Intraductal probing for meibomian gland dysfunction (MGD) is a new approach to help manage dry eye disease.
Meibomian Gland Dysfunction
Meibomian gland dysfunction is a common, chronic condition where the meibomian glands in the eyelids become blocked or dysfunctional, leading to reduced or poor-quality meibum (oil) production.
This oil is crucial for maintaining a healthy tear film, as it prevents the rapid evaporation of tears, ensuring the eyes remain moist and comfortable. When these glands don’t function properly, it can lead to or exacerbate dry eye symptoms.
Obstructive MGD is a specific subset of MGD that occurs when scar tissue has formed in the meibomian gland ducts’ openings. As a result, this obstructs the glands and prevents the meibum from leaving the glands, affecting the tear film.
Intraductal probing can pierce through these scar tissues, which then allows the meibum to leave the glands, promoting a healthier tear film.
Patients with obstructive MGD may find little to no relief from heat therapy. They may also experience increased tenderness around the lid area. Intraductal probing can often be beneficial for patients with obstructive MGD.
Symptoms of MGD can range from pain in and around the eyes, pressure, heavy or tired eyes, burning, tearing and irritation. As MGD progresses, these symptoms can worsen and becoming more debilitating.
Understanding Intraductal Probing
Intraductal probing for meibomian gland dysfunction (MGD) represents a relatively novel approach in the management of dry eye disease, particularly addressing the challenges caused by MGD.
Intraductal probing is an in-office procedure typically performed under local anesthesia to help minimize any discomfort. The procedure uses small fine sterile probes to physically open and dilate the ducts of the meibomian glands along the lid margins.
This process breaks up any obstructions inside the glands such as thickened meibum (oils) or scar tissue. When these obstructions are cleared, the meibum can restore its natural flow into the tear film and thus alleviating dry eye symptoms.
Upon finishing the probing procedure, patients may note an immediate improvement in symptoms such as increased pressure or tenderness around the lids. For others, it may take weeks to months to notice an improvement. However, as the glands continue to heal, patients often notice a reduction in irritation, dryness and an improvement in the quality of the tear film.
Safety and Considerations
Many research studies, including randomized control trials (often considered the gold standard of clinical trials), have demonstrated that intraductal probing is a safe procedure. Dr. Steven Maskin, the inventor of intraductal probing, has tried intraductal meibomian gland probing on thousands of patients and published numerous studies demonstrating the effectiveness and safety of the procedure.
However, like all procedures, there are potential adverse events. These include allergic reactions and bleeding along the lid margins. Thankfully, these events are managed well, and relatively easy to treat as they often self-resolve or can be treated with eye drops.
Rest assured, probing does not hurt or damage the glands in any way. If a probe were to hit the wall of the meibomian gland, the probe is designed to simply break and not leave any damage to the glands themselves.
In the instance that the probe does indeed break, the practitioner uses an ophthalmic tweezer to safely remove it from the gland. No fragments or debris is left behind causing any damage as a result.
Although intraductal probing can provide significant improvement in a patient’s dry eye symptoms and MGD, it is not a cure for MGD.
To optimize the meibomian gland function, other co-treatments and at-home regimens may be necessary to allow the tear film and glands to function optimally. Co-treatments may include warm compresses, lid hygiene regimens, omega-3 supplementation, artificial tears, or in office heat therapy such as radiofrequency (RF) or intense pulsed light (IPL) therapy.
Intraductal probing is a novel but promising and effective option for patients suffering from meibomian gland dysfunction. Specifically, those who may have obstructive MGD can greatly benefit from the unblocking of the meibomian glands.
Probing can address and target obstructions inside the glands that may be preventing the meibum from naturally flowing into the tear film. By addressing this issue, symptoms can be significantly alleviated for those suffering with MGD and dry eye symptoms.
