfide, a dermatological agent, may appropriately manage MGD.

Historically, researchers have emphasized the melting point of meibum lipids in an effort to develop a way to liquify build up along the gland’s canal using lid warming and massage devices. This recent research review focuses on the underlying pathology of MGD, rather than simply removing the obstruction. The researchers found that patients with MGD have abnormal keratinization of the gland orifice, central ducts, and within the meibum itself. They suspect that keratin modification via selenium sulfide, a potent keratolytic agent sold as an antifungal agent to manage dandruff, could offer a potential treatment.

“Selenium sulfide decreases the differentiation of epidermal cells and minimizes corneocyte production by slowing the production and development of keratinocytes,” the researchers explain.

In support of intervention with selenium sulfide-containing therapies, the reviewers cite a trial involving 0.5% AZR-MD-001 ointment in MGD patients, as well as a trial of 1.0% AZR-MD-001 ointment in contact lens wearers with symptoms. They found that sulfide-containing ointment restore gland function, reduce eye dryness, and attenuate fluctuating vision, as well as boost comfort in lens wear, all while avoiding serious negative side effects.

“These positive findings with a selenium sulfide- containing ointment are consistent with the role selenium sulfide plays in targeting aberrant keratins and disrupting disulfide bonds of the keratin plaques that can occur in both the meibum matrix and at the gland orifice, to unblock the glands,” report the investigators. “While many more studies are needed, this is an important step in demonstrating that addressing the root cause of MGD, hyperkeratinization, may bring relief.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Gupta P, Periman L, Lain E, et al. Meibomian gland dysfunction: A dermatological perspective on pathogenesis and treatment outlook. Published online November 9, 2021. doi:10.2147/opth.s327407