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Name of publication:IOVS Investigative Ophthalmology & Visual Science
Date of publication: 2011
Title: The International Workshop on Meibomian Gland Dysfunction:
Link: http://www.iovs.org/content/52/4.toc
While looking up some information on MGD (having been recently casually diagnosed with "blocked glands") I stumbled on this report, which is similar to the DEWS report of 2007, only it's focus is MGD and was published in 2011.
I'm posting this because it provides a step-wise approach for testing, and suggests how the MGD can be monitored during the course of treatment. I am hoping to have a better informed conversation at my next appointment. This is an excerpt from the Executive Summary document on diagnosis:
"A two-tiered approach to the diagnosis of MGD-related dry eye is
recommended. In the first step, normal subjects are distinguished
from patients with dry eye of any type (generic dry eye). The
second step involves the differential diagnosis of MGD-related
evaporative dry eye and aqueous-deficient dry eye.
Two approaches are proposed: one suitable for practitioners
working in a general clinic and the other for investigators
working in specialized units. The evidence base of the tests
proposed varies according to the clinical setting.
"A suitable sequence of tests to perform in a general clinic
for the diagnosis of MGD-related disease in patients presenting
with symptoms of ocular surface disease is as follows:
1. Administration of a symptom questionnaire;
2. Measurement of the blink rate and calculation the blink
interval;
3. Measurement of lower tear meniscus height;
4. Measurement of tear osmolarity (if available);
5. Instillation of fluorescein and measurement of the tear
film breakup time (TFBUT) and Ocular Protection Index
(OPI);
6. Grading of corneal and conjunctival fluorescein staining;
7. Schirmer test or alternate (phenol red thread test).
"Positive (abnormal) results in tests 1, 4, 5, and 6 provide partial
evidence of the presence of a generic dry eye, without specifying
whether it is aqueous-deficient or evaporative. Evidence
of aqueous-deficient dry eye may be obtained by measuring
tear flow or an assessment of aqueous volume on the basis of
tear meniscus height or Schirmer test.
8. If MGD has not been characterized (symptomatic/asymptomatic)
at a previous visit, then it can be assessed at the
end of this sequence as follows:
a. Quantification of morphologic lid features
b. Expression: quantification of meibum expressibility
and quality
c. Meibography: quantification of dropout.
"If testing suggests the diagnosis of a generic dry eye and tests
of tear flow and volume are normal, then an evaporative dry eye
is implied and quantification of MGD will indicate the meibomian
gland contribution. This test sequence also permits a diagnosis of
symptomatic MGD to be made, with or without ocular surface
staining and with or without dry eye. The graded scores for each
test can be used to monitor the disease during treatment."
Date of publication: 2011
Title: The International Workshop on Meibomian Gland Dysfunction:
Link: http://www.iovs.org/content/52/4.toc
While looking up some information on MGD (having been recently casually diagnosed with "blocked glands") I stumbled on this report, which is similar to the DEWS report of 2007, only it's focus is MGD and was published in 2011.
I'm posting this because it provides a step-wise approach for testing, and suggests how the MGD can be monitored during the course of treatment. I am hoping to have a better informed conversation at my next appointment. This is an excerpt from the Executive Summary document on diagnosis:
"A two-tiered approach to the diagnosis of MGD-related dry eye is
recommended. In the first step, normal subjects are distinguished
from patients with dry eye of any type (generic dry eye). The
second step involves the differential diagnosis of MGD-related
evaporative dry eye and aqueous-deficient dry eye.
Two approaches are proposed: one suitable for practitioners
working in a general clinic and the other for investigators
working in specialized units. The evidence base of the tests
proposed varies according to the clinical setting.
"A suitable sequence of tests to perform in a general clinic
for the diagnosis of MGD-related disease in patients presenting
with symptoms of ocular surface disease is as follows:
1. Administration of a symptom questionnaire;
2. Measurement of the blink rate and calculation the blink
interval;
3. Measurement of lower tear meniscus height;
4. Measurement of tear osmolarity (if available);
5. Instillation of fluorescein and measurement of the tear
film breakup time (TFBUT) and Ocular Protection Index
(OPI);
6. Grading of corneal and conjunctival fluorescein staining;
7. Schirmer test or alternate (phenol red thread test).
"Positive (abnormal) results in tests 1, 4, 5, and 6 provide partial
evidence of the presence of a generic dry eye, without specifying
whether it is aqueous-deficient or evaporative. Evidence
of aqueous-deficient dry eye may be obtained by measuring
tear flow or an assessment of aqueous volume on the basis of
tear meniscus height or Schirmer test.
8. If MGD has not been characterized (symptomatic/asymptomatic)
at a previous visit, then it can be assessed at the
end of this sequence as follows:
a. Quantification of morphologic lid features
b. Expression: quantification of meibum expressibility
and quality
c. Meibography: quantification of dropout.
"If testing suggests the diagnosis of a generic dry eye and tests
of tear flow and volume are normal, then an evaporative dry eye
is implied and quantification of MGD will indicate the meibomian
gland contribution. This test sequence also permits a diagnosis of
symptomatic MGD to be made, with or without ocular surface
staining and with or without dry eye. The graded scores for each
test can be used to monitor the disease during treatment."