Meibomian gland expression is a procedure to diagnose as well as treat meibomian gland dysfunction (MGD), one of the causes of dry eye disease. MGD refers to a condition where the meibomian glands are clogged and blocked. The glands are located in the rim of the lower and upper lids where the eyelashes are found. They secrete oils onto the eye's surface, which prevents the tears from evaporating too quickly. If the tears evaporate too fast, the eyes may dry out and become irritated.
People aged 40 and above are at an increased risk of developing MGD. The condition can lead to eyelid inflammation, irritation, and redness, and left untreated, it can permanently damage the eyes. In meibomian gland expression, the doctor squeezes out the eyelids' oil to check if the glands are clogged. The procedure also reduces MGD symptoms and improves MGD signs.
Meibomian gland expression can be performed together with other eye treatments such as blephasteam and intense pulse light therapy.
- Diagnostic – is performed to determine if one has MGD and the stage of MGD’s severity. The meibomian glands are healthy if the oil expressed is clear and has a little color. However, thick or discolored meibum is an indication of MGD. At this juncture, the doctor can proceed with the therapeutic expression as a viable treatment option
- Therapeutic – is performed to treat MGD where the glands are more thoroughly expressed.
Before the Procedure
Topical anesthetic drops are instilled into the eyes of patients undergoing the therapeutic procedure.
About 10 minutes before the therapeutic expression, hot compresses are applied to the site. The purpose is to soften or liquify the meibum to cause effective expression. There are many options available concerning the choice of heating masks. Those that retain heat for 10 to 15 minutes are the most recommended.
The doctor will have the patient look down if the upper eyelid is to be expressed and look up for lower lid expression.
For inferior meibomian gland expression, the surgeon:
- Pulls the eyelid inferiorly to expose the palpebral conjunctiva and the pores of the meibomian gland
- Applies a pre-moistened cotton-tip applicator (with saline) or expressor paddle to the palpebral conjunctiva (the eyelash and fornix’s middle)
- Applies pressure to the inferior eyelid adnexa after releasing the eyelid by use of another expressor paddle or cotton-tip applicator
- Rocks the paddle from the base or rolls the cotton-tip applicator from the meibomian glands’ base to the eyelid margin’s pores
- Inferiorly pulls the lower eyelid and moves the paddle or cotton-tip applicator to the next meibomian gland section that needs expressing
- The same procedure is repeated on the rest of the inferior meibomian glands
For superior meibomian glands, the surgeon:
- lifts the upper eyelid a little off the globe while the patient looks down
- Inserts the paddle or cotton-tip applicator below the eyelid (about midway between the eyelashes and superior fornix)
- Expresses the glands by rocking the paddle or rolling the cotton-tip applicator inferiorly
- Repeats the procedure until the remaining superior glands have been expressed
Risks & Complications
In most cases, one session of meibomian gland expression may not be sufficient, requiring repeat sessions.
Aftercare & Recovery
After the procedure, the doctor will immediately instil a drop or two of artificial tears in each eye. S/he will also prescribe an artificial tear gel for home use to relieve the irritated palpebral conjunctiva.
The patient is made to understand that the management of MGD is a long-term undertaking since a single gland expression may not permanently address the problem. Masks that retain heat for 10-15 minutes, such as the Bruder mask, can be performed once or twice a day to help evacuate meibum from the glands. Besides, lipid-based tears such as Soothe XP or Retaine MGD help supplement the tear film and secretions by the gland.
Some patients may exhibit signs and symptoms of posterior blepharitis and will require short-term steroid therapy. The patient can use these drugs overnight for two to four weeks to help alleviate the symptoms.
Tetracyclines can be prescribed to prevent inflammation besides stabilizing the tear film’s lipid layer. However, these drugs should not be used in the mildest MGD stages. About 3g of omega-3 fatty acid supplements taken daily can also aid in meibum production.
The patient is taught how to perform a meibomian gland massage at home as a long-term management strategy for MGD.
In most cases, meibomian gland expression is successful and will increase the quality of oil production in the glands as well as reduce the symptoms of dry eyes. Although some patients may benefit from one session, others may require regular treatment.