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Caroline Blackie, Donald Korb; Debridement of the Lower Lid Margin and Line of Marx is effective in increasing meibomian gland function and patient comfort. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6017.
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The purpose of this study was to evaluate whether mechanical debridement of the Line of Marx (LOM) and the lower lid margin would improve meibomian gland function and reduce dry eye symptoms.
16 symptomatic subjects undergoing treatment for evaporative dry eye (age range: 26-81 yrs, mean: 55.9 +/- 15.0 yrs) who also evidenced anteroplacement and a thickened LOM, were enrolled and consented according to the tenets of the Declaration of Helsinki. Exclusion criteria included active ocular infection/inflammation, ocular surgery within the previous 6 months, lid abnormalities other than those related to meibomian gland dysfunction and/or normal age related lid margin changes. Prior to debridement the LOM was stained with lissamine green (Odyssey Medical, TN). The entire width of the keratinized lower lid margin was debrided, followed by debridement of the stained LOM using a stainless steel, foreign body, golf club spud (Akorn Ophthalmics, IL). Meibomian gland function and symptoms were assessed pre and approximately 1-month post lid margin debridement. No new or additional treatment was permitted during the 1-month post debridement period. Using standardized diagnostic expression with the meibomian gland evaluator, meibomian gland function was evaluated along the full length of the lower lid margin. Symptoms were evaluated with the SPEED questionnaire (maximum score = 28). Only data for the right eye is reported.
There was a significant decrease in symptoms and increase in the number of functional meibomian glands as a result of the debridement of the lid margin and LOM. Symptoms: baseline mean pre-debridement = 13.4 +/- 4.6 and 1 month post-debridement = 10.5 +/- 3.7 (p < 0.0001, paired t-test). Number of functional meibomian glands: baseline mean pre-debridement = 2.5 +/- 1.2 and 1 month post-debridement = 3.7 +/- 1.4 (p = 0.0007, paired t-test).
The results indicate that debridement of the lower lid margin and LOM provides significant symptom relief and improves meibomian gland function. Thus, lid margin debridement should be given further consideration in the context of age related lid margin changes, and for the prevention and management of meibomian gland dysfunction and dry eye symptoms.
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