Thousands of patients with meibomian gland dysfunction may find relief with a new method that probes the intraductal meibomian
glands. The technique—in which 2-, 4-, and 6-mm disposable, stainless steel, sterile solid-wire probe cannulas (Rhein Medical)
are used—appears to be highly effective in quickly relieving inflammatory symptoms of obstructive meibomian gland disease,
said Steven L. Maskin, MD, at the annual meeting of the Association for Research in Vision and Ophthalmology. He and his colleagues
currently are using an intraductal cannula to lavage the gland with pharmaceuticals.
"Meibomian gland dysfunction is arguably the most common cause of dry eye and has certainly been the most challenging to treat,"
said Dr Maskin, director of the Dry Eye and Cornea Treatment Centre, Tampa, Florida. "Traditional therapies have failed to
consistently provide effective results, leading to ongoing suffering and frustration for patients and physicians alike."
In light of this situation and the large numbers of patients with meibomian gland dysfunction, he conducted a retrospective
study of the efficacy of this new invasive approach for treating symptomatic obstructive meibomian gland dysfunction. Twenty-five
consecutive patients were included in the study.
Dr Maskin said that 20 of the 25 patients with meibomian gland dysfunction complained of pre-treatment lid tenderness or soreness
that was immediately relieved with probing. One month after the procedure, all 20 patients continued to have decreased tenderness
or soreness. Additionally, eight of the 20 patients (40%) reported increased lubrication, five (25%) reported less friction
or improved comfort on blinking comfort, three (15%) reported decreased need for artificial tears, two (10%) reported decreased
light sensitivity, and two (10%) reported increased vision.
The other five study patients had nonspecific complaints about lid margin congestion before treatment. After probing, two
of the five patients (40%) reported increased lubrication, two (40%) reported decreased gumminess and filminess, and one (20%)
each reported increased vision, decreased lid heaviness, and decreased light sensitivity. One patient with a localized mature
hordeolum did not obtain relief after the procedure.
No complications were associated with the technique, and the typical improvement lasted for at least 4 to 6 months.
"The findings suggested that intraductal fibrotic and neovascular membranes were frequently identified," Dr Maskin said. "These
membranes were opened up by probing, which allowed sequestered plugs of meibum to escape."
The lid margin and glands are examined with and without transillumination to evaluate the patency of the orifice and the status
of the glands, with special attention to the gland proximal and distal atrophy, the length of the glands, and signs of ductal
dilation that suggest proximal obstruction, he said. The glands are palpated individually for gland tenderness seen with inflammation
Dr Maskin said he begins the procedure by passing the 2 mm probe through the orifice. A fine router movement may be needed
to find the opening, especially in the setting of orifice metaplasia, he added.
After penetrating the orifice with the 2 mm probe, the 4- or 6-mm probe is used, depending on the length of the gland to achieve
complete patency of the ductal highway.
"Resistance may be encountered," Dr Maskin said. "Respecting the length of the gland will prevent extending the probing too
deeply. Therefore, if resistance is obtained, the probe may be up against a fibrotic band. Check to ensure that the probe
is co-linear to the gland, then provide additional force to pop through the intraductal scar."
In some cases, a drop of heme can be seen at an orifice, which can occur as the probe passes through a fibrotic neovascular
scar or simply a neovascular membrane.
Pre-, postoperative changes
He referred to preoperative and postoperative photos from a case. Following the procedure, the patient had less deep lid margin
redness, less prominent superficial vessels, and reduced orifice pouting.
"Together, these findings suggest reduced congestion correlating with the immediate and dramatic reduction in tenderness,"
Dr Maskin said.
"Intraductal fibrotic and neovascular changes may explain the persistence of obstructive meibomian gland disease despite exhaustive
therapies directed at the lid margin and orifice and the inconsistent effect of warm compresses and lid massage," he continued.
"Intraductal meibomian gland probing appears highly effective in quickly relieving inflammatory symptoms of obstructive meibomian