What Are Capped Meibomian Glands?

Ever wonder what those little flesh like blisters / bubbles are on your eyelid margin? Stop wondering, keep reading. I’m Dr. Tanya Gill, Optometrist, and today we’re exploring your capped meibomian glands. Meibomian glands are essential for producing the oils that help maintain a healthy tear film. A healthy tear film is the #1 refractive surface of the eyes. A healthy tear film also allows things like comfortable contact lens and eye makeup wear.

When the chemistry of the tear film goes awry, an inflammatory response happens at the level of these oil glands. A common sign are these little flesh like blisters. Think of it like a 'mini clog.' When I see capped meibomian glands, I'm also always concerned about my patient developing Meibomian Gland Dysfunction (MGD).

 

Understanding Capped Meibomian Glands

Capped meibomian glands occur when the openings of your meibomian glands get blocked so that oil cannot properly secrete oil like it should. This blockage can lead to symptoms such as dryness, irritation, foreign body sensation on blink, and inflammation.

• Essential Role: The meibomian glands produce oils that form the outer layer of the tear film. Without oil, the aqueous part of your tear evaporate too fast. Then the dry eye problems start.
• Capping Explained: A "cap" is formed when these oils harden and block the gland opening. It is an inflammatory response so a capped meibomian gland should always be considered the precursor to MGD until ruled out with a proper eye exam with your optometrist.
• Symptoms: Blocked glands may cause dryness, irritation, foreign body sensation upon blink, and sometimes a gritty feeling in the eyes. The more capped glands, the more symptoms. The more capped glands, the more likely for a MGD diagnosis.

Why DIY Removal is a Bad Idea

My patients are awesome. Most just flat out tell me the truth. Tempting, but this is why I tell them to NEVER use a fingernail or a safety pin to scrape the capped gland. 

• Risk of Injury:
  I've treated many corneal and eyelid abrasions from fingernails, safety pins, tweezers, etc. The injury is fixable with a few weeks of topical steroids, topical antibiotics and sometimes a bandage contact lens. A corneal abrasion is a 10 out of 10 pain. It's no joke. Avoid at all cost. ❌
• Infection Hazard:
  Oh the bacteria and/or fungus from sharp objects and fingernails introduced to the ecosystem of the eyelids and tears. Add MGD, and it's a recipe for infection. I've had 1 case of fungal infection in my 20+ years of practicing. Fungal infections are vision threatening. Avoid at all cost. 
• Proper Technique:
  Always use a 10X magnifying mirror and tools designed specifically for the eyelid margin to safely clear capped glands at home. If you are unsure, see your optometrist to remove it for you, and whiles you're in the exam chair – ask if you've got MGD. 

The Right Way to Uncap Meibomian Glands at Home

For effective and safe removal of caps, use the appropriate tools and cleansers:

• 10X Lighted Magnifying Mirror: I use a slit lamp magnifier in the exam room. You use a 10X lighted magnifying mirror at home. This is precision work. Your naked eyes are not good enough to do this task. Well, unless you're a super hero.
• Specialized Eyelid Cleansing Tool:
  Behind the 10X lighted magnifier, use Eyelid Margin Scrub Brush, to gently scrub away that cap.
• Oil Cleanser:
  Eyelid Scrub Brush cannot be used naked. Place 1 tiny drop of Tea Tree Eyelid Eyelash Cleansing Oil or Rosemary Eyelid and Eyelash Cleansing Oil. The oil will clean the glands while releasing the cap and the debris underneath. 
• Wash Off:
  Use Tea Tree Eyelid and Eyelash Foaming Cleanser or SuperGLA Eyelid and Eyelash Foaming Cleanser as the final wash off to complete the double cleanse. This will also wash away any oil gland debris and keep the rest of the eye area clean. 
• Consistent Care:
  Do the steps above as needed, but consider maintaining the oil + foam cleansing daily for regular, consistent eyelid hygiene to combat that inflammatory response that's happening. 

It's Still a Big Fat NO:

Never use your fingernail or a safety pin (or other sharp objects) to remove capped meibomian glands. Instead, copy what I do in the exam room: magnification, the scrub step, and oil + foam cleansing.