Could the Squeezing Ability of Meibomian Glands Get Directly Impacted by the Removal of Muscle & Fat After Blepharoplasty?

Could the squeezing ability of the meibomian glands get directly impacted by the removal of muscles & fat attached to the under eye fatty tissue during a blepharoplasty?

Doctor Answers 3

This is not out of the question.

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Meibomian gland dysfunction after belpharoplasty is not well studied.  In my experience damage to the orbicularis oculi muscle from lower blepharoplasty can make existing meibomitis worse.  Can motor injury to the orbicularis oculi muscle also have a direct bearing on function of these glands.  This is a good question and the answer is probably yes it can.  See an ophthalmologist or oculoplastic surgeon for help with these issues.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Meibomian gland problems are not typical with blepharoplasty

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I'll assume you already know something about eyelid anatomy because I have not had a single patient (in tens of thousands) ever specifically ask about the Meibomian glands! But it is a good question. The majority of the "pump function" of the eyelid muscles relates to the tear outflow system and eyelid closure. Thus, aggressive blepharoplasty with removal of too much orbicularis muscle can cause tearing, hanging out or down of the eyelid (ectropion) or problems with closing the eyes. Most experienced oculoplastic surgeons do not aggressively remove orbicularis muscle.

Blinking of the eyes does indeed help with the secretion of oil from the many small meibomian gland located in the tarsal plates of the eyelids. This oil is excreted from small openings along the eyelid margins and provides a coating to decrease tear evaporation. So one could imagine that in addition to the myriad of other problems you'd have with an overzealous blepharoplasty, decreased meibomian gland secretion might occur as well.

In summary: Choose a surgeon experienced in eyelid anatomy and surgery!

Evan Black, MD
Detroit Oculoplastic Surgeon

Interesting theory

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The eyelid blink is a well accepted as performing a "tear pump" action on propelling tears into the tear sac and nose. The effect on the  expulsion of oil from the meibomian glands has never been studied as it relates to eyelid muscle [orbicularis oculi] function.

Based on the anatomy, it would seem unlikely that the eyelid muscle "squeezes" oil out of the gland, because the meibomian glands reside within the tarsus [the part of the eyelid that gives it the firmness], whereas the muscle responsible for blinking [and the tear pump] lies external to it.

However, it is possible that inflammation from surgery cause also cause subtle inflammation of the meibomian glands thereby decreasing production? I think that may be a more plausible.  Though again, no studies exist to confirm or contradict this theory.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

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