Meiboscopy/ Meibography - What it Shows
Channel: Meiboscopy
Date: 2012-02-06

This drawing represents meibomian glands seen with the meiboscope.

Drawings make it clearer what you can see as we can point things out easier.

Meibomian glands look darker than the background in trans illuminated meiboscopy.

Healthy meibomian glands are regular, long even thickness and do not cause sinking of the palpebral conjunctiva here.......  or have sunken orifices  here

Blocked glands cause convex ridges on the palpebral conjunctiva here - easiest seen at the eyelid fold - here

the gland maybe only blocked lower down - giving the gland a focal bulbous area.

Empty glands can be seen as grey enlarged stripes.

Gland stress cause irregular shape and width. Glands don't die completely - in many cases only the far end dies and the gland seems short = the deeper distal part being either empty or irregular. 

= or it maybe its the orifice end that inflames and blocks leaving the central duct and acini deep in the lid without access to the lid margin - sometimes these excavate to a nearby gland duct.

Inflamed or blocked orifices set up enlarged or uneven glands near to the orifice. 

Orifice inflammations always give associated telangeictasia of the nearby lid margins. Deeper inflammations are always localized and cause acini death and damage leaving an uneven thickness to the gland and duct.

Gland width irregularity is due to focal acini being blocked and degenerating.

We think there are assumptions made about notching and orifice sinking. We reviewed the literature and find they assume notches are due to gland death - that is drop-outs. The true picture is more complex and theser ideas based on our observation.

If the associated gland dies - then the notch will form as the orifice sinks - it also forms a posterior notch as the overlying palpebral conjunctiva moves into the space once occupied by the gland.

Dimpling - that is, (after Chen) simple sinking of the orifice occurs in relation to deep, distal blockages and die back. The proximal gland may well be normal = but it is unusually shortened as the deeper part is damaged. This causes dimpling without posterior movement.

Full thickness lid notches are formed due to orifice and margin inflammations - the full thickness notch is really a crease and is caused in part from blinking - which causes the margins to crumple and flex.

So,a normal lid margin - may not show the meibomian drop outs underneath. There maybe many empty glands or gland drop outs and still have a no dimples, posterior notches or full thickness notches.

However, we find there is a strong relationship between notch progression and gland death. To summarize -
meibomian problems don't necessarily lead to dimples and notches = but when they do - the relationship is progressive but loose. And even with meibomian gland health improvements the notches and dimples will remain.

The pattern of the drops out as seen meiboscopically - relate to the cause.

Mechanical or infectious Inflammations occur randomly, and drop-outs and orifice blockages in random positions on the eyelids are from this cause. 

Changes in the meibomian gland environment - such as increases in immune activity - such as in chronic smoking or Ulcerative Colitis - cause groups of meibomian gland to dysfunction together. Usually this is confined to the nasal third of the lower eye lid. These drop-outs start nasally and increase temporally in relation to time of intensity of the irritant or inflammation. 

Smoking cessation will stop further changes and temporal creep of the meibomian die back.

People with chronic dry eye - your meiboscope will give you a fantastic view of related palpebral conjunctival folds. 

These may be from (1) mild chronic inflammation from the meibomian glands and also the tugging and stretching caused when one blinks. These mirror LIPCOF - which are bulbar conjunctival folds from blinking over a dry bulbar conjunctiva.

In short your meiboscope will help you diagnose dry eye and lipid deficient conditions, differentiating between random causes and immune-active causes. It will open a new world onto what it happening and for how long.