Meibomian glands are located on the posterior or back surface of your eyelid. Their primary responsibility is to secrete an oil called meibum into the eye which prevents your tears from evaporating. This leads to more comfortable and less dry eyes. If meibomian glands are disrupted in any way, it can lead to meibomian gland dysfunction (MGD), which results in symptoms of dry eyes, grittiness, irritation, inflammation, redness, and that feeling like you have “sand in your eye.”
NERD ALERT → Meibomian glands have little oil producing factories, called acini, that produce oil. Acini release the oil into the meibomian gland and, with the help of the eyelid muscle (the orbicularis oculi), milks the oil down the gland and out the opening called the terminal duct. This occurs every time you blink. The oil is then released onto the eye’s surface to help prevent evaporation of your tears.
Meibomian gland dysfunction (MGD), or posterior blepharitis, occurs when any part of the process discussed above is dysfunctional. The muscle can lose its function, the oil factories can stop working, and the opening can become clogged. Treatment is directed at helping avoid these problems and will be discussed below.
Meibomian gland dysfunction (MGD) is going to cause the following signs and symptoms of blepharitis:
Meibomian gland dysfunction treatment can be as simple as warm compresses at home (which are shown to provide symptom relief), to diet changes and supplements, to in-office procedures such as IPL, MiBiFlo, or Lipiflow.
Warm compresses are best performed with a mask that is specifically formulated for dry eye, like ourHeyedrate Dry Eye Warm Compress, which contains flaxseed and lavender in a silk mask. You can also make a warm compress by taking dry rice or whole flax seed and putting it into a clean sock.
We recommend applying warm compresses at least every night, but you cannot overdose, so feel free to do it as often as you want for symptom relief. More recent studies have shown that warm compresses are not as effective as other treatment options for meibomian gland dysfunction, but we still consider it a staple in the routine of our dry eye patients. Other treatment options are more expensive, but not as convenient. We will discuss these briefly below and in more detail later.
Meibomian gland expressionis the process of expressing the meibomian glands after heating. Heating up your meibomian glands helps turn the oil into more of a liquid (think of placing a stick of butter on the stove... it melts). After doing this you can milk the glands by rolling a q-tip starting away from your eyelid margin and rolling towards it (or you can use your finger).
After you perform your warm compresses and meibomian gland expression, it is essential to clean your eyelids with a great lid scrub to eliminate all the exfoliated oil from the surface. Heyedrate Lid & Lash Cleanser is the lid scrub we recommend in our clinic. This spray is a natural antiseptic and mimics your body’s natural ability to heal. It is free of any harsh chemicals, alcohol, parabens, sulfates, or other preservatives. It is great for all skin types as it does not clog pores and is hypoallergenic. It is also vegan, natural, and organic. Another similar product that is prescription and just as effective is Avenova. We do NOT recommend products like baby shampoo, as was used commonly in the past.
Lipiflow applies heat to the inside of the eyelids while simultaneously applying a pulsation to the outer eyelids. This helps to liquefy meibum (oil) and express the meibomian glands at the same time. This procedure usually lasts about 15 minutes.
Treating the outer eyelids only, this is very similar to a Lipiflow procedure. MiBo Thermoflo is also a spa-like setting that delivers consistent heat for ten minutes, which will lead to a melting of hardened oil leading to less symptoms and signs of meibomian gland dysfunction. This is usually more affordable than Lipiflow.
Originally used as a treatment for Rosacea, patients that were having IPL, or Intense Pulsed Light Therapy, on their skin condition noticed improvement in their dry eye symptoms. IPL is also used for laser hair removal. IPL is brief, powerful bursts of light that cause changes in the blood vessels near the surface of the skin, which raise the skins temperature, and eliminates problematic flora (bacteria) on the skin and eyes. For meibomian gland dysfunction, the increase in temperature acts like the world’s best warm compress and helps eliminate stagnate oil from the glands. It will also decrease inflammation from the treatment area due to changes in the blood vessels.
Warm compresses should still be done in conjunction with these in-office procedures. Another great treatment option are omega-3 fatty acids, which will be discussed in depth in the next section.
Dr. Travis Zigler
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