Vol. 2, #08  •   Thursday, May 6, 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 is Key to Managing Dry Eye Disease

According to research, 86% of dry eye disease involves meibomian gland dysfunction.1 If you aren’t willing to identify MGD, then managing DED will be futile. Here we discuss some strategies for gland expression.

MGD is found in over 96% of glaucoma patients on prostaglandin analogs,2 86% of dry eye disease,1 59% of contact lens wearers,3 and over 52% of cataract patients.4 In this era of digital devices, it will only increase. So how do you identify it?

Gland expression is essential and truly the only way to fully identify MGD in DED. It’s analogous to looking at the optic nerve in assessing glaucoma. No one would consider making a diagnosis of glaucoma without examining the optic nerve.

Fortunately, expressing meibomian glands only takes seconds, and no anesthetic is required. Numerous instruments and devices are available for expression. One of the more common ones is the Mastrota Paddle (OcuSoft). While at the slit lamp, it is placed behind the central to nasal lower eyelid. The clinician places a thumb on the outside eyelid and gently presses in an upward direction to push the oils out. Another option is the Meibomian Gland Evaluator (Johnson & Johnson Vision), which mimics the pressure of a blink. The clinician places the device externally below the lower eyelashes where the meibomian glands reside and applies pressure. Dual forceps and numerous other options with varying designs are available. The key is just to do it—purchase a device and start using it on every patient that mentions complaints that sound like potential MGD or DED.

Normal expression is clear and thin like olive oil. I grade that as a 3, and I typically assess five to 10 glands. If the expression is turbid (or gelatinous but clear), I grade that a 2. If it’s paste-like, that’s a 1, and if no expression occurs from the glands, it’s a zero.

Once you start this process you will see how easy it is. Having these findings offers an instant critical diagnostic sign that will help you to increase your chance of the successful management of evaporative dry eye disease.

KEY TAKEAWAY: Meibomian gland expression is essential for a DED diagnosis and proper management. It simply requires seeing what the meibum looks like as it expresses from the lower central to nasal eyelid area.

1. Lemp MA, Crews LA, Bron AJ, et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012 May;31(5):472-8.
2. Mocan MC, Uzunosmanoglu E, Kocabeyoglu S, et al. The association of chronic topical prostaglandin analog use with meibomian gland dysfunction. J Glaucoma. 2016 Sep;25(9):770-4.
3. Machalińska A, Zakrzewska A, Adamek B, et al. Comparison of morphological and functional meibomian gland characteristics between daily contact lens wearers and nonwearers. Cornea. 2015 Sep;34(9):1098-104.
4. Cochener B, Cassan A, Omiel L. Prevalence of meibomian gland dysfunction at the time of cataract surgery. J Cataract Refract Surg. 2018 Feb;44(2):144-8.

Supported by an independent medical grant from Kala Pharmaceuticals


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