Meibomian Gland Dysfunction
Another form of dry eye is caused by a condition called Meibomian Gland Dysfunction. The meibomian gland and specialized sebaceous/oil glands found in the eyelid positioned very close to the eye lashes at the lid margin. A human being has an average of 25 meibomian glands in the lower lid and 50 meibomian glands in the upper lid. Their role is to secret the outermost layer of the tear film known as the oily lipid layer.
Consider this, Imagine a drop of gasoline on a puddle. That rainbow colored iridescent sheen at the surface is the thin layer of gas (oil) that has floated to the surface of the puddle. In the eyes, the oil layer does the same thing. It floats to the surface of the tears film and acts as a vapor barrier preventing the tear film from evaporating as quickly.
If these meibomian glands get clogged up, the oil they are producing does not flow onto the eye surface appropriately. These gland can get clogged by dust and debris in our environment and also by taking incomplete blinks. When the oily layer is reduced, the tear film to become unstable. This tear film disruption promotes evaporation of the tears and allows the corneal surface to become exposed to air leading to dryness symptoms.
Clogged Meibomian Glands
Treatment for Meibomian Gland Dysfunction
When the meibomian glands are completely clogged a bump develops that is generically referred to as a “stye“. More often, the gland does not become completely obstructed but only partially. Consider leaving the lid off of your toothpaste tube. The edges gunk up and only a small volume of toothpaste comes out when you squeeze it. The same happens in meibomian gland dysfunction. Meibomian glands can be expressed in office to jump start the process of returning them to normal functionality.
Once the meibomian glands have been expressed, the waxy plug at the gland opening is likely cleared. Some special care must be taken to ensure the gland stays clear and continues to function optimally. The following steps are the “homework” to be performed by the patient to accomplish full symptom relief.
Since the gland secretes and oil, when it gets gunky and clogged the oily material becomes much thicker and waxy. Adding a hot compress for 7-10 minutes has the benefit of melting down the waxy substance which allows it to flow much more easily. Hot compresses are commercially available and can even be purchased from our office. In a pinch, anything that retains heat can be used as a hot compress many people use a washcloth soaked in a bowl of hot water. The only drawback is a washcloth only retains heat for about a minute and must be re-soaked periodically to warm it back up.
Hot Compress Mask
Immediately after applying the hot compresses, the waxy oil glands will have melted down and become much more likely to flow. At this point it is time to gently massage the eyelids in an attempt to expel any oily fluid blocking normal flow out of the gland. Work from the bottom of the lid toward the eyelid margin being careful not to scratch the eye.
After performing the digital massage, the waxy oily should be as close to the surface of the opening as it is going to get. At this point we want to wash the eyelid margin to emulsify the waxy secretion in order to clear a path for the normal oil to begin to flow again. CAUTION! They eye is a sensitive organ and standard shampoo or soap is not recommended. Our office recommends We Love Eyes Tea Tree Eye Lid Cleansing Oil. The We Love Eyes brand was created by an eye doctor using natural and non toxic ingredients and has fantastic results. We Love Eyes products are available for purchase from your doctors at Keen Eyecare Consultants.
Another lid scrub option we recommend is the Occusoft lid scrubs. It is a pre packaged moist towelette with a type of cleaner formulated to dissolve the waxy substance at the margin without irritating the eye. Ocusoft has a proven track record and is commercially available at most convenience or super stores.
In a pinch, Johnson and Johnson type, “No-More-Tears,” Baby shampoo will work but studies have shown it leaves patient with more irritation compared to that of the We Love Eyes and Occusoft Lid Scrubs.
It usually takes a week or more of diligently performing these task each day to experience complete resolution of meibomian dysfunction. Although most people do not need to perform these tasks every day perpetually, it is commonly seasonal and often requires periodic repeat maintenance to ensure the glands continue functioning optimally.