MG Expression and How To Unblock Meibomian Glands with Dr. Lorin Vogel
Dr. Lorin Vogel is a second generation optometrist practicing in Westwood, CA adjacent to UCLA. His private practice was started by his father in 1971, and he’s married to an optometrist as well. Dr. Donna Weiss is a contact lens specialist and also works in the same practice.
He’s been in and around the optometric practice since he was a young child, and he’s worked his way up through being an optician to now practicing optometry. A few years ago, he remembers being at the International Society of Contact Lens Specialists where he heard Dr. Donald Korb presenting on his recently invented LipiFlow device. This was incredibly intriguing to Dr. Vogel, and it occurred to him that he could probably achieve similar results by doing the same thing manually.
He started doing MG expressions using a Bruder Mask and tools to express the meibum afterward. Since then, the practice has invested in technology to view the meibomian glands, as well as Miboflo and IPL.
What is MG Expression? Who Should Have MG Expression?
Meibomian gland dysfunction (MGD) is a huge issue across the world. Those suffering from this condition have issues creating the lipid layer of the tear film, which comes from the meibomian glands in the upper and lower eyelids. This lipid layer is essential for the proper functioning of the tear film, as it helps to lubricate the eyes and create a smooth surface for crisp vision. If the meibomian glands are the problem, meibomian gland expression will be considered.
This simply involves heating the glands first (Dr. Vogel uses Miboflo or IPL for this), which allows the impacted, hardened oil within the glands to soften a bit. After this, he uses a drop of anesthetic in the eyes and expresses the contents of the glands. It is important to evacuate the stagnant oil from the glands in order to make room for healthier, higher quality oil. This part is done with a small metal paddle placed on either side of the eyelid.
The lids are lightly compressed during this procedure, and he’s found that as long as the eyelids are heated properly beforehand, he doesn’t have much trouble expressing the glands. Sometimes, less pressure is actually more in this case.
Contraindications and Risks of MG Expression
Meibomian gland expression should not be performed on anyone without gland issues. If meibography looks great, it won’t be performed. In addition, anyone with aqueous deficiency alone will not have this procedure done. Any patients who have a previous history of MG expression without results, or anyone who is particularly sensitive on the skin of their eyelids may want to avoid expression.
What To Expect After the Procedure
After an in-office expression, patients are left with dilated glands. This is a good thing because it means that the contents have been expressed, but it can also be a bad thing since bacteria has the potential to invade the glands shortly after expression. Because of this, Dr. Vogel prescribes a topical antibiotic-steroid combination to avoid any bacterial overload and inflammation that could lead to a stye.
He also recommends that patients do warm compresses once per day while at home. This helps to maintain the health of the meibomian glands and keeps the oil softened and flowing. Patients may also want to try some gentle lid massage, although consciously blinking is likely more important than actually doing lid massage at home.
Some patients will need to be retreated once per month and others will come every few weeks. A few will even go six months between meibomian gland expressions, and this is very patient dependent. Dr. Vogel also recommends patients keep up with their eyelid hygiene, which would include cleansing the eyelids with a hypochlorous acid cleanser or an eyelid wipe at least once or twice daily.
If you’d like to contact Dr. Vogel for an appointment, visit his website or give them a call at (310) 208-3011. Also, make sure to follow his Instagram@drdryeyeguy to watch some of the meibomian gland expressions he’s performed on patients. If you or someone you know are interested in specialty contact lenses for keratoconus, post-injury or post-surgery, you can also get in contact with his wife, Dr. Weiss. She specializes in difficult to fit contact lenses such as scleral lenses, and together the two of them will be glad to help you with your dry eye diagnosis.
Dr. Lorin Vogel is a glaucoma certified therapeutic optometrist who specializes in dry eye disease therapy and management. At his dry eye clinic, Dry Eyes Los Angeles, Dr. Vogel has been a leader in providing state-of-the-art care for those suffering from dry eyes in Los Angeles.
In addition to his dry eye practice, Dr. Vogel provides primary optometric care, manages and treats eye diseases including glaucoma and macular degeneration, and provides preoperative and postoperative care for his patients. Dr. Vogel also regularly fits orthokeratology lenses (aka: ortho-k/corneal refractive therapy) for patients who would like to live a life free of glasses or contacts during the daytime without surgery.
Dr. Vogel completed his undergraduate education at UCLA and earned his Doctorate of Optometry from the New England College of Optometry in Boston, Massachusetts. He is a proud UCLA Bruin despite his maternal family’s strong USC heritage and feels lucky every day to work next to such a wonderful school (on the better side of town).
Dr. Vogel is also a proud father, a lover of live music, a skier, and always looking forward to life’s next adventure.