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Ouch! Why did my optician squeeze my eyelid?

meibomian glands

You have just had your meibomian glands expressed!

This usually gentle compression is designed to let your eye care professional see the condition of the meibum produced by a series of small glands found along the edge of the eyelids, just behind the eye lashes. There are typically 20-30 on the lower lid and 40-50 on the upper lid. If you look carefully you can see the tiny openings or ducts running the length of your eyelid.

What are they looking for?

The condition of the meibum will indicate whether or not you have meibomian gland disfunction (MGD), a leading cause of dry eye.

Meibum is the oily substance which plays an important role in keeping your eyes moist and comfortable. If it cannot be expressed easily or it is thicker than usual (It should be more like olive oil than butter or toothpaste) it can indicate a problem. There could be an issue with the quantity or quality of the oil or most commonly the glands might be blocked or clogged up. If you want to see what it thickened meibum looks Dr Claudia Lee made a great video you can watch here – but don’t try this at home!

What does meibum do?

This oily secretion is a vital part of your tears, the eyes natural moisturiser. It sits on the surface of the tear film and slows down the evaporation rate of the watery aqueous component. If the meibum layer is compromised then you will be more prone to the tear film drying out leaving you with dry, tired or sore feeling eyes.

How can you fix this?

It might not always be possible to fully fix the problem but you can certainly make things a lot better by clearing away any clogging. Once the tiny gland ducts are free from debris the oil can flow more easily into the eye.

How is this best achieved?

This is most usually achieved by the use of heat therapy and cleansing. Back in the day your optician might have told you to put a clean warm flannel over your eyes but now there are specialist heat compresses like The Eye Doctor Premium compress. This heats the oil to just the right temperature and keeps it there for over 12 minutes. This gives the oil time to soften allowing it to be gently massaged out and any clogging cleaned away using a specialist cleaning wipe.

How do you go about massaging your eyelids?

Your eye care professional, or one of their team, will no doubt show you but there are plenty of demonstrations on line. Essentially you gently but firmly roll a clean finger along the eyelid edge, working from the nose outwards. Both top and bottom eyelids need to be massaged and ideally 2-3 times each to get things moving. Some dry eye specialists might offer this unblocking of the meibomian glands as part of their treatment.

Is MGD unusual?

Sadly not, MGD is very common and one of the most widely seen causes of dry eye. The exact frequency of MGD is not known as diagnosis is not always easy and reports vary widely. A published scientific paper of over a 1000 people in Austria found that 70% of those studied had some sign of MGD. However, their average age was 55 years old and we do know you are more likely to suffer from MGD as you get older. A systematic review and meta-analysis by a study group put the global incidence at around 36% but this varied by country.

If you are experiencing dry, tired feeling eyes then you should ask the advice of your eye care professional.

Image: Professor Mark Abelson. Harvard Medical School.


Dr Jonathan Hatley, Dr Nathan Lighthizer. How to Impress (and Express) Your Patients

Want to express meibomian glands like a pro? Here’s a step-by-step tutorial. Review of Optometry. May 15, 2015.

Rabensteiner DF, Aminfar H, Boldin I, Schwantzer G, Horwath-Winter J. The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population. Acta Ophthalmol. 2018 Sep;96(6):e707-e711. doi: 10.1111/aos.13732. Epub 2018 Apr 15. PMID: 29656524; PMCID: PMC6619403.

Hassanzadeh S, Varmaghani M, Zarei-Ghanavati S, Heravian Shandiz J, Azimi Khorasani A. Global Prevalence of Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis. Ocul Immunol Inflamm. 2021 Jan 2;29(1):66-75. doi: 10.1080/09273948.2020.1755441. Epub 2020 Jun 26. PMID: 32589483.

Abelson M D et al. Review of Ophthalmology (online). The form and function of meibomian glands. 10 May 2016.



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