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Donald R. Korb, Caroline A. Blackie, Erin McNally; Evidence That The Upper and Lower Lids Do Not Make Complete Contact Even When The Lids Are Closed. Invest. Ophthalmol. Vis. Sci. 2012;53(14):586.
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To investigate whether the keratinized portions of the upper and lower eyelid margins make complete contact during complete blinking.
10 subjects (mean age = 21.7 +/- 1.5 years) asymptomatic for dry eye, with healthy appearing eyelids were enrolled. Only left eyes were used for analysis. Using a custom application device, a 0.1 microliter drop of unpreserved 2% liquid fluorescein (B&L, Chauvin, France) was placed in the temporal (T) third of the keratinized lower lid margin. The drop was placed anterior to the Line of Marx (LOM), between two meibomian gland (MG) orifices and slightly anterior to the orifices to avoid the sulcus. The drop was viewed under 16x magnification for 10 complete blinks. The number of complete blinks required to alter the appearance of the drop was recorded. If 10 complete blinks did not alter or spread the drop, the subject was instructed to squeeze their lids shut. The number of lid squeezes required until the drop appearance was altered was recorded. This was repeated for the central (C) and nasal (N) sections. Next, standardized diagnostic MG expression was performed along the lower lid margin to assess MG functionality. Finally, a 30-microliter drop of fluorescein was added to the inferior cul-de-sac and, after 60 seconds, the proximity of the LOM to the lower lid MG orifices was noted.
The mean number of MGYLS per lid section: T = 0.8+/-2.2, C = 4.3+/-2.3, N = 4.4+/-0.8. In all but 2 of 30 cases, 10 complete blinks did not alter the appearance of the drop in any way; Lid squeezing was required to spread the drop. The mean number of lid squeezes for each lid section was: T = 1.5+/-1.3, C = 1.9+/-1.8, N = 1.2+/-0.8. The position of the LOM relative to the MG orifices by lid section was: T: the LOM in 30% of eyes was posterior to the MG orifices and in 70% of eyes was mixed (a combination of the LOM posterior, touching, bisecting or anterior to the MG orifices); C: 70% posterior, 30% mixed; N: 90% posterior, 10% mixed.
Counterintuitively, the keratinized portions of the upper and lower eyelid margins, over 90% of the width of the lid margins, frequently do not fully contact each other during complete blinking.
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