Meibomian glands are the oil-producing glands located in both the upper and lower eyelids. When these become chronically blocked, which occurs in about 30% of the population, increased evaporation of the watery component of tears occurs, causing the symptoms of irritation and dryness. This condition is called meibomian gland dysfunction (MGD), and is also known posterior blepharitis.
Meibomian glands are the oil-producing glands located in both the upper and lower eyelids (Fig 1). They number about 25 to 30 and normally slowly release oil into the tear film. This oil/lipid helps to stop the watery component of the tears from evaporating, thus helping to prevent dry eyes.
CAPTION: Figure 1: Meibomian Glands
Sometimes the oil becomes slightly thicker than normal which can lead to blockage of the narrow duct which takes the oil from the gland to the tear film. Dry eye and irritation occur as the stabilising oil cannot reach the tear film. This is called Meibomian Gland Dysfunction (MGD) and is also referred to as posterior blepharitis, as naturally occurring bacteria can cause the oils to thicken and stagnate.
Severe blockage can lead to much enlarged glands (a cyst) or even infection. It is therefore important to firstly unclog the blocked glands, and secondly prevent them from blocking up again - as much as possible.
CAPTION: Examples of heated eye bags used for MGD compresses. They are filled with wheat or Bruder medibeads.
The first step in unblocking the glands is to liquefy the thickened oil in them. This is achieved with a hot facecloth against the closed eye for a minute or so. A heated wheat bag can be used instead for better heat transfer. These are available at Innovative Eye Care. Some patients prefer to use the warmth of their shower to heat up the glands.
CAPTION: Figure 2: Liquefying the thickened oil with a heated wheat bag
After liquefying the oils with this warming, place your index finger on your cheek and press firmly at the edge of the lower lid, rolling your finger upwards to ‘milk’ the gland and empty its contents out of the lid (Fig 3). The picture below shows this technique.
CAPTION: Figure 3: Emptying the glands
If the MGD is more severe, some patients’ glands will initially need a little more help to become unblocked. This can be done by your optometrist with the aid of a meibomian gland expression paddle (Mastrota paddle). Generally this will only require a 15 minute appointment. This in-office expression is more effective than just normal hot-compresses and massage at home. Some patients prefer having this procedure every few months due to the long-term relief it provides.
An exciting new treatment for MGD is now available at Innovative Eye Care. Intense Pulsed Light treatment shows exciting promise for patients with MGD. It involved three treatments over the course of 6 weeks at the clinic with your optometrist. For more information please visit our IPL treatment page here.
There are several therapeutic options which are useful in MGD management:
There are constant updates in the field of MGD research and treatments. Be sure to ask your optometrist if you have any questions about your recommended treatment.