Do you suffer from dry eye? Is MG probing right for you?
Over 350 million people worldwide have Dry Eye. Meibomian Gland Dysfunction (MGD) is a major factor in approximately 90% of cases.1
MGD is recognized as the primary cause of dry eye and standardized treatment is still a developing field.
Dry eye affects physical and mental wellness, and it is essential to receive sustainable restorative treatment. Like many conditions, MGD progresses and can be debilitating if left untreated. Many patients end up on multiple drops and receiving various therapies, yet the disease progresses and long term relief remains elusive. Effective intervention is important before glands atrophy. Addressing the underlying causes of dry eye and maintenance such as good eye hygiene are equally important.
Are your eyes gritty or sore while reading this text? If so, talk to your optometrist or ophthalmologist…
What are Meibomian Glands? Why should they be probed?
Meibomian Glands (MGs) play a critical role in the maintenance of your eye health. They produce the oil (meibum) that protects the eye’s tear film from evaporation. The eyelids distribute this lipid layer during blinking. The tear film protects the cornea and requires both oil (meibum lipid) as well as the watery (aqueous) layers. Both aqueous volume and meibomian gland health are key metrics for dry eye sufferers.
The scientific recognition and validation of the importance of meibum secretion has led to treatment methods that attempt to restore the flow of meibum. Drops are prescribed as a first line approach, such as supplementing aqueous, reducing inflammation, or temporarily remediating parasites. (While drops sound benign, it is recommended to learn about long term effects). Some therapies apply heat to the eyelids with the aim of melting thickened oil and expressing it with pressure. The understanding of what is fundamentally happening in the glands continues to be studied and evolve. Recent discoveries illuminate a further understanding of progressive blockages – nonvisible (occult) fibrosis constraining the meibomian gland ducts.
Gland ducts become constricted, creating resistance inside the duct that blocks oil flow, frequently causing elevated pressure within the gland. This pressure, which is often associated with lid tenderness and inflammation, can lead to gland atrophy. Heat and expression (external pressure) alone may not be sufficient and may risk exacerbating the long term condition. Instead, physicians using MG probing recognize that proper release of duct constrictions requires mechanical intervention inside the gland.
Fibrosis (scarring) can occur at various points along the duct, allowing glands to be partially functional in oil secretion or entirely blocked. Glands may produce some oil but still not be healthy. Without clearing the gland of constrictions, the problem only progresses further while the root cause contributors to dry eye remain unaddressed.
Dr. Maskin has dedicated his career to researching MGD and treating ocular surface disease. In his experience, patients with varying degrees of dry eye have benefited from MG probing. Some patients have had the disease progress to an extremely debilitating state and sought all other available clinical remedies to no avail, and upon receiving probing, they experience immediate relief.
What are common symptoms of MGD?
In 2017, the International Dry Eye Workshop II (DEWS) defined dry eye as “…a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”
The International Workshop on MGD defined MGD as “A chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion. It may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease.”
Dry eye can be episodic, such as when environmental or task-based events result in less blinking and tear instability, or chronic and persisting continuously. Chronic dry eye can result in damage to the ocular surface and further exacerbate dry eye symptoms.
The physical impact of MGD can result in significant social and psychological impacts, leading sufferers to lose their occupations, social relationships, and resulting in mental health struggles. MGD can be a very serious condition whereby the debilitating impact also affects family members and friends.
Work with your eye doctor to craft a treatment plan.
Assessing your eyes for co-morbidities, or other diseases, that are contributing to your dry eye allows creation of a comprehensive treatment plan that tackles the root of the problem. Temporary solutions like eye drops are often recommended as the only treatment method, and ignore various contributors that must be identified and properly addressed.
The 3 key elements of any dry eye diagnosis plan include:
Aqueous tears - sufficient production without excessive evaporation. Increasing aqueous production or retention (such as punctal occlusion) complements MG probing for the right patients.
Meibomian Glands and ductal integrity - adequate quality and quantity of meibum (oil) and health of glands
Ocular surface health - smooth eye surface without degenerative tissue or masses misdirecting tear flow
While MGD is often associated with additional eye care needs that must be assessed, clearing your glands to allow oil flow is a key first step in treatment.
What is Meibomian Gland Probing (MGP)?
your doctor will use Maskin® probes to address constrictions in your Meibomian glands.
MG probes mechanically access the meibomian glands, ensuring patency and allowing flow of meibum, proven essential for eye health and moisture. As glands are probed, you may hear popping indicating the breakup of scar tissue surrounding glands and equilibration of pressure inside the gland. This scar tissue constricts the duct at various points along the gland. As Dr. Maskin likes to say, “It’s all about the pop!” as patients have correlated this sensation with immediate relief of lid tenderness.
Probing meibomian glands is a key element of a dry eye treatment plan. Also, be sure to talk to you doctor about possible co-morbidities (additional conditions or diagnoses contributing to your dry eye). Without adequate treatment of underlying and co-existing conditions, your Meibomian Glands may once again become impacted by scar tissue with blockage of essential meibum flow.
