Write thWhen I was first diagnosed with meibomian gland dysfunction (MGD), I thought: okay, at least now I know what is wrong with me. My glands are blocked. My meibum is too thick. Now we treat it and eventually everything goes back to normal. Simple, right?
I really wish it were that simple. One of the biggest things I've learned during my dry eye journey is that MGD is not really one problem with one solution. You can put ten people with MGD in one room, and they may all have completely different stories β different reasons why it started, different things happening inside their glands, different symptoms, and probably different treatments that will help them. And this is exactly why I think treating MGD can become so confusing.
First: Why Did This Happen?
This was the question I obsessed over for a very long time. Why did my glands stop working properly? Was it inflammation? Hormones? Something autoimmune? Some deficiency? Something else going on in my body? I did a lot of tests and looked for explanations everywhere. And in the end... we didn't find anything dramatic.
Today, my own explanation is actually much simpler. I wore contact lenses for around 25 years. I spent a lot of time looking at screens. And at some point I realized that my blinking was terrible β incomplete and probably not frequent enough. So my current theory about my own case is that this wasn't something that happened overnight. My glands were producing meibum, but for years I probably wasn't releasing it properly. Slowly, things became thicker and more obstructed until eventually the whole system stopped working properly. Can I prove that this is exactly what happened? No. But after everything I've seen during my treatment, this explanation makes the most sense to me.
But Knowing the Cause Is Only Half the Problem
Because then comes another question: what is actually happening inside the glands right now? And this is where MGD gets really frustrating. Is the oil simply too thick? Are the glands blocked? How badly? Is inflammation a major part of the problem? Is there scar tissue? Are some glands working normally and others not? Or are several things happening at once?
Sometimes I honestly wish there were a machine that could just show us a little live video from inside every meibomian gland... "Here is gland number 17. Here is the blockage. Here is the thick meibum. Here is exactly how much is left". Unfortunately, it doesn't work like that. In my case, a lot of what we learned came from simply seeing what happened when my doctor tried to express the glands. And what we saw was pretty clear: they were incredibly blocked.
During my first meibomian gland expression, almost nothing came out. Later we started getting something out, but calling it "oil" would have been very generous. π
It was incredibly thick. I usually describe it as toothpaste or clay because that's honestly what it reminded me of. And naturally, I thought: okay, great. We found the problem. Now squeeze all this horrible stuff out and we're done.
Except... you can't necessarily do that.
Why Can't You Just Empty Blocked Meibomian Glands?
In my head, I imagined a gland almost like a tiny tube of toothpaste. There's thick meibum inside β you press β it comes out β gland empty. Done. But during my expressions, only a tiny amount might come out, and then that was it. There was still a lot left inside. I would go home, live my life for another few weeks, and then come back and we would try again.
But here's the part I hadn't really thought about: the glands don't stop doing their job while you're trying to unblock them. They're still there. They're still producing secretion. So imagine you already have this tiny pathway full of extremely thick meibum. At one expression, you manage to get a little bit out, but most of it stays there. Then you go home, time passes, the gland continues working, and eventually you come back and get another little bit out. Then you repeat the whole thing again. And again. And again.
When you imagine it this way, suddenly the fact that MGD treatment can take time doesn't seem quite so mysterious. At least it stopped being mysterious to me.
Sometimes Even My Doctor Thought Something Else Must Be Going On
There were appointments when things looked better. Then I would come back and they looked worse again. At some point my doctor said that perhaps there really was something happening in my body that was continuously making my meibum thick. Maybe we were missing something. And I completely understood why she thought that. We were treating the glands, expressing them, doing IPL, things would start looking better... and then suddenly they looked terrible again.
For a while, I thought: okay, there must be some hidden reason we're not finding. But then more time passed, and eventually the bigger picture started to look completely different. When I stopped looking at individual appointments and started looking at the whole process, there was actually a very clear change. At the beginning, almost nothing came out. Then we started getting that horrible toothpaste-like meibum. Then it became softer. And eventually β oil. Actual oil.
Not perfect every time. Not every gland. Not some magical moment when suddenly everything became normal. But the overall direction was obvious. My glands could produce much more normal meibum. And this made me realize something that I wish I had understood much earlier: one bad appointment didn't necessarily mean I was going backwards. Sometimes it was simply one bad appointment in a very, very long process.
Looking at MGD Day by Day Drove Me Crazy
I wanted immediate feedback from everything. I did a warm compress β are my eyes better? I had an expression β are the glands better? I did IPL β did it work? The doctor said something looked worse β OH GOD, I'M GETTING WORSE.
I analyzed everything. And with a condition that can change from day to day anyway, this was probably one of the worst things I could have done for my mental health. My progress didn't happen on a nice little graph going steadily upwards. It was more like: better β worse β better β weird β worse again β surprisingly good β what the hell is happening β better. π Only when I zoomed out could I see the direction.
And there was another thing that seems obvious to me now but wasn't obvious at all in the beginning: finding the cause doesn't magically remove what's already there. Let's say you figure out what contributed to your MGD. Great. Maybe you change your screen habits. Maybe you work on your blinking. Maybe there is inflammation and you treat it. Maybe there's another underlying factor you can address. But what about the situation that already exists inside the glands?
In my case, even if my poor blinking and years of contact lens wear were major contributors, changing those things wasn't going to magically remove all that extremely thick meibum that was already there. I still had to deal with the consequences. And in my case, clearing severely blocked meibomian glands was incredibly slow. There didn't necessarily have to be some mysterious disease continuously destroying my glands. The existing problem itself was already difficult enough.
And Then My Treatment Became Even More Complicated
As if this process wasn't slow enough, I eventually had another problem. My eyelid skin was injured during one of my IPL treatments. After that, I simply couldn't keep doing procedures as frequently as before. My skin became extremely sensitive, so we lost one of the main tools we had been using. And here I mean gland expression. I stopped doing IPL completely, but looking back, I'm not even sure I needed it. But that's a different story.
And yet, strangely enough, things continued to improve. Slowly. Very slowly. For quite a long time now, I haven't been doing frequent clinic procedures at all. I mostly live my life, do my warm compresses, gently massage my glands, try to blink properly β and watch what happens. And I'm still seeing changes.
So... Can MGD Get Better?
This is probably the question I would have typed into Google a thousand times when all of this started. And I can only answer it from my own experience: mine did. A lot. I can't tell you what will happen with someone else's MGD. I can't tell you how long their recovery will take, and I definitely don't think everyone needs the amount of treatment I needed. Some people probably have a much simpler problem. Others may have something completely different happening in their glands. But I know one thing I wish somebody had told me: slow doesn't automatically mean that nothing is happening!!! For a long time, my progress was almost impossible to see while I was living through it. Today versus yesterday? Nothing. This month versus last month? Sometimes I wasn't even sure. But six months versus six months? Oh yes. And me now versus me two and a half years ago? It's almost difficult to compare. That's why understanding whether meibomian gland expression can be done without IPL is essential. MGD wasn't difficult for me because we simply couldn't find the magic treatment. It was difficult because there were several different things to understand: Why did this happen? What is actually happening inside my glands? What can I change now? And what consequences of years of dysfunction do I still have to deal with? And then there was the hardest part: time. So much time. My MGD recovery has been slow, messy and very non-linear. There were many moments when I thought I had stopped improving. There were moments when I thought we were missing something. There were moments when I was convinced that if a treatment hadn't worked quickly, it simply wasn't going to work. Now I see it differently. When I stopped looking at individual days and started looking at the bigger picture, I could finally see what had been happening all along. Things were changing. Just much, much more slowly than I wanted them to. And if you're somewhere in the middle of your own dry eye or MGD journey right now, maybe that's worth remembering.
