Blocked Glands Surrounding Eyelids Create Receptive Environment for Bacteria

May 7, 2010 Dear Mayo Clinic: Please share any information you have on the eye condition meibomitis. Answer: Meibomitis is a chronic inflammation of tiny glands that line the upper and lower eyelids, just behind the lash line. Called meibomian glands, they secrete oil that lubricates the eye surface. The oil keeps the surface of the eye smooth and moist, allowing for clear vision. You can't see meibomian glands by looking in a mirror. There are about 50 on each upper lid and about 25 on each lower lid. They can only be seen with magnification. Like any other skin glands, they can become blocked — which occurs with meibomitis. The blockages create a receptive environment for bacteria. If you've ever experienced a sty in your eyelid, the underlying cause was likely a blocked and infected meibomian gland. When the oil-producing glands are blocked, the layer of tears on the eye's surface quickly evaporates, especially if you are outdoors, in low humidity or spending lots of time looking at a computer screen. The resulting symptoms can include dry, burning, itchy or gritty eyes and blurry vision. The blurry vision often prompts patients to seek care. Meibomitis can occur at any age, even in babies. However, it's more common in two groups: the elderly and people who live or work in environments that have abundant small particles (such as dust or pollen) in the air. Your eye doctor can diagnose meibomitis with an examination. Treatment focuses on reducing symptoms, removing the blockages and preventing recurrence. Meibomitis is a chronic condition but usually can be managed with simple self care. Treatment options include: Eye lubrication: Over-the-counter artificial tears with oil (Soothe XP, Refresh Endura, others) provide symptom relief. Most artificial tear products don't include oil and as a result do not stay on the eye as long and therefore require more frequent use. Hot compresses: A hot compress applied to the eyelids for 10 minutes once or twice a day dilates the glands, melts waxy blockages and helps to keep glands open. A washcloth heated with hot tap water works well as a compress. Eye hygiene: People with meibomitis need to clean their eyelids every day to reduce blockages and lower the risk of gland infection. Just add eye hygiene to your daily route, similar to brushing your teeth or washing your hair. Moist disposable wipes called lid scrubs are a good way to disinfect lids and clear any obstruction. These products are available at drug stores. During flare-ups, I advise patients to forgo mascara and eyeliner for a time. Eye makeup can harbor bacteria, too. Steroid or antibiotic ointments: Applied on the lids or corners of the eyes, these ointments help relieve acute flare-ups. They are used only for short periods. When home care isn't enough to control symptoms, new treatments are available to open blocked glands. An eye doctor can insert a small probe into each gland, removing the obstruction. The process takes 10 to 15 minutes. It's not known yet how often the process might need to be repeated. Because the therapy is new, it may not be covered by insurance. Another option is special goggles worn while sleeping. They feature heated pads that help open blocked glands. For most people with meibomitis, symptoms are not difficult to manage, but they should not be ignored. Without treatment, inflammation can progress to unsightly and painful infections, requiring a drainage procedure and antibiotic therapy. Especially in patients who are ill or immunocompromised, infection can progress and threaten vision. — Dharmendra (Dave) Patel, M.D., Ophthalmology, Mayo Clinic, Arizona

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