Physical Therapy for Eyelids and Meibomian Glands


 

Physical Eyelid Therapy is a basic therapy for Meibomian Gland Dysfunction (MGD) with blocked oil glands - as the main reason for dry eye disease

It can improve oil deficiency and potential gland damage by reactivating the meibomian oil glands inside the eyelids

The concept of ´physical therapy´ is based on simple but effective physical techniques for the treatment of the eyelids and the meibomian glands. Heating and humidification, massage and squeezing as well as subsequent intense cleaning of the lid margin is performed.

Before any manipulation of the eyelid and eye, it is of course important to consult an ophthalmologist beforehand in order to get a qualified diagnosis and appropriate therapy suggestions to avoid injuries to the eyelid and eye ! It is also important to have the potential progress or failure of therapy followed by the eye doctor !

Dry eye disease is a chronic illness, that has typically developed over a period of years or often decades and thus it is often necessary to perform an equally consistent permanent i.e. ´chronic´ treatment. Long-term physical therapy is therefore typically necessary about once or twice daily.

The Methods of Physical Therapy can be applied in different ways (=> HERE is more information):

Physical therapy consists of 3 steps:

1. Warming of the eyelids

if possible with moist heat for at least 10 minutes

  • to achieve a temperature of approx. 40 ° C inside the eyelid, i.e. also in the Meibom oil glands

  • this serves to re-liquefy the changed and inspissated oil in the meibomian glands.

  • according to studies, in order to reach a temperature of 40°C inside the eyelid, a warm, moist compress / clean washcloth (with a temperature of approx. 45 ° C) must be used for approx. 10 minutes; (please see animated figure)

  • as the temperature cools down quickly, the compress/ rag must be renewed/ reheated approximately every 2 minutes

The moisture softens encrustations at the gland openings and on the edge of the lid

Commercially available Gel Masks or even electrically heated and moistened Goggles can make the laborious physical EyeLid therapy significantly easier.

2. Subsequent massage of the eyelids to squeeze and empty the glands

When the inspissaated oil in the meibomian glands is warmed up enough, it becomes more fluid again

  • by gently massaging the eyelids, it can then be squeezed out of the glands

    • this must be done towards the open edge of the eyelid, i.e. towards the eyelashes (see animated figure) - so:

    • down the upper eyelid and

    • upwards on the lower eyelid

  • In any case, as already mentioned, a chronic illness like dry eye disease with Meibominan gland dysfunction, also requires chronic therapy in order to achieve noticeable improvements.

  • Therefore, even a properly performed gentle eyelid massage does not necessarily always lead to visible expressed thickened Meibom oil on the lid margin.

    • Still, a consistently performed physical therapy typically results in a constant improvement of the condition … constant dripping wears the stone !

    • ... if the glandular squeezing does not achieve a sufficient improvement of gland function despite long (over months) regular and careful application, then there are further specialized procedures and devices for the therapy of Meibom gland disorders (MDD) and eyelid inflammation (Blepharitis) in the ophthalmologist's practice.

3. Eyelid margin hygiene at the end

Finally, the eyelids should be cleaned together with the eyelashes:

  • of the squeezed oil

  • of bacteria that multiply in the oil residues

  • of hardened lipid deposits and skin cornification on the edge of the eyelid

  • Cleaning consists of a mild (soap-free ) 'scrubbing' of the edge of the eyelid with a cotton swab or facial tissue to remove deposits that can promote inflammatory events:

    • if the deposits are more liquid-oily, a dry cotton swab can often do a good job

    • if the deposits are rather dry and crusted, a damp cotton swab is usually more suitable


There are also commercially available cleaning sets with solutions, typically oil-based so as not to damage the tear film lipids. Such sets already contain all the necessary things and can thus make physical therapy considerably easier. Pre-prepared sterile cleaning pads are available for daily lidcare.

In case of a chronic therapy-resistant chronic eyelid inflammation (blepharitis), an increased infestation with normal Demodex hair-mites may be considered, which are sensitive to a therapy with tea tree oil products.


Overview of the options of physical therapy

The physical therapy measures shown here have the advantage that they can usually be carried out by the patient himself in his home environment. This is the BASIC therapy for meibomian gland dysfunction (MDD) and chronic eyelid inflammation (blepharitis).

=> here you will find more information about BASIC Therapy at home

A disadvantage may seem to be that this has to be done permanently and regularly, preferably twice a day, in order to achieve a noticeable positive effect - similar to brushing your teeth - but requires a little more time. 

If the basic therapy of the eyelids at home does not achieve a sufficient improvement in spite of a longer period of regular practice, there are other specialized procedures and devices for the APPARATIVE therapy of meibomian gland dysfunction (MDD) and chronic eyelid inflammation (blepharitis) in the ophthalmologist's practice.

=> here you will find more information about APPARATIVE device therapy in the medical practice


but ... the effort is worth it, because a 'happy' eyelid typically ensures a happy patient !

... or to put it in Roman form: ´ palpebra sana in corpore sano ´ - unconfirmed quotation from the famous Roman doctor Clarissimus GALEN ;-)