These images show the meibomian glands, which exist within the lining of our eyelids. These glands produce the oils that coat the surface of our eyes and keep the watery portion of our tears from evaporating (drying out). Together, the watery component and the oily layer make up the tear film. The first image, above, shows an eye with a healthy distribution of meibomian glands. The other images show eyes with varying degrees of meibomian gland drop out. Meibomian gland drop out is a major cause of dry eyes and ocular surface disease. Once these glands are compromised they do not grow back or regenerate. There are a number of technologies that enable us to manage dry eye disease including many over the counter lubricating drops as well as a number of prescription medications. I have found that a well designed and fit scleral lens is a technology can allow many patients with dry eye disease to regain ocular comfort once again as well as providing so many patients with clear vision.