Manually expressing the contents of the meibomian glands helps diagnose meibomian gland disease (MGD) and is a proven therapy for posterior blepharitis and evaporative tear dysfunction. It’s not “sexy” but it does work.
What is it?
Tiny “paddles” are used to compress the lower eyelid to squeeze out the contents of the meibomian glands.
Why do it?
The meibomian glands of patients with MGD are usually full of stagnant secretions. These poor quality secretions block the gland opening, irritate the eye and fail to lubricate the eye and prevent evaporation of the tears. Draining the glands encourages the production of new secretions
Does it hurt?
In most cases the procedure is painless. Patients with eyelid inflammation may need to use anti-inflammatory eye drops for a few weeks beforehand. Some patients take paracetamol an hour before their appointment. If the eyelid is very inflamed it can be fully anaesthetised.
What to expect
The amount and type of secretions expressed vary enormously. The gland contents may be clear, cloudy, buttery, gelatinous or toothpaste-like. Sometimes nothing comes out. Frothy secretions are common. Patients who have taken retinoic acid to treat acne often have small plugs of solid “lipid” blocking the gland orifices.
What do the secretions mean?
Generally the thinner the secretions and the more glands that can be expressed the better. Repeated expression usually results in thinner and thinner secretions.
Frequency of expression
Some patients need just a single treatment, others benefit from regular expression. It is normal to repeat the procedure after a month and then determine when further review is needed. Most patients quickly work out how often they need to be seen.
Who can do it?
When MGD is severe it is best for meibomian gland expression to be performed by an optometrist or ophthalmologist. Dr McKellar has written some advice for eye care professionals who want to do this. Click here to view.
Patients with mild MGD can often express their own meibomian glands.