Meiboscopy Lid Margin Notches
Channel: Meiboscopy
Date: 2012-02-13

Explains how Notches, Dimples and Full thickness Notches occur due to different stimuli. This can reveal what is happening. 

Notching seems to hapen from two causes:
1) Internal inflamatory events (such as one gets in auto immune diseases). The example used: Chronic Smokers cause lid margin notches on the nazal lid margin, three times faster than never smokers.

External inflamations and irritants seem to cause lid margin notches randomly.

This maybe explained quite simply by the nazal eyelid margin being squeezed on a blink and temporal margin stretched on a blink. So having a mechanical origin.

A full thickness notch is often just a crease on the lid margin - with a dropout under it. 
A posterior notch - is often caused by meibomian orrifice constrictions and inflamations and is usually accompanied by telangeictasia.
A dimple is often a sign of the meibomian gland being shortened with acini changes at the far end. 
Thus dimples can progress to posterior notches and full thickness notches. If the cause of the inflamation is removed = then the notching stablises (but never heals). The example is ex-smokers - keep the notches equal to the pack years upto the point to quittal.
If many glands drop-out then the margin generally sinks.
Stefano Manelli BSc hons