Meibomian gland expression

Expressing the meibomian glands with cilia forceps. This patient has thick buttery secretions.

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.

Why is it done?

Thick stagnant secretions plug the meibomian gland openings, irritate the eye and allow the tears to evaporate. Emptying the glands allows them to make fresh, better-quality secretions. 

Technique

A paddle or 'tweezers' are used to compress the eyelid and squeeze out the contents of the meibomian glands. 

Anaesthetic

The eye and eyelid are anaesthetised with eyedrops and the procedure is not usually painful. If you find the squeezing uncomfortable take paracetamol before your appointment. 

What happens?

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 anti-acne therapy often have small plugs of solid 'oil' blocking the gland orifices. 

What does it all 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.  Most quickly work out how often they need to be seen. 

What will you notice?

You may notice a significant improvement within a few days but usually it takes more than one expression before the glands recover.  

Who can express your meibomian glands?

Most optometrists and ophthalmologists have the needed skills and training or can find advice on how to help you here.

Can you express the meibomian glands yourself?

When the secretions are thick it is very difficult to squeeze out the secretions yourself. When the secretions become thinner it is possible for patients to express the glands themselves. See MGD self-expression for more details.