Intraductal Meibomian Gland Probing

Intraductal meibomian gland probing, invented by Dr. Steven L. Maskin, an ophthalmologist who specializes in the treatment of Dry Eye Syndrome, is a procedure designed to clear obstructions in the meibomian glands, including the periductal fibrosis found in 75% of diseased glands. It is an effective treatment for meibomian gland dysfunction (MGD). The procedure is considered non-invasive, and is performed in the office with only topical anesthetic. At least one study has shown that atrophied glands can regenerate after probing.

Tens of thousands of glands have been probed by Dr. Maskin, and others, since the procedure became available. When the procedure is performed with Maskin probes, following recommended protocols, it is very safe and highly effective.

Many patients only need to be probed once, whereas others require repeat probing. Repeat probing is usually not required for a minimum of 7 months, and usually quite a bit more.

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Meibomian Gland Probing Procedure

Probing typically involves 8 steps:

1) Examination
The lid margins and glands are examined with and without trans-illumination to evaluate patency (opening) of orifice and status of the glands, specifically looking at gland proximal (near the opening) and distal (deeper in the gland) atrophy, length of glands, and signs of ductal dilation suggestive of proximal obstruction. Glands are palpated individually to check for gland tenderness, usually seen with inflammation and obstruction, with presumed elevated intraductal pressure.

2) Anesthetic
To anesthetize, first a bandage contact lens is placed over the cornea, then a drop of proparacaine 0.5% or tetracaine 0.5% solution is placed in the conjunctival sac. A generous amount of jojoba ophthalmic anesthetic ointment is applied on the lower lid margin using a sterile cotton tipped applicator. The patient closes their lids for 10-15 minutes. There will be some mild burning, which gradually dissipates over 30 seconds. After 15 minutes, the patient opens eyes, and another drop of the topical anesthetic solution is placed into the conjunctival sac. The bandage contact lens is removed and residual anesthetic ointment is rinsed off the ocular surface.

3) Initial probing to completely open the glands
Probing begins with the shortest and stiffest probe, the 1 mm length probe. After penetrating the orifice with the 1 or 2 mm probe, the 4 or 6 mm probe is then used, depending on the length of the gland, to achieve complete patency of the ductal highway.

4) Piercing through fibrotic tissue
At times resistance may be encountered. The length of the gland is respected to prevent extending the probe too far. If resistance is felt, the probe is believed to be against a fibrotic band. After checking to ensure the probe is co-linear to the gland, additional mild force is used to pop through the intraductal fibrotic tissue.

5) Dilating glands
After completion of regular probing, a dilator probe is seated on the orifice and advanced into the distal duct, about 1mm.

6) Injecting steroid
With steroid in tuberculin syringe with attached microtube, the plunger is advanced to eliminate air, then placed through the dilated orifice into distal duct. Approximately 10ul is injected into each gland.

7) Rinsing after the procedure
Each eye is rinsed copiously with saline to remove residual anesthetic, and cotton tipped applicators are used to remove anesthetic from lashes.

8) Clearing secreted debris with eye drops
Patients use artificial tears every 30 to 60 minutes, if needed, until bedtime to wash away debris that is secreted from the now opened glands.

All glands of all lids may be probed initially and during follow-up procedures. Occasionally only some glands may be probed. After initial probing if several glands remain blocked, indicated by symptoms of persistent pain or foreign body sensation in the area of the blocked glands, only these glands may need to be re-probed.

If anesthetic cannot be tolerated, probing can be performed safely without anesthetic, although there will be copious tearing.

Sometimes, after probing, gland expression is recommended.

Reference

Adapted from Intraductal Meibomian Gland Probing to Restore Gland Functionality for Obstructive Meibomian Gland Dysfunction (MGD)
Maskin SL, Kantor K.
Retrieved October 27, 2015 from www.drmaskin.com

Research

Studies conducted around the world indicate that intraductal meibomian gland probing safely provides rapid and lasting relief, and significantly improves symptoms of MGD.

Growth of meibomian gland tissue after intraductal meibomian gland probing in patients with obstructive meibomian gland dysfunction
Maskin SL, Testa WR.
British Journal of Ophthalmology
June 28, 2017
View the full reportEffectiveness of intraductal meibomian gland probing for obstructive meibomian gland dysfunction
Sik Sarman Z, Cucen B, Yuksel N, Cengiz A, Caglar Y
Cornea
2016 Mar 30. [Epub ahead of print]
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Efficacy of intraductal meibomian gland probing on tear function in patients With obstructive meibomian gland dysfunction
Ma X, Lu Y.
Cornea
2016 Mar 9. [Epub ahead of print]
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Analysis of meibum before and after intraductal meibomian gland probing in eyes with obstructive meibomian gland dysfunction
Nakayama N, Kawashima M, Kaido M, Arita R, Tsubota K.
Cornea
2015 Oct;34(10):1206-8. doi: 10.1097/ICO.0000000000000558.
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Intraductal meibomian gland probing for the treatment of blepharitis
Fermon S, Zaga IH, Alvarez Melloni D.
Archivos de la Sociedad Española de Oftalmología
2015 Feb;90(2):76-80. doi: 10.1016/j.oftal.2014.04.014. Epub 2014 Jul 5.
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Clinical research on intraductal meibomian gland probing in the treatment of patients with meibomian gland dysfunction
Qin Dongju,Liu Hui,Xu Jianjiang
Chinese Journal of Optometry, Ophthalmology, and Visual Science
2014, Vol. 16. Issue (10): 615-621 DOI: 10.3760/cma.j.issn.1674-845X.2014.10.009
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Efficacy of physiotherapy and hygienic procedures in treatment of adults and children with chronic blepharitis and dry eye syndrome
Prozornaia LP, Brzhevskiĭ VV.
Vestnik oftalmologii
2013 May-Jun;129(3):68-70, 72-3
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Intraductal meibomian gland probing in the management of ocular rosacea
Wladis EJ.
Ophthalmic Plastic and Reconstructive Surgery
2012 Nov-Dec;28(6):416-8. doi: 10.1097/IOP.0b013e3182627ebc
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Intraductal meibomian gland probing relieves symptoms of obstructive meibomian gland dysfunction
Maskin SL.
Cornea
2010 Oct;29(10):1145-52. doi: 10.1097/ICO.0b013e3181d836f3
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Clinical Trial

The Massachusetts Eye and Ear Infirmary conducted a double blind study on the effects of meibomian gland probing (MGP) in patients with refractory MGD, who have already tried traditional management with no success in resolving their clinical signs or symptoms.

The investigators also evaluated the effects of using two post-procedural medication treatments: Blephamide or GenTeal PM Night-Time to determine if treatment after the MGP procedure has an effect on its outcome.

Learn more about the clinical trial