Abstract
Purpose: :
To review characteristics of intraductal meibomian gland probing (MGP) findings to evaluate frequency of an audible "pop" and tactile relief (pops) of intraductal resistance suggestive of fibrotic obstruction as well as gritty sensations (grits) suggestive of keratinized cell debris as factors of O-MGD.
Methods: :
Intraductal meibomian gland probing data were reviewed retrospectively of patients status post MGP for O-MGD as previously described in Cornea 2010;29:1145-1152. There were 189 patients and 642 lids probed. Average age was 62.5 + 15.9 with a range of 17-95. Male: female ratio was 55/134 or 0.4/1.
Results: :
Of a total of 15,642 glands probed, 6384 or 41% had pops with a range of 0- 100%, 3687 or 24% had grits with a range of 0-83% and 5571 or 35% had neither. Looking at upper vs lower lids, there were 9771 total upper lid glands and 5871 total lower lid glands probed. The upper lid glands had 4298 or 44% pops, 2880 or 30% grits and 2593 or 26% neither while the lower lid glands had 2117 or 36% pops, 837 or 14% grits and 2917 or 49% with neither. There was a total of up to 74% of upper glands and 50% of lower glands showing some detectable intraductal resistance.
Conclusions: :
Intraductal meibomian gland probing has uncovered characteristics consistent with intraductal mechanical resistance to meibum flow. The greatest component of resistance appears to be from "pops" suggestive of fibrotic obstruction. Lacking histopathologic evidence of intraductal fibroses would suggest the location of fibrotic obstruction is periglandular (Hamrah et al) and the "pops" represent release of this fibrotic "collar" reducing intraductal pressure, enhancing meibum flow and reducing symptoms of O-MGD.
Keywords: cornea: tears/tear film/dry eye