Over time the glands that supply the lipid component to the tears (essential in preventing evaporation) can develop blockages (See figure 3}. These blockages are usually a result of dried lipid (Meibum) in or around the gland. The purpose of any lid heating treatment is to open the gland orifice and soften or partially melt the Meibum within these glands. Research has shown that continuous heat needs to be applied for 6-10 minutes to the upper & lower lids to be effective. There are three methods (listed below) that can be used to accomplish this.
Now that the tear glands have been heated much of the material inside the glands will have liquefied, and the gland opening will be enlarged. This is the optimal time to flush some of that material out of the gland. We accomplish this with lid massage.
On the top lids, massage downwards toward the lid margin putting mild pressure with the ball of your finger toward the globe (ball) of the eye. Your stroke should start on the upper portion of the eyelid and end where you feel the base of the eyelashes-this is the lid margin. Massage 5-6 times on the upper lid (approximately 20 seconds per lid). Repeat on the bottom lid, massaging upward toward the lid margin. This is always done to both eyes.
lf you have done a good job, some of the dried Meibomian oil should now be on the lid surface. (It is too small to see with the naked eye.) We do not want it to stay there and have an opportunity to fall back down into the enlarged gland opening you just created with the hot compress. Clean the surface by diluting Baby shampoo and a Q tip or use Lid Scrub pads that can be found at the local pharmacy. Gently move the Q tip or Lid Scrub pad back and forth over the lower and upper lid margin (by the lash base) for 3-4 swipes. Be sure to wipe along the lid margin itself and not to touch the very sensitive front of the eye (the cornea).