Debridement-scaling: a new procedure that increases Meibomian gland function and reduces dry eye symptoms.

PURPOSE: To evaluate whether a new in-office procedure, the mechanical debridement-scaling of the line of Marx (LOM) and keratinized lid margin, improves meibomian gland (MG) function and reduces dry eye symptoms.

METHODS

Twenty-eight patients symptomatic for and diagnosed with evaporative dry eye (16 test patients and 12 controls), who also evidenced anteroplacement and a thickened LOM, were enrolled and consented. SYMPTOMS were evaluated with the Standard Patient Evaluation of Eye Dryness questionnaire. The MG function was evaluated with the standardized MG function evaluator. The LOM was stained with lissamine green (Odyssey Medical, TN) for evaluation. For the test group only, the stained LOM and the entire width of the keratinized lower lid margin were debrided-scaled using a stainless steel, foreign body, golf club spud (Hilco Wilson Ophthalmics, Plainville, MA). All the patients were monitored for change in symptoms and MG function approximately 1 month later.

RESULTS

The mean ages of the patients were 55.9 ± 15.0 years (test) versus 53.7 ± 15.3 years (control). There was a significant improvement in the symptoms and MG function 1 month post-debridement-scaling in the test group. The controls evidenced no significant change in either parameter.

SYMPTOMS: baseline mean pre-debridement-scaling: 13.4 ± 4.6 (test) versus 13.9 ± 5.5 (control); 1 month post-debridement-scaling: 10.5 ± 3.8 (test, population level statistic < 0.0001) versus 14.3 ± 7.5 (control, population level statistic > 0.05). Number of functional MGs: baseline mean pre-debridement-scaling: 2.6 ± 1.3 (test) versus 2.7 ± 1.5 (control); 1 month post-debridement-scaling: 3.8 ± 1.4 (test, P = 0.0007) versus 2.4 ± 1.1 (control, P > 0.05). Only data for the right eye are reported.

CONCLUSIONS

The debridement-scaling of the LOM and lower lid margin provides statistically significant symptom relief and improvement in the MG function. The novel procedure should be considered in the management of MGD and evaporative dry eye.