meibomian gland fibrosis dry eye disease - to probe or not - confocal microscopy gives the answer скачать в хорошем качестве

meibomian gland fibrosis dry eye disease - to probe or not - confocal microscopy gives the answer

For years dry eye specialists have talked about meibomian gland fibrosis in dry eye disease patients. The thought is with long standing dysfunction you can develop scar tissue that prevents the gland from releasing meibum. We have not had a definitive answer until now. Cornea Confocal Microscopy, CCM, has been traditionally used to look at the nerves, inflammation, and health of the cornea. The confocal can now be used to look at directly at the meibomian gland microscopically to determine if there is any scar tissue. We used to look at the meibomian glands of normal and dry eye disease patients and found scarring of the meibomian glands (fibrosis) is very rare. It is more common in patients that have had a prior intrductal probing procedure. This could be due to the fact that the probing could transect the gland causing eventual scarring. Now some patients have what I call SOS syndrome - small opening syndrome. We have a bell shape curve of gland sizes and some patients have genetically smaller openings. If they have thicker meibum you can see where these glands could get plugged easily. Probing has been tested by several scientific centers including the Harvard Medical School study that showed no improvement in the signs of MGD/DED - Kheirkhah et al. Recently doctors have been advocating the use of Intense Pulse Light (IPL) and probing, stating that it can help patients who are unresponsive to IPL. Our success rate with IPL is well over 97%. I find that the difficulties that doctors are having with IPL is a lack of training and experience with the procedure. We now have several different IPL systems and they are not all the same. Each one needs a studied and established protocol. I painstakingly devoted several years to develop protocols and I find some doctors are not following these well established protocols. Then they add ill-advised procedures to try to bring up their success rate. Several doctors have demonstrated that IPL alone done the right way can restore gland function and improve the signs and symptoms of dry eye disease. Confocal microscopy is leading the way in helping diagnose and treat dry eye disease. I caution patients to think very carefully before undergoing a probing procedure.