Meibomian Oil Glands (MG) are the glands located in the eyes that provide the protective oils, mucus, and fluids that keep the eyes moist and comfortable. However, many women who reach menopause, children, men and women across the nation find that they suffer from dry eye syndrome. This can be caused by blocked Meibomian glands ( Meibomian Gland Dysfunction – MGD). Many patients undergo heat treatments to unblock these glands, but there may be a better, less expensive solution.

Younger Patients and Testing for MGD

Many people believe that dry eye syndrome is exclusively a problem for older patients. However, pilot studies and clinical evidence have shown that younger patients are vulnerable to dry eye disease and meibomian gland dysfunction (MGD). If this problem is not corrected, in time, this dysfunction can lead to gland atrophy.

Testing for dry eye disease was not readily available in the past. However, diagnostic testing for this disease is becoming more accessible to eye doctors. In addition, there are many diverse options available that allow for a wider range of measurements. The problem lies in the utilization in the pediatric patient population.

Children may not do well with invasive testing, therefore, identifying any potential diseases in the eye becomes a frustrating process for patients and doctors alike. In order to assess the pediatric patient, specific dry eye diagnostic tests must be non-invasive and quick. There are several options available: Meibography, Phenol red thread, and non-invasive Keratograph break-up time.

Meibography

If a child is suspected of having dry eye disease, visualization of the meibomian glands is essential. Creating an image of the glands not only allows for current diagnosis but also provides a base for long-term observation of the glands in the future. Imaging of pediatric glands, as well as adults who suffer from critical to moderate advanced dry eye disease, is vital for diagnosis and treatment. The images obtained from Meibography units occur quickly and are virtually painless for patients of all ages. One such imaging device is called “LipiView”

Phenol Red Thread (PRT)

Comparable to traditional Schirmer’s testing to measure tear volume, PRT uses phenol red thread to obtain a measure of aqueous volume. The thread is placed at the lateral canthus (the outer edge of the eye) for 15 seconds. During this time, the amount of fluid is measured in millimeters. The red thread changes color to yellow to show saturation. A normal result is 20 millimeters or greater. This is a preferred test because patients find little discomfort.

Non-invasite Keratograph break-up time (NIKBUT)

Many children are reluctant to having drops or dyes placed in their eyes. Unlike drops, dyes require additional patient cooperation once place on the eye surface. In order to accurately obtain results, the timing between dye placement and doctor observation must be precise. Equipment such as the Oculus Keratograph 5M requires patients to sit still for 15-20 seconds. In younger patients, this may be difficult. The NIKBUT eliminates the use of dyes that many younger patients may find frightening or irritating. A Placido-disc topographer can also assist with the NIKBUT measurement by measuring the time between the eye-opening and the break-down of corneal fluids.

The next frontier is diagnostic testing is quickly becoming the pediatric dry eye assessment. Keenly in tune with making even more dry eye diagnoses in the adult population, clinicians are beginning to understand that diagnosing younger patients has many benefits. With early detection of dry eye syndrome (DES), many of the problems that arise over time can be prevented, such as obstruction of the Meibomian glands and inflammation.

Finally, tests that once were considered invasive and almost impossible to perform on children are being redesigned with these younger patients in mind. As the old adage says, “An ounce of prevention is worth a pound of cure.” This is especially true in detecting dry eye disease in younger patients.

What to ask your eye doctor before signing up for heat treatments?

Before you spend thousands of dollars getting the heat treatment, ask your eye doctor to squeeze your Meibomian oil glands and tell you what comes out? Descriptions should be clear, cloudy, toothpaste or nothing comes out. If the secretions are thick, toothpaste like or nothing comes out. Heat treatments may not work.

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