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Zeba Almas Syed, Francis Sutula; Dynamic Intraductal Meibomian Probing (DIMP): A Novel Approach to the Treatment of Meibomian Gland Dysfunction. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4761.
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Meibomian gland dysfunction (MGD) is among the most common disorders treated by ophthalmologists. Warm compresses and lid hygiene usually do not provide lasting symptom relief. Meibomian gland probing has been shown to be effective in severe posterior blepharitis. Here we describe a modified technique, Dynamic Intraductal Meibomian Probing (DIMP), which has several advantages over traditional probing including greater magnification, stabilization of the patient’s head, facilitated probing against resistance, and easier identification of orifices
A retrospective chart review was performed on patients undergoing DIMP by one physician between January 2013 and July 2014. Inclusion criteria were patients with symptomatic MGD (dryness, tearing, foreign body sensation, and/or irritation) and clinical signs of MGD (eyelid erythema, thickening, irregularity, and/or telangiectasias) who did not respond to conservative therapies including warm compresses, lid hygiene, and topical anti-inflammatory medications. We reviewed the electronic medical records for the presence of symptoms after DIMP treatment.<br /> <br /> During DIMP, the patient is seated supine on a surgical chair and an operating microscope is positioned over the target lid. Von Graefe fixation forceps are used to grasp the lid and apply upward traction, and a 2 mm probe is inserted to dilate each meibomian gland orifice sequentially along the lid margin. The 4 mm probe is then substituted to allow for deeper probing. After DIMP, meibum spontaneously expresses through glands along the lid margin.
Thirty-six eyes of 22 patients underwent DIMP treatment. The average age of patients was 59 years. Eleven patients were male and 11 were female. The majority (82%) of procedures were performed on a lower lid. Follow-up ranged from 1 to 16 weeks, with a mean of 3.5 months (± 3.1 months). Most (92% ± 4.6%) patients reported symptomatic improvement during follow-up. No major complications were noted. Rarely, small areas of bleeding were appreciated at ductal orifices. This always stopped spontaneously without need to apply pressure.
DIMP is an effective and safe technique for symptomatic MGD that is resistant to traditional therapies. The development of tools to quantify the severity of MGD would allow for more objective outcome measurements.
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