Meibomian cysts are lumps in the eyelids caused by blocked oil glands in the lids. These lumps often occur in groups. They are not due to infection and usually resolve over time, though this may take some months.
- Heat and massage can be helpful in clearing them, though it may take some weeks to show improvement.
- Surgical drainage of the cysts can be performed (usually only considered for adults). However, the procedure does not prevent more cysts from forming in the future.
What are the meibomian glands?
The meibomian glands in the lids (see diagram below) are responsible for maintaining a robust tear film by providing a protective oil layer to stop the eyes drying out. If the glands are not functioning 100%, the lid margin is typically red, the eyes get irritated and dry (gritty, burny), there is watering, vision can be variable (due to butter-like grease in the tears rather than smooth thin oil) and occasionally they will block completely and form a cyst.
Cysts often come in groups
There are usually 30-40 glands per lid, and this explains why meibomian cysts are common and often come in groups. They are not due to infection. The redness and swelling is due to the body attempting to unblock the glands by increasing the blood supply (causing inflammation). As there is no infection, antibiotic ointments and drops make very little difference.
Cysts do not threaten vision
All meibomian cysts will resolve with time, and being only a blocked gland they are not vision threatening – they are cosmetic only. The best management is time, although treatment using heat and massage to the cysts can speed up the process, by increasing the inflammatory response. Realistically this can take months, but a lot of shrinkage occurs in the first few weeks making them less obvious.
The quick solution is incision and curettage (I&C; a simple surgical drainage): but in children this requires a general anaesthetic and is almost never justified due to the risks of the anaesthetic. Adults have the choice of a local anaesthetic injection, so I&C for cosmetic reasons is more commonly performed in adults.
However, the cyst can reform, and others can develop, so for a cyst that will resolve by itself (even if this takes six to nine months) the usefulness of I&C is limited. If you can feel it, but not really see it much, then there is no need to have a meibomian cyst drained. Commonly, when people with meibomian cysts are placed on the public waiting list for I&C, the cysts have usually resolved by the time of surgery. The best treatment is to leave them alone, or perform heating (to melt the oil) followed by firm lid massage.
For further information about meibomian cysts, or any vision or eye health concerns, contact your optometrist or ophthalmologist for individual assessment.
Request an appointment - Eye Institute, Auckland, NZ