Meibomian Gland Expression: A Step-by-step Guide

Dry eye usually occurs in three main forms—tear instability, insufficiency, and contact lens-induced dry eye. Of the three, the most common is the dry eye from unstable tears. This form of dry eye syndrome can occur due to different issues, but the underlying cause is usually the same—meibomian gland dysfunction. Meibomian gland expression is one of the best approaches to managing the problem.

What are Meibomian Glands?

The tear film that lubricates your eyes comprises three main layers: mucin, watery, and lipid. The lipid layer is the topmost part, protecting the lower layers from evaporating. It is secreted by the glands found within the eyelid called the meibomian glands. 

When these glands are affected, they may produce thick oils that can lead to blockages. When this happens, it usually leads to dry eyes from unstable tears. You will first have to deal with the oils clogging up the glands to treat this condition.

What is Meibomian Gland Expression?

Meibomian gland expression is one of the best approaches for managing the problem. These will usually work for thick oil clogs. Sometimes, the oils clogging up the glands have hardened and require a different treatment. Here, meibomian gland expression entails manually massaging the glands to help remove the excreted oils. 

What are the Different Types of Meibomian Gland Expression?

You can perform two primary types of expression. However, they are more like two parts of one complex process.

Diagnostic Expression

It determines whether the person has MGD and, more particularly, the stage of severity. It is typically carried out before treatment. It must be applied using a finger or cotton-tipped applicator pushed on the lower eyelid for five to fifteen seconds. Clinical experience demonstrates that the most crucial area to determine how severe a patient's MGD is central to nasal lower lids. A larger instrument, like a Mastrota paddle, can help boost effectiveness.

Therapeutic Expression

It can improve the quality of meibum produced and lessen the signs and symptoms of dry eyes. It accomplishes this because it is a more comprehensive expression of the glands. Therapeutic expression is carried out to encourage healthy meibum production. It is also more extensive than diagnostic expression despite being identical.
 

How to Express Your Meibomian Glands

• Beginning on the nasal side, pull the lower lid inferiorly to reveal the meibomian gland openings and sclera.

• At a location halfway between the fornix and the lashes, use the expresser paddle or cotton-tip dab that has been premoistened with saline to the palpebral conjunctiva.

• Release the lid and use a second cotton-tip dab or expresser paddle to apply pressure on the inferior eyelid adnexa.

• From the meibomian gland base to the pores on the edge of the eyelid, roll the cotton-tip dab or rock the paddle.

• Pull the lower lid inferiorly, then transfer the paddle or cotton-tip applicator to the next area of the meibomian glands that should be expressed.

For more on a step-by-step guide to meibomian gland expression, visit Envision Specialty EyeCare & Dry eye Center at our office in Meridian, Idaho. Call (208) 490-8823 to book an appointment today.