Sarah Koseki, a field consultant from Boise, Idaho, experienced a sudden and agonizing corneal tear while on vacation in Mexico. The incident, where her eyelid felt stuck to her eyeball, caused sharp, knife-like pain that lasted for days and disrupted her trip.
Initially diagnosed with a corneal tear, Koseki's condition recurred with increasing frequency over the next few months. Each episode involved debilitating pain lasting up to 48 hours, leaving her unable to find comfort with her eyes open or closed and severely impacting her ability to sleep. At one point, both of her corneas tore simultaneously, prompting her to seek further answers.
After undergoing a series of tests at a specialist clinic, Koseki was diagnosed with meibomian gland disorder (MGD), a condition affecting millions of Americans where the oil-producing glands in the eyelids malfunction. This can lead to severely dry eyes, irritation, and untreated, damage to the cornea. While aging, hormonal shifts, and skin conditions can contribute to MGD, doctors determined that Koseki's MGD was likely caused by her nearly 20-year habit of sleeping with eye makeup on.
Experts explain that MGD occurs when the small oil glands along the eyelid margins become blocked or cease to function properly. These glands produce the oily outer layer of the tear film, which prevents eye dryness. When the oil thickens or gland openings are obstructed, the tear film destabilizes, leading to dry eyes. Prolonged screen use, reduced blinking, infections like blepharitis, rosacea, contact lens wear, hormonal changes, and certain medications can also be contributing factors.
MGD is a leading cause of dry eye disease, characterized by a gritty, burning sensation, redness, blurred vision, and watery eyes. The compromised tear film leaves the cornea more vulnerable to painful scratches and tears. Ophthalmic surgeon Mfazo Hove noted that applying eyeliner to the waterline can be particularly risky, as makeup left on overnight can accumulate around the meibomian gland openings, contributing to obstruction and inflammation. This can lead to progressive gland dysfunction and loss of tissue over time.
For Koseki, the diagnosis came too late for her eye damage to be fully repaired. She now follows an extensive daily routine to manage her condition and prevent further tearing. This includes using eye drops six times a day, washing her eyes with tea tree oil morning and night, and applying a heat mask to help the gland oils flow better. She also uses eye ointment before bed to keep her eyes moisturized.
Koseki has stopped wearing eye makeup altogether, except for occasional under-eye concealer. She likens her daily routine to brushing teeth to prevent cavities, emphasizing that missing even one day can cause her eyes to become inflamed.
Preventative measures recommended by Mr. Hove include blinking properly, as each full blink helps express oil from the meibomian glands. He advises taking regular breaks from screens, consciously blinking fully, and maintaining good eyelid hygiene. Regular warm compresses can also help keep the oils fluid. Individuals experiencing persistent gritty, burning, watery, or intermittently blurred eyes should seek professional assessment if symptoms continue for several weeks.
While Koseki has found some benefit from Intense Pulsed Light (IPL) treatment, which helps melt thickened oils blocking the meibomian glands, the procedure is expensive and often not covered by insurance, with a full course of treatment costing thousands of dollars. Koseki expressed regret, stating that if she had known the potential consequences, she would have established a nighttime face-washing routine decades earlier.