Meibomian Gland Expression

Meibomian gland expression is a procedure to clear blocked meibomian glands—the oil-producing glands in your eyelids. When these glands are blocked (meibomian gland dysfunction or MGD), the oil layer of your tear film is compromised, leading to evaporative dry eye.

What Are Meibomian Glands?

Their Function

• Located in upper and lower eyelids
• Produce oil (meibum) that forms the outer layer of tears
• Oil prevents tears from evaporating too quickly
• About 30-40 glands in each eyelid

What Happens When They're Blocked

• Oil becomes thick and waxy
• Gland openings become clogged
• Oil doesn't reach tear film
• Tears evaporate too quickly
• Results in dry eye symptoms

When Is Expression Recommended?

Conditions Treated

• Meibomian gland dysfunction (MGD)
• Evaporative dry eye
• Blepharitis
• Chalazion (in some cases)

Signs You May Benefit

• Dry eye symptoms despite artificial tears
• Thick, cloudy, or no oil expressed from glands
• Gland dropout seen on imaging
• Crusting along eyelid margins

Types of Meibomian Gland Expression

Manual Expression

• Doctor applies pressure to eyelids
• Expresses thickened oil from glands
• Usually done after warm compresses
• Immediate but may be uncomfortable

Device-Assisted Expression

LipiFlow:

• Applies controlled heat and pressure
• Thermal pulsation system
• Treatment takes about 12 minutes per eye
• Less discomfort than manual expression

iLux:

• Handheld device
• Applies heat and compression
• Allows real-time visualization

TearCare:

• Wearable eyelid device
• Provides sustained heat
• Followed by manual expression

Other In-Office Treatments

Intense Pulsed Light (IPL):

• Reduces inflammation
• Improves gland function
• Often combined with expression

BlephEx:

• Mechanical lid debridement
• Removes debris and bacteria
• Helps with blepharitis component

What to Expect

Before the Procedure

• May receive numbing drops
• Warm compresses may be applied first
• Discussion of what to expect

During Manual Expression

• Examiner uses fingers or paddle instrument
• Applies pressure to eyelid margin
• Works along the length of the lid
• Expresses both upper and lower lids
• Brief discomfort or pressure sensation

During Device-Assisted Treatment

• Device applied to eyelids
• Controlled heat warms glands
• Pressure expressed thickened oil
• Less hands-on than manual expression
• Duration varies by device (10-15 minutes)

After Treatment

• Mild redness or irritation possible
• Can resume normal activities immediately
• Use recommended eye drops
• Effects may take days to notice

Results

What to Expect

• Improved tear film stability
• Reduced dry eye symptoms
• Better response to artificial tears
• Results vary by individual

How Long Do Results Last?

• Not a permanent fix
• Benefits may last weeks to months
• Ongoing maintenance usually needed
• Home warm compresses help maintain results

Multiple Treatments

• Series of treatments often recommended
• Especially for device-assisted methods
• Frequency depends on severity

Home Care to Maintain Results

Warm Compresses

• 10 minutes daily (or as directed)
• Use heated eye mask or warm washcloth
• Followed by gentle lid massage
• Helps keep oil flowing

Lid Hygiene

• Daily lid cleaning
• Hypochlorous acid spray or foam
• Lid wipes
• Remove makeup thoroughly

Ongoing Treatment

• Artificial tears as needed
• Omega-3 supplements (may help)
• Prescription dry eye medications if indicated
• Avoid known irritants

Risks and Side Effects

Common

• Mild discomfort during procedure
• Temporary redness
• Slight eyelid swelling
• Tearing

Uncommon

• Bruising
• Irritation lasting more than a day
• Corneal abrasion (rare)

Generally Very Safe

• No significant risks for most patients
• Temporary side effects resolve quickly

Cost Considerations

Insurance Coverage

• Manual expression may be covered as part of office visit
• Device-assisted treatments often not covered
• Coverage varies by plan

Out-of-Pocket

• Device-assisted treatments typically $400-1000 per session
• Multiple sessions often recommended
• Check with your provider about costs

Frequently Asked Questions

Does meibomian gland expression hurt?

Manual expression can be uncomfortable—there's pressure on your eyelids. Device-assisted methods are generally more comfortable because heat softens the oil first. Numbing drops help. Any discomfort is brief.

How often do I need this done?

It depends on the severity of your MGD. Some people benefit from treatment every few months; others need it less frequently. Home warm compresses can extend the time between treatments.

Can I do this at home?

You can do warm compresses and gentle lid massage at home—this is an important part of ongoing care. However, professional expression (especially with devices) provides more thorough gland clearance than home care alone.

Will this cure my dry eye?

MGD is a chronic condition, so there's no one-time cure. However, regular treatment and good home care can significantly improve symptoms and prevent further gland loss. It's about management, not cure.

What's the difference between LipiFlow and manual expression?

LipiFlow uses a device to provide controlled heat and pressure, treating all glands simultaneously. It's typically more comfortable and consistent but more expensive. Manual expression is lower cost but may be less comfortable and dependent on technique.

Can blocked glands be permanently damaged?

Yes, if left untreated long-term, meibomian glands can atrophy (shrink and die). This is why treating MGD early and consistently is important—you want to preserve the glands you have.

References