The 2 images below are of the “meibomian” glands of 2 different patients. These glands exist within the lining of our eyelids and produce the oils that cover the watery portion of our tears. If these glands are compromised, we can lose the tear film covering the ocular surface of our eyes (through evaporation) exposing the underlying ocular tissues to the environment and the blinking action of the eyelids. “Meibomian gland dropout” or atrophy is one of the leading causes of dry eyes if not the leading cause. In the images below, the white vertical lines are the meibomian glands. In the 1st image, note that these white lines (which exist on the underside of our eyelids) appear compromised and do not extend the length of eyelid lining. In this image, these glands are atrophied and as a result this patient has a very dry eye. This eyelid belongs to an otherwise healthy 25 year old woman. In the 2nd image, note that the meibomian glands extend the entire length of the eyelid lining. As you all know I am not a proponent of LASIK surgery. However, it would be interesting to know what percentage of LASIK patients had a meibomian gland evaluation before undergoing LASIK surgery.