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D. R. Korb, C. A. Blackie, J. D. Solomon, B. T. Gravely, T. Douglass; A Device to Standardize and Quantify the Force Used to Diagnose Meibomian Gland Obstruction and Dysfunction. Invest. Ophthalmol. Vis. Sci. 2007;48(13):439.
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© ARVO (1962-2015); The Authors (2016-present)
Individual meibomian gland (MG) patency can be determined by applying force to the external lid surfaces overlying the MG, while observing with the biomicroscope. This technique can assess whether individual MG are secreting oil, and thus patent, or not secreting and thus obstructed. The magnitude of the force has not been quantified but the qualitative terms ‘gentle’ and ‘forceful’ expression have been used to describe it. Our observations have established that diagnosis of individual MG patency may be a function of the amount of force applied. The purpose of this study was to evaluate a new device designed to standardize the technique and quantify force applied to the lower lid when performing a MG patency test.
The device was designed to mimic the forces applied to a MG of the lower lid, during forced blinking, which are known to express MG secretion. The device applies a force of 15 grams per 30 mm2 to the external lid surface overlying the MG, independent of operator technique. Subjects were recruited for two groups, symptomatic and asymptomatic (n=25 in each). Dry eye symptoms were quantified by the SPEED questionnaire: subjects with ≤ 2 points were grouped as asymptomatic, subjects with ≥ 10 were grouped as symptomatic. Additional criteria were fluorescein break-up-time (FBUT) and lipid layer thickness (LLT); asymptomatic group: FBUT ≥ 10 s, LLT ≥ 90 nm; symptomatic group: FBUT ≤ 5 s, LLT ≤ 75nm. The central 10 MG of the lower eyelid were evaluated with the device.
The mean (± SE) number of obstructed glands was 8.6 ± 0.3 for the symptomatic group and 1.4 ± 0.3 for the asymptomatic group (p < 0.0001). Both FBUT and LLT are significantly correlated with number of obstructed MGs. However, in a multiple linear regression, only FBUT remains significant.
Determining the patency of individual MGs may be conducted with a new device providing a standard force of 15 grams per 30 mm2 to the external lid surfaces overlying the MGs. The results further indicate MG gland obstruction is positively correlated to dry eye symptoms, FBUT and LLT.
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