Pearls of Vision: Managing Meibomian Glands

CECELIA KOETTING: Hello again. It’s Cecelia Koetting coming to you from Denver, Colorado. And today, we’re going to talk about meibomian gland dysfunction (MGD), how to diagnose by looking at some lipiscans, and then my favorite part, how to treat using some meibomian gland expression. Kind of gross, but kind of fun. First, let’s talk about meibography, which is imaging of those meibomian glands. First, we see this patient here, who has probably got grade 1 to 2 MGD, moderate inspissation towards the nasal area, with not really any truncation or loss of glands. This is good. However, this patient still needs to begin at-home therapy.

This patient has more significant inspissation, as well as we start to see some truncation of the glands. We see some shortening, and some atrophy. This is probably grade 2 to 3 MGD. Lastly, our third patient here has severe grade 4 MGD. We see 90%, give or take, loss of glands, as well as severe truncation of the few glands that are still there. This patient is at severe risk for loss of the remaining glands. Surprisingly, any of these patients at any stage may or may not actually present with complaints. Just as important as the meibography, it’s almost more important to remember to express these glands in the slit lamp, making sure to grade the expressibility, the color, and the quality of the meibum that comes out. Use a Q-tip, use your finger, I don’t care, whatever makes you happy, just express it. Next, we get into treatment, and we’re going to talk more specifically about thermal pulsation. Here, we see this patient who has probably grade 2 to 3 MGD. We see a decent amount of inspissation towards the nose, and this patient needs to have these glands expressed, along with continuing at-home therapy. This same patient underwent iLux® from Alcon. Here, we see that patient’s same eye that was in the meibography picture being expressed using the iLux®. Pulsing to express the oil while heat is continuously applied helps to clear those glands and allow them to reset. This is the same patient’s other eye. Not good either. And here again, we see all of that unhealthy meibum being expressed from the glands. Pretty gross, but kind of awesome.

While we only talked about a few of the options as far as expressing the glands in office, the first step is identifying the unhealthy glands. So my challenge to you this time, push on those glands.
Cecelia Koetting, OD

Next, we’re going to look at another option for clearing the clogged meibomian glands from Sight Sciences called TearCare®. With this patient, we see severe MGD and truncation, loss of glands, lots of atrophy. This patient, amazingly enough, is one of those who had minimal symptoms, however, quite a bit of signs of dry eye and MGD. After applying the heat to the gland using the SmartLid™ portion of the TearCare® system, we go through and manually express the glands. You can see some of the meibum coming out here, a little bit toothpaste-like. We continuously move the paddles along, expressing all the glands. Oh, yup, there’s the cheese. But guess what? That was all unhealthy, sick meibum that needed to come out so that this patient can start to feel better. and those glands can start to repair themselves, and fill again with healthy, happy oil. While we only talked about a few of the options as far as expressing the glands in office, the first step is identifying the unhealthy glands. So my challenge to you this time, push on those glands.

This has been Cecelia Koetting with Optometry Advisor.