Vol. 2, #09  •   Friday, May 14, 2021


Review's Chief Clinical Editor
Paul M. Karpecki, OD, FAAO

Provides you with cutting-edge clinical strategies for optimal management of ocular surface disease and beyond.


MGD to Evaporative Dry Eye Disease (EDED)

MGD has many causes; some can be identified and addressed while others cannot. But one way or another the obstructed glands still must be cleared.

Our trigeminal nerve is responsible for our blink, and our blink is essential to naturally expressing meibum. So anything that prevents a proper blink is likely to be a cause of MGD.

A good example is a patient who had cosmetic eyelid surgery in which the eyelids no longer appose. Such patients can quickly develop MGD. Other causes are lid laxity, trigeminal nerve issues such as a Bell’s Palsy, and even hormonal regulation. They could also include too much time on digital devices—when our blink rate decreases by as much as 5-fold!1 Other causes are poor sleep and incomplete closure.

One of the best tests for incomplete closure is the Korb-Blackie Light Test. In your darkened exam lane, instruct the patient to close their eyes as if sleeping, but not squeeze. Place the transilluminator on the closed upper eyelid and look for light escaping from the bottom between the eyelids.

A good test for lid laxity is to pull the lower eyelid down and see how quickly it snaps back. A slow recovery is indicative of lid laxity and may require surgery. It’s easier to repair the lower eyelid at this stage rather than when it’s a full ectropion.

If the patient is left to progress, MGD may lead to EDED. By then, the issue is likely an adaptive immune-mediated disease and will take significant treatments to control the inflammation (and address obstructed meibomian glands). Like most conditions, it’s best to treat earlier—and MGD is no exception.

KEY TAKEAWAY: Think about the blink when considering a potential diagnosis of MGD. A poor blink can be caused by long hours spent on digital devices, trigeminal issues, cosmetic surgery, lid laxity, partial blinking, or incomplete lid closure.

1. Patel S, Henderson R, Bradley L, et al. Effect of visual display unit use on blink rate and tear stability. Optom Vis Sci. 1991 Nov;68(11):888-92.

Supported by an independent medical grant from Kala Pharmaceuticals


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