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Alternatives to Expressing Meibomian Glands

  • Last updated November 8, 2022

7 min read

Danielle Stoken
Written byDanielle Stoken
Jovi Boparai, MD
Reviewed by Jovi Boparai, MD
Danielle Stoken
Danielle StokenEye Health & Wellness ContributorPittsburgh, PA

Bio

I was so excited when I learned about CorneaCare and am honored to share content, tips and stories about dry eye! I am a certified Health Coach through the Institute for Integrative nutrition so the intersection of nutrition/lifestyle and dry eye disease is one that I am particularly passionate about. Since recently becoming a mom, I care even more about my eye care and self-care and am learning so much through CorneaCare's educational resources.

Get to know me a little better!

Hobby: baking sourdough bread
Food: pasta
Superhero: my dad
Guilty pleasure: cold brew coffee (really, any coffee)
Secret power: serious facial recognition/recollection

Training:

Undergraduate: Carnegie Mellon University
Nutrition training: Institute for Integrative Nutrition

Jovi Boparai, MD
Jovi Boparai, MDCo-founder & CEO of CorneaCarePhiladelphia, PA

Bio

Dry eye disease is tough! I get it. I have struggled with dry eyes for several years from contact lens use, and from spending countless hours looking at computer screens. In college, my dry eyes got so bad that I couldn’t wear contact lenses, because of a constant “foreign body sensation” when I had them in. I had to stop reading every 30 minutes because my eyes would start to burn and my vision would get blurry. I tried a plethora of treatments and nothing seemed to work. Dry eye disease was not only impacting my eyes, but also my emotional wellbeing. It was preventing me from enjoying life, and getting in the way of my professional training. I felt overwhelmed, frustrated and hopeless.

It was only when I realized that my dry eyes were linked to my lifestyle, environment and overall health did things start to make sense. I noticed that on days when I spent less time on the computer, my eyes felt better. My symptoms would flare when it was windy, or when there was low humidity. I knew that if I wanted to get ahead of my dry eyes, I needed to not only treat my eyes, but to also address my lifestyle. I started a consistent regimen of artificial tears and eyelid hygiene. I switched from monthly contact lenses to daily contact lenses. I started taking scheduled breaks from looking at a computer. I ate a healthier diet focused on anti-inflammatory/antioxidants foods, and I bought a humidifier for my room. In the beginning doing all this seemed impossible, but over time it became part of my usual routine. Not only did my eyes feel better, but I was overall healthier and happier! Turns out what is good for my eyes, was also good for my mind and body. I carried this lesson with me as I started my career to become an ophthalmologist and ophthalmic surgeon.

Because of my personal journey and professional training, I believe dry eye treatment starts by listening to and empowering the patient. I listen for the struggles and cue in on their strengths, while picking up on their lifestyle. Only then do we together start building a treatment plan that incorporates good eye hygiene with small, but impactful lifestyle changes. Our sight is our most important sense, and it is intimately linked to our very being. I want dry eye patients to not only get their dry eyes under control, but to also enjoy good mental and physical health, and live a fulfilling life. What is good for the eyes should also strengthen the mind and fortify the body!

Get to know me a little better!

Hobby: vintage watches
Food: peanut butter
Superhero: Superman
Guilty pleasure: desserts
Secret power: has never had a headache

Training:

Undergraduate: University of Pittsburgh Honors College
Medical school: Weill Cornell Medicine
Ophthalmology residency: Wills Eye Hospital.

Alternatives to expressing meibomian glands

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Table of Contents

Key points

  • Meibomian glands produce oil to protect and optimize your tear film, which keeps the eyes lubricated and comfortable. 
  • Disruptions to meibomian glands can lead to discomfort, irritation and eye conditions such as meibomian gland dysfunction and dry eye disease. 
  • You can help your meibomian glands express naturally with eyelid hygiene techniques, or an eye doctor can manually express meibomian glands with specialized equipment.
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Keywords

Blepharitis, dry eye disease, eyelid hygiene, meibomian glands, meibomian gland dysfunction, meibomian gland expression

Taking the first step

Has an eye doctor (optometrist or ophthalmologist) suggested expressing your meibomian glands to treat clogged or dysfunctional glands? If so, you may be wondering if it is safe and if there are alternatives. 

The answer is yes, to both. 

While meibomian gland expression is safe, there are alternatives you can try at home. Because symptoms can occur at any time, it’s important to understand all of the available options.

Understanding Meibomian Glands

An intricate system of glands in your eyelids is responsible for keeping your eyes lubricated and comfortable through lipid (oil) production. 

Glands and goblet cells

Meibomian glands are oil glands along the edge of the eyelids where they meet the eyelashes.¹ They are located in both the upper lid and lower lid.² These glands secrete oil onto the lid margin called meibum.³ Meibum forms the topmost layer in your tear film, called the lipid layer, and is important for tear stability and in preventing tear evaporation.³

Tear film: cornea, tear film layers, mucin layer, aqueous layer, lipid layer

Meibomian glands sometimes stop working well because of various factors. Instead of releasing oil into your tear film, the oil secretions can deposit on the eyelids or in the glands, causing blockages.²

Meibomian Gland Dysfunction (MGD)

Meibomian Gland Dysfunction (MGD) is a group of related ocular surface disorders. With MGD, oil glands overproduce or underproduce oils needed to lubricate your eyes.² The typical signs of MGD are dry eye symptoms such as dryness, watery eyes, irritation, redness and gritty sensation.⁴

Key Symptoms of dry eye disease

MGD can lead to eyelid inflammation called blepharitis, triggering irritation, burning and redness along the eyelids.⁴ MGD is just one risk factor for blepharitis, more specifically, posterior blepharitis. Rosacea, infections, allergies and dry eyes also contribute to blepharitis.³⁴ 

Many experts believe MGD is severely underdiagnosed. Age is a contributing factor to MGD and experts predict that over 70% of people over 60 suffer from the disease.² 

Causes of MGD

Several conditions and risk factors lead to the development of MGD. Some MGD patients experience symptoms because of multiple factors. 

Age

MGD rates increase with age due to meibomian gland atrophy (where meibomian cells die off) as part of the natural aging process. This atrophy leads to disruptions in the cells that produce and release oils.⁴

Environmental and Lifestyle Factors

Living in dry climates with low humidity, smoking cigarettes and having a poor diet lacking omega-3 fatty acids can contribute to MGD.³ 

Environmental conditions that affect dry eye disease

Medical Conditions

Autoimmune conditions like Sjögren’s syndrome, which causes severe dry eyes and mouth, can contribute to MGD, as can rosacea and lupus.⁵

Other Eye Conditions

There is overlap between MGD, blepharitis and dry eye disease. It is possible that patients can experience all three at once.⁵ 

Eye infections, like allergic conjunctivitis (eye allergies), can cause MGD. The meibomian glands become distorted and clogged with oil when the eye is inflamed.⁶

Key exam findings for dry eye disease

Contact Lens Wear 

People who wear contacts are more likely to get MGD. Contact lens wearers have a higher degree of meibomian gland dropout (the loss of meibomian glands), especially with chronic use.³

Treating MGD and Dry Eyes

Treatment for MGD will vary depending on the cause and severity of symptoms. Some people respond well to at-home eye care routines, while others require mechanical/manual expression of meibomian glands. 

CorneaCare believes in empowering individuals to take control of their eye health and avoid costly procedures and medications when possible. Eyelid hygiene may be all you need to manage your MGD and dry eyes. However, it can also be an effective tool used in conjunction with medical treatments like in-office meibomian gland expression. 

Eyelid Hygiene

More eye doctors now recommend eyelid hygiene as an important tool in treating eye conditions such as dry eye disease, MGD, blepharitis, and eye allergies. 

So what is it? 

Your eyelids protect your eyes from the outside world. As we’ve learned, they contain glands, oils and tears that help your eyes function and keep them comfortable. Eyelid hygiene is simply caring for your eyelids on a routine (daily) basis much like you do your teeth, skin and hair. It’s important to show them some love!

Even better, eyelid hygiene can improve symptoms associated with MGD, dry eye disease, blepharitis and eye allergies. 

Eyelid hygiene routine: warm compress, eyelid wipes, eye mask

5 Simple Eyelid Hygiene Steps to Help with MGD Symptoms

The best part about eyelid hygiene is that you can do it in the privacy and comfort of your home. Trips to the clinic can be inconvenient and expensive. You have tools available to treat your symptoms at home for a fraction of the cost. Here are five eyelid hygiene steps you can start practicing today. 

Warm Compress

Warm compresses are a great way to stimulate and open the meibomian glands. They can be made with hot water and a soft washcloth. Simply run the washcloth under hot water, ring out and apply directly to your eyes for 10-15 minutes. You can also make one at home by placing a handful of uncooked rice in a tennis sock, and then heating the tennis sock for about 30-60 seconds.

CorneaCare’s Rest Warm Eye Compresses are self-heating and stay warm longer, so no need to microwave or reheat. 

rest warm compresses

Rest

Warm Compresses

Perfect for eye dryness, fatigue, tearing, and puffiness of the eyelids. Free shipping 📦.

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Cold Compress

Try a cold compress when you have a sudden flare-up of symptoms because cold compresses reduce inflammation and provide immediate relief. Similar to a warm compress, you can make a cold compress at home, except with cold water or an icepack. 

Try CorneaCare’s Rescue Hydrogel Self-Cooling Cold Compresses for a convenient, on-the-go cold compress. Made with cooling plant-based extracts, it provides safe and long-lasting relief all without needing a freezer! 

rescue self cooling hydrogel cold compress

Rescue

Cold Compresses

Perfect for sudden flare-ups of eye dryness, pain, burning, and swollen/inflamed eyelids. Free shipping 📦.

Try today - $12

Eyelid Wipes

Because MGD leads to oil secretion disruption, oil often accumulates on the eyelids and leads to blepharitis. Eyelid wipes, like CorneaCare’s Rise Eyelid Wipes, are great for when you first wake up in the morning to help remove build-up from your eyelids. Rise Eyelid Wipes contain natural tea tree oil and hyaluronic acid to combat MGD and blepharitis symptoms naturally. 

Rise eyelid wipes

Rise

Eyelid Wipes

Perfect for eye dryness, itching, burning, and crusting/flaking of eyelashes. Free shipping 📦

Try today - $25

Artificial Tears

If used correctly and consistently, eye drops can be an effective tool in managing MGD symptoms. There are several artificial tears, gels and ointments on the market, so you may have to try a few to experience relief.⁷ 

Dry eye artificial tears

Artificial tears can contain preservatives to prolong their shelf-life. The problem is that preservatives can worsen dry eye symptoms if used for a long period. Preservative-free artificial tears are a great alternative but have a shorter shelf life and should be handled with care to avoid spreading bacteria.⁷ 

Be on the lookout for CorneaCare’s Preservative-free Eye Drops available this summer. With one-way valve technology, germs and bacteria stay outside of the bottle where they belong!

Supplements

Eating a balanced diet rich in healthy fats, fruits, vegetables and whole grains is great for overall health and even better for your eyes! Fatty acids are anti-inflammatory and improve the function of the nerves and nervous tissue in and around your eyes. To ensure you are getting the proper amount of essential fatty acids needed to reduce inflammation, you might try an Omega-3 supplement. 

Nutritional health

In addition to Omega-3s, adding a multivitamin formulated specifically for the eyes can help reduce symptoms of MGD and dry eyes. 

When Meibomian Gland Expression is Necessary

If you’ve tried eyelid hygiene consistently and your symptoms have not improved or have gotten worse, it may be time to discuss meibomian gland expression with your eye doctor. Meibomian gland expression is the act of stimulating the meibomian glands to produce oil or to break up clogged ducts.⁸ 

Typically, a warm compress (when done consistently) is enough to liquefy the capped oil glands to begin expressing naturally. When that doesn’t work, an eye doctor can manually express meibomian glands in the office by applying gentle force on the eyelids or can use specialized equipment. 

How Eye Doctors Express Meibomian Glands

An eye doctor can manually express meibomian glands, or can use heat and light therapy machines. 

Your eye doctor will first warm the eyelids using a warm compress or eyelid heating device to loosen the meibum.⁸ They will then apply gentle pressure using a mastrota paddle, cotton swabs or other meibomian gland expressors to the upper and lower eyelids.⁸ Once the doctor has finished the procedure, they will typically apply eye drops and prescribe artificial tear gel to help reduce conjunctiva (outer membrane of the eye) irritation.⁸ 

Intense Pulsed Light (IPL) therapy is where a machine projects intense, brief bursts of light into the eyelids.⁹ The light causes changes in blood vessels and temperature and can help loosen blockages and stimulate oil production in the meibomian glands.⁹

Lipiflow is a device that is best used for mild to moderate cases of dry eyes, MGD and blepharitis.⁹ The device uses warmth and massage to break up clogged glands and stimulate lipid production.⁹ Its specialized construction protects the cornea from heat and pressure.⁹

prescriptions and procedures: eyelid thermal heating devices, punctal plugs, prescription eye drops

Putting It All Together

When it comes to helping your meibomian glands express, you have options. While dry eye symptoms can be frustrating, they shouldn’t interfere with your daily life! 

You can manage your symptoms at home and discuss treatments with your eye doctor. Start by practicing one eyelid hygiene step per week, and layer on additional steps until you find your perfect routine. 

Make eyecare a part of your self care – your eyes will thank you! 

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What’s next

Dry Eye 101 is a comprehensive course designed with you in mind. Begin today to learn how you can take control of your dry eyes for good.

Bibliography

  1. “Meibomian Glands.” American Academy of Ophthalmology, 19 January 2018, https://www.aao.org/eye-health/anatomy/meibomian-glands. Accessed 13 April 2022.
  2. Bunya, Vatinee Y. “Meibomian Gland Dysfunction (MGD) – EyeWiki.” EyeWiki, https://eyewiki.org/Meibomian_Gland_Dysfunction_(MGD). Accessed 13 April 2022.
  3. Galor, Anat. “Meibomian gland disease: the role of gland dysfunction in dry eye disease.” NCBI, 1 November 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685175/. Accessed 13 April 2022.
  4. “Blepharitis – Symptoms and causes.” Mayo Clinic, 12 January 2022, https://www.mayoclinic.org/diseases-conditions/blepharitis/symptoms-causes/syc-20370141. Accessed 13 April 2022.
  5. Canter, Julie. “Meibomian Gland Dysfunction (MGD): Symptoms, Causes, & Treatment.” WebMD, 29 November 2021, https://www.webmd.com/eye-health/meibomian-gland-dysfunction. Accessed 13 April 2022.
  6. “Study strongly links allergic conjunctivitis, meibomian gland duct distortion.” Healio, 2010, https://www.healio.com/news/ophthalmology/20120331/study-strongly-links-allergic-conjunctivitis-meibomian-gland-duct-distortion.
  7. Cole, Jane. “Artificial Tears: What Matters and Why.” Review of Optometry, 15 November 2020, https://www.reviewofoptometry.com/article/artificial-tears-what-matters-and-why. Accessed 13 April 2022.
  8. Hatley, Jonathan, and Nathan Lighthizer. “How to Impress (and Express) Your Patients.” Review of Optometry, 15 May 2015, https://www.reviewofoptometry.com/article/how-to-impress-and-express-your-patients. Accessed 13 April 2022.
  9. “Devices for Treating The Meibomian Glands.” Review of Ophthalmology, 25 September 2018, https://www.reviewofophthalmology.com/article/devices-for-treating-the-meibomian-glands. Accessed 13 April 2022.

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