Meibomian gland expression at the clinic

On this page

1. What meibomian gland expression is
2. Why a compress at home is sometimes not enough
3. Who the treatment may suit, and who it may not
4. How to prepare for the treatment
5. How the treatment is done at the clinic, step by step
6. What it feels like, and what happens after the treatment
7. Possible side effects and risks
8. What to do at home between visits
9. How expression fits with other treatments
10. Cost

This page is for people who have been diagnosed with blocked meibomian glands, or who suspect this is the cause of their dryness, burning and blurred vision. Here you will find what in-clinic gland expression is, who it may suit, how it is done and what it feels like.

What meibomian gland expression is

The meibomian glands are dozens of tiny glands inside the eyelids, whose openings are at the eyelid margin. They secrete a thin oil that covers the tear film and stops it from evaporating quickly. When the oil thickens, it gets stuck in the glands, the tears evaporate and the eye dries out. This condition is called meibomian gland dysfunction (MGD). In expression at the clinic, the eyelids are warmed to soften the oil, and then pressed in a controlled way to empty the glands and unblock their openings.

Why a compress at home is sometimes not enough

A warm compress and gentle massage at home help soften the oil and keep the glands open. But when the secretion becomes very thick, or when the gland openings are plugged by a layer of cells and scales, heat at home does not always reach the temperature and depth needed, and the gentle pressure of the fingers is not enough to empty the gland. In this situation, controlled expression at the clinic may open the glands, after which home care can work better.

There is another reason not to wait: glands that stay blocked for a long time may shrink and stop working. Earlier treatment gives a better chance of preserving the glands that are still working.

Who the treatment may suit, and who it may not

The treatment may suit people who:

• Have been found on examination to have blocked glands or a thick, cloudy secretion.
• Use warm compresses regularly and still have symptoms.
• Have recurring styes or chalazia, or ocular rosacea.
• Are having IPL treatment, after which the glands are usually expressed.

Sometimes it is better to postpone the treatment, for example when there is an active inflamed stye, an infection of the eye or eyelid, or after recent eyelid or eye surgery. People who take blood-thinning medicines should say so, because small bruises may appear on the eyelid.

How to prepare for the treatment

• Come without eye make-up, especially without mascara and eyeliner on the eyelid margin.
• If you wear contact lenses, bring a case and solution. You may be asked to remove them before the treatment.
• Tell us about blood-thinning medicines, previous eye or eyelid surgery and sensitivity to drops.

How the treatment is done at the clinic, step by step

1. Examination. The condition of the glands and the quality of the secretion are assessed as part of dry eye testing.
2. Warming. The eyelids are warmed to soften the thick oil. When expression is done straight after IPL treatment, the heat from the treatment also helps.
3. Numbing drops. Local anaesthetic drops are put in to reduce the discomfort.
4. Expression. Using a gentle instrument or a swab, the eyelid is pressed from below and above, along the margin, and the secretion is emptied. Sometimes it comes out thick, like toothpaste.
5. Cleaning and instructions. The eyelid margin is cleaned and you are shown how to continue at home.

What it feels like, and what happens after the treatment

Most patients feel pressure and discomfort during expression, and some feel pain. Eyelids with more severely blocked glands tend to be more sensitive. You can ask for a break at any stage.

After the treatment the eyelids may be red, tender and slightly swollen, and the eye may water or feel irritated. This usually passes within a day or two. You can return to most activities straight away, but it is best to avoid eye make-up that day. It is important to continue the home care you are given, such as warm compresses and eyelid cleaning, so that the glands do not block again quickly.

Possible side effects and risks

• Pain and discomfort during the treatment.
• Redness, slight swelling and tenderness of the eyelid for a day or two.
• Small bruises on the eyelid or tiny blood spots, especially in people taking blood thinners.
• Temporary irritation of the eye.

The benefit is not the same for everyone. In some patients the symptoms improve for a period and then return, so expression is usually part of long-term treatment and not a one-off solution.

What to do at home between visits

• Warming: a warm compress on the closed eyelids, according to the guidance you receive. The heat should be pleasant and not scalding, so as not to damage the skin.
• Gentle massage: after warming, gentle pressure on the eyelid towards the margin, without pressing on the eyeball.
• Eyelid margin cleaning: daily cleaning that removes oil and scales from the gland openings.
• Lubricating drops: preservative-free drops, as needed, may ease the sensation while the glands recover. If you use them many times a day, mention it at your follow-up visit.
• Breaks from screens: in front of a screen we blink less, and the glands empty less. Short breaks and full blinks may help.

How expression fits with other treatments

Gland expression is often combined with IPL treatment, which may help soften the secretion and reduce the inflammation around the glands. When there is also inflammation of the eyelid margins or Demodex, eyelid margin cleaning with BlephEx may open the gland openings and improve the result. The eye doctor may also prescribe anti-inflammatory drops or ointments as needed.

Cost

The cost is set and discussed at the consultation, according to the treatment that suits you.

Want a basic explanation first?For basic information on the meibomian glands: the guide on the Mitzmutz site

Frequently asked questions

Does gland expression hurt?

The sensation varies from person to person. Many describe pressure and discomfort, and some feel real pain, especially when the glands are very blocked. You can ask to stop or slow down at any moment.

How often does expression need to be repeated?

It depends on how severe the blockage is and on the response to treatment. Some people need several treatments a few weeks apart, and some come back only occasionally, alongside regular home care.

Can I express the glands myself at home?

Gentle massage of the eyelid after a warm compress is part of home care, according to the guidance you receive. Strong expression at home may injure the eyelid or the eye, so it is done at the clinic.

Does the treatment also help with recurring styes?

Recurring styes and chalazia are often linked to blocked glands. Emptying the glands and home care may reduce how often new styes appear in some patients.

Sources

1. Geerling G, Tauber J, Baudouin C, et al. The International Workshop on Meibomian Gland Dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2011;52(4):2050-2064.
2. Nichols KK, Foulks GN, Bron AJ, et al. The International Workshop on Meibomian Gland Dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52(4):1922-1929.
3. Blackie CA, Solomon JD, Greiner JV, Holmes M, Korb DR. Inner eyelid surface temperature as a function of warm compress methodology. Optom Vis Sci. 2008;85(8):675-683.
4. Dell SJ, Gaster RN, Barbarino SC, Cunningham DN. Prospective evaluation of intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction. Clin Ophthalmol. 2017;11:817-827.

The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.