Dry Eyes – Intraductal Meibomian Gland Probing
Meibomian Gland Dysfunction (MGD) is one of the common underlying causes of Dry Eyes. The meibomian glands secrete the oil layer that overlies the aqueous layer of the tear film. When the oil layer is deficient, then evaporation occurs unchecked, resulting in stinging, dry and sore eyes.
For decades, patients with MGD have been instructed to apply a hot compress and massage their eyelids. Many patients have done this dutifully, without much improvement in their symptoms. Given the almost ubiquitous nature of dry eye suffering, much research and development has occurred in the past few years, yielding some very interesting developments.
Maskin Intraductal Meibomian Gland Probe
Dr Steven Maskin, MD, an American ophthalmologist, has developed and patented these probes that are now available in Australia. They work by unblocking the gland openings that have scarred closed from chronic inflammation. After this procedure, many patients find that the re-established oil layer is enough to significantly improve their dry eye symptoms.
My experience with the Maskin Probe
I have been using the Maskin probes since they were introduced into Australia early in 2013. In my opinion, this is a logical solution to overcome a common problem. The results back this up with many patients now beyond twelve months since the procedure. I have evolved my technique slightly from what Dr Maskin first described, to enhance patient comfort and to make it easier to perform.
I prefer using local anaesthetic injected into the eyelid, in preference to topical anaesthetic. The concentration of anaesthetic described in the article below, is not readily available in Australia, and what we do have available was insufficient for most patients. So now I inject local anaesthetic, just like when I perform eyelid surgery, and the procedure is virtually pain free.
I also prefer the patient to be lying down, rather than sitting up at a slit lamp, as I have had the occasional patient feel faint during the procedure. It also means I can use a surgical microscrope and then both hands to perform the procedure which makes it less fiddly and time consuming.
After the probing, I express the glands using the Hardten forceps, followed by a small injection of steroid into the eyelid. This procedure can be performed during the course of a normal consultation and patients can safely drive themselves home.