MEIBOMIAN GLAND DYSFUNCTION

 

The Meibomian glands are the 25-30 oil-producing glands located in both the upper and lower eyelids that release oil slowly into the tear film.  This oil helps to stop the water in the tears from evaporating, so helping to prevent dry eyes.

Sometimes, the oil becomes slightly thicker than normal and this can lead to a blockage of the narrow duct that takes the oil from the gland to the tear film.  Production will continue but the stabilising oil can no longer reach the tear film, and this may lead to engorgement and swelling of the glands in addition to causing a dry eye. Severe blockage can cause greatly enlarged glands (otherwise know as a cysts) and infection.  It is important to unclog the glands that are blocked and then to try to prevent them from blocking up again.

 

The first stage of unblocking the glands is to liquefy the thickened oil in the glands.  

 

· This is achieved by running a face cloth under the hot tap (make it warm but not hot) and holding it against the closed eye for about one minute (see figure One).  

· Having liquefied the oils through this process, hold one finger firmly against your cheek to anchor the skin and then place your index finger above this, pressing firmly on the lower lid and pushing upward to release the oil up into the tear film (see figure Two).  Do this a few times over the entire lower eyelid, and then do the same thing on the upper eyelid.

· Repeat the procedure for the other eye.

· Do this every day for one week to help unclog the blocked glands.

· After one week, continue the procedure once or twice per week to help prevent the glands from becoming blocked again.

· Another method of warming the eyelid glands is to microwave or boil a new potato, wrap it in a damp cloth and hold it against the closed eyelid until it becomes uncomfortably hot.   Remove it from the eye for a few seconds and repeat. This can be repeated over several minutes to produce the maximum effect without the risk of burning yourself.

· Afterwards, cleanse the eyelids with a cotton bud, using a pinch of Bicarbonate of Soda in the sterile solution (rather than the baby shampoo solution used for blepharitis in another section of this website).

 

                       

     Figure One. Liquefying the oils.                                        Figure Two.  Releasing the loosened oils.

 

In more severe cases, topical antibiotics such as erythromycin ointment can be used 4 times a day.  This will help remove the bacterial load on the lids and relieve symptoms sooner.  If the patient suffers from recurrent meibomianitis, the use of tetracycline or doxycycline antibiotics, taken orally for a couple weeks, can help re-establish a normal oily secretion from the glands.  Initially, the patient may be followed-up to see how things are getting on, but in persistent or deteriorating cases - or as they get older - patients will often understand what treatment works best for them and what needs to be done.  The most important aspect of treatment is the hygiene of the lids and, by taking care of this once or twice a week, symptoms may often be kept at bay for the majority.