What the meibomian glands do
A row of glands runs vertically through each eyelid, opening just behind the lashes. Each blink squeezes a thin film of clear oil, called meibum, onto the tear surface, where it spreads to form a layer a few molecules thick that slows evaporation and keeps the tears smooth. In MGD the oil thickens, the gland openings clog with keratin, the glands dilate behind the blockage and, over years, atrophy. The oil that does emerge is thick and cloudy rather than clear.
Why it happens
- Reduced blinking during screen work, which fails to express the glands
- Age and hormonal change, which alter the oil's composition
- Blepharitis and demodex mites, which inflame the lid margin
- Ocular rosacea, which thickens the secretions
- Contact lens wear
- Isotretinoin and some other medications
- Eye makeup along the lid margin, which blocks the gland openings
Symptoms
The symptoms of evaporative dry eye: burning, grittiness, redness, fluctuating vision, tired eyes, and symptoms that worsen through the day and in dry or windy conditions. Crusting at the lashes and a foamy tear film are visible signs. Many patients have no symptoms until gland loss is advanced, which is why the glands are assessed at every evaluation.
Diagnosis
Meibography images the glands through the everted lid and grades how many are blocked, shortened or lost. Gentle pressure on the lid shows whether oil flows and what quality it is. Lipid layer interferometry measures the thickness of the oil on the tear film. Together these stage the disease and set expectations: blocked glands can be cleared; atrophied glands cannot, and the aim becomes preserving what remains.
Treatment
Treatment clears the glands and keeps them flowing. At home: warm compresses that reach 40 degrees for ten minutes, followed by lid massage; lid margin cleansing; omega-3 supplementation; and full blinks. In the office: thermal pulsation treatments that heat the glands from inside the lid and express them under pressure, which can clear established blockage in a single session; manual gland expression; intense pulsed light for rosacea related MGD, which reduces the inflammation that thickens the oil; and, for the lid margin, treatment of blepharitis and demodex. Anti-inflammatory drops and a short course of doxycycline help thick secretions. Results build over two to six weeks and are maintained with home care and periodic retreatment.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is what is affecting your vision is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Bavand Youssefzadeh, DO. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
