My Eyes Water All the Time, So How Can They Be Dry? Meibomian Gland Disease Explained.

The short answer.

Burning, gritty, tired eyes that water a lot are very often caused by blocked oil glands in the eyelids, called meibomian gland disease (MGD, also called meibomian gland dysfunction). It is one of the most common causes of dry eye. Eye drops soothe it but do not unblock the glands. MGD is usually long-term, but with the right mix of daily home care, drops when needed and, for some people, in-clinic treatment such as MiBoFlo, it can be well controlled. The earlier it is treated, the more of your glands you keep.

What you hear.

The first is the most common misunderstanding we see in clinic. Watery eyes are often dry eyes, as you will see below. The second treats the symptom and leaves the cause untouched. The third promises more than any dry eye treatment can deliver. Let’s take them one at a time.

Does this sound like you?

• Burning or stinging eyes
• A gritty, sandy feeling
• Red, tired or heavy eyes
• Watery eyes, even though they feel dry
• Blurred vision that clears when you blink
• Discomfort with screens, AC or contact lenses
• Crusty or sticky eyelids in the morning

If several of these are familiar, your eyelid oil glands may need a check-up.

What are meibomian glands?

Inside your eyelids is a row of tiny oil glands called meibomian glands. There are about 25 to 40 in each upper lid and 20 to 30 in each lower lid. Each gland ends in a tiny opening on the edge of the eyelid, just behind the eyelashes.

Every time you blink, the lids gently squeeze these glands, and a little oil comes out of the openings and spreads over your tears.

How the oil protects your tears

Your tears have three layers:

1. A thin oil layer on top, made by the meibomian glands
2. A water layer in the middle, which keeps the eye wet and clean
3. A mucus layer that helps the tears stick to the eye

The oil works like a lid on a cup of water. It stops the water layer from evaporating between blinks. Without enough oil, the water evaporates quickly and the surface of the eye develops dry patches.

Why do the glands get blocked?

Healthy gland oil is clear and runny, like cooking oil. In MGD, the oil turns thick and cloudy, more like toothpaste or butter. This thick oil sticks in the openings and blocks them, so very little oil reaches the tears.

Common reasons include:

• Growing older
• Long screen time (we blink less, and often only halfway)
• Swollen, irritated lid edges (blepharitis)
• Hormone changes, such as menopause
• Contact lens use
• Dry air from AC, fans or travel
• Skin conditions such as rosacea
• Some medicines, such as isotretinoin tablets for acne
• Eye make-up on the lid edge

How blocked glands lead to dry eye, and to watery eyes.

Without enough oil, your tears evaporate within a few seconds of each blink. The front of the eye dries and gets irritated. This irritation makes the lid edges swell, which blocks the glands even more. The problem keeps feeding itself, round and round.

This is also why your eyes may water a lot. The eye makes extra tears to fight the dryness, but without oil they do not stay on the eye and simply run off.

What happens if MGD is not treated

When glands stay blocked for months or years, the thick oil and swelling slowly damage them. The glands shrink, and some disappear completely. Doctors call this gland dropout.

Glands that are lost usually do not grow back. With fewer glands there is less oil for good, and dry eye can become permanent. Treating early protects the glands you still have.

How we find out what is going on: dry eye analysis.

A dry eye analysis is a set of quick, painless scans that measure your tears and photograph your oil glands. Nothing touches your eye. It shows what kind of dry eye you have and how far it has gone, so we can choose the right treatment and check your progress later.

NIBUT: how long your tears last. NIBUT stands for non-invasive tear break-up time. You look into the machine and blink once. It shines a pattern of rings onto the front of your eye, and a camera counts the seconds until the rings start to break up. Healthy tears usually stay smooth for 10 seconds or more; in dry eye they break up sooner. No dye is used.

Meibography: a photo of your oil glands. We gently turn the eyelid over and take an infrared photo. The glands show up in white, so we can see their actual shape and whether they are healthy, twisted, shortened or lost. Meibography shows damage that cannot be seen any other way, lets you see your own glands on screen, and lets us compare photos before and after treatment.

We also look at your lid edges and gland openings under the microscope, and gently press the glands to see the quality of the oil.

Treatment works in steps.

Most people need a mix, chosen by the doctor after the dry eye analysis:

• Home care, every day: warm compresses, cleaning the lid edges and blinking exercises
• Eye drops, as advised: lubricating drops top up the water layer, and some also add oil for a while. Drops to calm swelling are used only if prescribed.
• Medicines, if needed: short courses of tablets or ointment that calm lid swelling, only when your doctor advises
• In-clinic treatment: MiBoFlo heat treatment and gland clearing to melt and clear the blocked oil

MiBoFlo treatment at EYON.

MiBoFlo uses gentle, steady warmth on the outside of your closed eyelids to melt the thick oil, so the blocked glands can be cleared.

1. Relax with your eyes closed. You lie back comfortably, and a clear gel is put on your closed eyelids.
2. Gentle warmth. A smooth, warm probe glides over the outside of your eyelids at a steady 42°C, for about 10 to 12 minutes per eye. The thick oil softens and melts.
3. Clearing the glands. Your eye specialist then gently presses the eyelids to push the melted oil out of the openings.
4. A short course. Usually 3 sessions, about 2 weeks apart. Some people need top-up sessions later.

Nothing touches the eye itself, there are no needles or cuts, it feels like a warm massage, and you can return to your routine the same day. The device has a built-in safety cut-off if it gets too warm.

How MiBoFlo makes its heat

MiBoFlo has its own (proprietary) thermoelectric heat pump, based on the Peltier effect. When electric current flows through special blocks made of two different materials, heat is pumped from one side to the other. One side gets warm and heats the probe tip, while the other side gets cool.

Because the heat comes from electricity, not from hot water or a heated gel pack, it can be controlled very precisely. Built-in electronics hold the tip at a steady 42°C for the whole session.

How MiBoFlo is different from heat at home

Swipe sideways to see every column

	MiBoFlo at EYON	Eye mask at home
Heat	Steady 42°C for the whole session	Starts warm, then cools down within minutes
Reaching the glands	Smooth metal tip and gel pass the heat through the eyelid	Much of the heat is lost to the cloth and the air
Massage	Gentle massage along the lids while warming	No massage
Clearing the oil	Your specialist presses the melted oil out of the openings right after	Softened oil often stays inside the glands
Best for	Opening blocked glands	Daily upkeep between sessions

Both work together. MiBoFlo does the deep clearing that heat at home cannot, and your eye mask helps keep the glands flowing between sessions.

What to expect from MiBoFlo

MiBoFlo is a gentle, comfortable treatment, but it is not a one-time cure. It works best as part of the whole plan above, with daily home care between and after sessions. It also cannot bring back glands that are already lost, which is one more reason to treat early.

Most people notice a gradual improvement over the sessions. Results differ from person to person, and home care is still needed to keep the glands healthy.

Blinking exercises.

On screens we blink less, and often only halfway. A full, firm blink squeezes the glands and pushes fresh oil onto your tears.

1. Close: close your eyes gently, as in a normal blink. Hold for 2 seconds.
2. Squeeze: gently squeeze your eyelids together. Hold for 2 seconds.
3. Open: open your eyes and relax. Hold for 2 seconds.

Repeat 10 times, about every hour while you use a screen. Also follow the 20-20-20 rule: every 20 minutes, look at something 20 feet (6 metres) away for 20 seconds, and blink fully.

Daily care at home.

• Warm compress: 5 to 10 minutes, once or twice a day, with a heated eye mask or a clean cloth in warm (not hot) water. Re-warm it as it cools.
• Clean the lid edges: after the compress, gently wipe along the lash line with cooled boiled water or a lid wipe your doctor suggests.
• Screens: keep them a little below eye level, so your eyes are less wide open.
• Air: do not let AC or fans blow on your face.
• Make-up: remove it fully at night, and avoid lining the inner lid edge.
• Drops: use your eye drops as advised, even on good days.
• Water: drink enough water through the day.

Questions to ask your eye doctor.

• Is my dry eye mainly from blocked oil glands, too few tears, or both?
• What did my meibography show, and have I already lost any glands?
• What should I do at home every day, and for how long?
• Do I need in-clinic treatment, or can home care and drops be tried first?
• How many sessions do you suggest, and how will we check whether they worked?
• What should I do if my eyes feel worse?

When to see a doctor quickly.

See an eye doctor without delay if you have eye pain, a sudden drop in vision, strong sensitivity to light, or a very red eye. These are not typical of MGD and need checking the same day.

Frequently asked questions.

The bottom line.

Dry, gritty, burning eyes, even watery ones, are very often a problem with the oil glands in your eyelids, not a lack of eye drops. Drops make the eyes feel better, but the glands need daily warmth, cleaning and full blinks, and some people benefit from in-clinic treatment such as MiBoFlo. None of these is a one-time cure, but together they control MGD well in most people. The most important step is to get the glands checked early, while there are still plenty left to save.

Want to know how healthy your eyelid oil glands are? A dry eye analysis is available at EYON Eye & Laser Institute, Riverdale, Kharadi, Pune. Call 090909 93399 to book, or book a consultation online.

This article is for general information and does not replace advice from your eye doctor. Treatment is planned only after a full eye examination, and results vary from person to person.

Dr. Bhalekar offers dry eye analysis and MiBoFlo treatment at EYON Eye and Laser Institute.

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