Got an Eye Problem? A Step by Step Tutorial for my MGD System

When it comes to complaints of eye irritation, posterior blepharitis is the most common eye problem in my clinic. Posterior blepharitis goes by many names – Meibomian Gland Dysfunction, MGD, demodex blepharitis, ocular rosacea, and are often used interchangeably.

Here are the clinical signs I look out for:

1. CAPPED GLANDS. Use a 10x magnification mirror and check your upper & lower eyelid margins. A capped meibomian gland is a yellowish, round, elevated area that looks like a tiny blister. Capped glands are clogged glands. Sometimes they are just clogged and need to find relief (chalazion). Sometimes they can also be the start of a stye (hordeolum).

 

2. DEMODEX COLLARETTES. Mites on your eyelids are not bad in small amounts, but can be quite nasty when the population gets out of control. Demodex mites can deposit debris around each eyelash. It looks like a “collar” around each lash, hence the name collarette. Removing this debris is key to improvement, but is quite tricky because the texture is sticky and caked onto individual lashes.  

 

3. OCULAR ROSACEA. I look for red, inflamed eyelid margins with lots of blood vessels in addition to clogged glands, capped glands, and collarettes. I once learned from a dermatologist that when a stye is recurrent for the 2nd time – it’s ocular rosacea and likely it’s affecting the face as well.

 

4. OLIVE OIL or BUTTER? A healthy meibomian gland system works in harmony with the blink. Upon each blink, a little bit of oil should secrete into the tear film to keep it smooth, slick, and happy. When I press on the eyelid margin to evaluate gland health, if the secretion looks like olive oil – it’s happy. On the other hand, when the secretion looks like butter – we have a problem.

 Here’s what you can do:

STEP 1 with 2: Place 1 drop of oil onto the scrub brush. Gently move brush along the eyelid margin back and forth like how you would use a toothbrush. You can target specific areas of the eyelid margin or repeat on all 4 eyelid margins for lid hygiene. Utilize a 10x magnification mirror for precision. 

GOAL: open capped glands; remove demodex collarettes

 

STEP 3: Dispense 1-2 pump of foam onto clean fingertips. With eyes closed, wash eyelid margins and face. Make sure to wash the sebaceous glands of the nose and cheek areas. Because the foam is a soap, do not let it get inside the eyes (it will sting).

GOAL: probiotic wash for ocular rosacea; wash away capped gland & collarette debris

 

STEP 4: Heat roller in hot water. Wrist test for heat tolerance. Roll up & down (from 12 to 6 o’clock) and/or side to side (3 to 9 o’clock) along eyelids. Timing will vary from 20 seconds to a few minutes per session. 

GOAL: heat up the butter to oil so it can release

 

I made this MGD system for my patients so they could quit the baby shampoo & hot towel compresses that never worked. Now you have the knowledge and tools to improve the appearance of your eyes and quality of life.

 

 

Love + Healthy Eyes,