Meibomian gland expression
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| 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.
Indications
Most patients with MGD benefit from manual expression.
Technique
Use cilia or other broad footplate forceps to squeeze the lower eyelid and express the contents of the meibomian glands. The procedure is best performed at the slit lamp allowing direct visualisation of the expressed contents.
Anaesthetic
In most cases the only anaesthetic required is topical eye drops. A lid block can be given.
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 often have small plugs of solid 'lipid' blocking the gland orifices.
How to interpret the signs
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. Check all cases after a month and then determine when further review is needed. Most patients quickly work out how often they need to be seen.
Tips and tricks
Patients with significant lid inflammation find the procedure painful. Prescribe topical steroids and wait a few weeks. Suggest patients take paracetamol before their appointment.
Apply a SLOW firm pressure. The secretions are often very thick and take time to exit the meibomian orifices.
Work your way slowly down the lid and repeat several times. Often the second or third pass expresses the most secretions.
Although manual expression can be all that is required it is usually best performed as part of a wider strategy that may include oral macrolides and topical steroids.
Don't be disheartened if you can't express anything on the first occasion. It may be easier once other therapies have had a chance to work.
Patients with thick secretions DO NOT benefit from massaging their own eyelids. Reserve this for later. At follow-up visits assess whether fingertip pressure expresses secretions. If so, the patient can be taught to stroke or buckle the eyelid margin. If not, proceed to expression with forceps.
