By the way, doctor: What can I do about Meibomian cysts?
Q. I have small white bumps on my eyelids, which are driving me crazy. They don't hurt, but they look awful. I've been told they're Meibomian cysts and that the only solution is surgery. What is your take on this?
A. From your description, you may have either of two common eyelid conditions: Meibomian cysts or milia.
A Meibomian cyst (also called a chalazion) is a small, fluid-filled sac that develops from a Meibomian gland, a specialized type of sebaceous gland. Like other sebaceous glands, Meibomian glands produce a thick liquid sebum — a mixture of oil and mucus — that helps keep skin (and hair, including eyelashes) from drying out. There are about 30 Meibomian glands in the upper eyelids and 20 in the lower lids. The glands discharge sebum through tiny openings (ducts) along the edge of the eyelid, just behind the eyelashes. There, sebum joins a layer of tears called tear film, which nourishes, lubricates, and cleans the outer surface of the eye and protects it from infection.
The duct through which the Meibomian gland drains can become blocked if the opening narrows or the sebum near the opening hardens. When that happens, the sebum backs up into the gland, causing inflammation and producing a cyst that grows toward the inside surface of the eyelid (see illustration). The walls of the gland may thicken into a firm, rubbery nodule (chalazion).
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Meibomian cysts or milia?
A Meibomian cyst is a hard, round lump that develops within the upper or lower eyelid from a blocked Meibomian gland. Milia are tiny white bumps that form on the skin's surface, often around the eyes, when dead skin cells become trapped in a sweat gland or hair follicle. |
Many Meibomian cysts disappear without treatment. However, some persist and may become as large as a pea, distorting vision and the shape of the eyelid. The first line of treatment is a warm compress applied for 10 to 20 minutes, three to four times a day. This can help soften the sebum and promote drainage and healing. If the nodule becomes infected, an antibacterial ointment may also be needed. If the condition persists, an eye specialist may drain or remove the nodule through a small incision on the underside of the eyelid or, more rarely, inject it with a steroid.
Milia are tiny white, dome-shaped bumps that form on the skin of the eyelid, around the eye, or on the nose or other parts of the face. Sometimes called "oil seeds," they're much smaller than Meibomian cysts — about the size of pinheads. They may not look good, but they don't hurt and don't interfere with vision.
Milia form when dead skin cells don't slough off normally but are trapped at the base of a hair follicle or sweat gland, where they mix with the oily sebaceous fluid and form a tiny cyst. They also occur closer to the outer surface of the skin than Meibomian cysts. Milia are common in newborn infants and generally disappear after the first few weeks of life. However, they often occur in adults, especially as a result of damage from chronic sun exposure, burns, heavy use of skin care products, skin resurfacing procedures such as dermabrasion, or long-term use of topical steroids.
I don't recommend trying to remove milia yourself. They have no opening on the surface of the skin and can't be expressed (popped) like blackheads or pimples. Surgical excision with a scalpel and comedone (plugged pore) extractor is the treatment of choice. Laser ablation, fruit acid peels, retinoic acid or, rarely, microdermabrasion procedures may be used. Be sure to see a dermatologist or ophthalmologist with expertise in managing eyelid conditions.
— Celeste Robb-Nicholson, M.D.Editor in Chief, Harvard Women's Health Watch
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