Meibomian Gland Probing
What Is Meibomian Gland Probing?
Meibomian gland probing is a method of clearing internal blockages causes by a build-up of scar tissue (fibrosis) within the glands which is preventing oils being secreted. A very fine wire, called a probe, is inserted into the glands to manually unblock them by breaking this scar tissue.
How Does Meibomian Gland Probing Work?
A full examination of the lid margins and glands is undertaken. This allows the consultant to see the exact status of the glands in terms of blockage and atrophy.
Next a special contact lens is placed in the eye over the cornea and a local anaesthetic is applied to the conjunctival sac and lower lid margin. The patient then closes their eyes for 10-15 minutes, after which they open their eyes and another drop of anaesthetic solution is applied to the conjunctival sac. There is some mild burning when the anaesthetic is first applied, but it wears off within 30 seconds.
A 1mm probe is then used to open the gland up. Once the gland is open, a 2mm or 4mm probe (depending on the length of the gland) is inserted.
Why Should I Have Meibomian Gland Probing?
If your glands are blocked internally with a build up of scar tissue (fibrosis) caused by chronic inflammation, the only thing that can help is probing. By opening up the glands again, their function can be restored. If they remain blocked for too long, they will wither and die – known as gland atrophy and gland drop-out.
Does Meibomian Gland Probing Have Any Risks Or Side-Effects?
If the right protocols are followed, meibomian gland probing is a safe procedure.
Who Will Carry Out My Treatment?
Your procedure will be carried out by Mr Mark Yodaiken, a consultant ophthalmologist with considerable expertise in gland probing.
Will I See A Result From Meibomian Gland Probing Immediately?
Meibomian gland probing often gives relief from discomfort within a few days if it is successful. However, it can take several weeks (or even a few months) for the glands to gradually return to normal function, producing good oils.
How Long Does the Improvement Last?
As meibomian gland dysfunction is a chronic condition, it is always possible that treatments will need to be repeated in the future. The duration of the improvement is highly variable, as it depends on the rate at which scar tissue builds up again. Some patients only need a single probing treatment. Others might need repeat probing, either for glands which couldn’t be unblocked the first time, or if glands become re-obstructed. This can be anywhere from a few months to a few years. Managing the background inflammation (with intense pulsed light therapy or anti-inflammatory drops) can be helpful in preventing a rapid re-scarring.
The probe is gently pushed through the gland, clearing any obstruction. Probing relieves fixed obstructions such as fibrosis. Resistance usually indicates fibrotic tissue blocking the gland and requires slightly more force to be used. Successful release of these fibroses causes a popping sound and the probe then passes freely through the gland.
Once the glands have been cleared, the eye is cleaned thoroughly with saline to remove any leftover anaesthetic. For the next few hours, you may need eye drops to help wash away any debris that comes out of the newly opened glands.
Can Anyone Have Meibomian Gland Probing?
Meibomian gland probing is appropriate for someone whose glands are known, or suspected, to have internal blockages. At our clinic, you will have a test probe of a couple of glands at your assessment to see if they are blocked. If this the case, and symptoms warrant it, full probing may be recommended.
As meibomian gland probing is an invasive procedure, if enough glands are still functioning, probing might not be the first choice and attention might be given to enhancing the function of the clear glands instead to compensate for the blocked glands.
What Are The Success Rates Of Meibomian Gland Probing?
It is difficult to assess absolute success.
Unblocking the glands will prevent atrophy and drop-out, which is a clear benefit and could be termed a successful outcome.
However, symptomatic improvement is more complex. Simply opening up the glands is not always enough to improve dry eye symptoms. Even when oils begin to be produced again, they are frequently very poor quality – sometimes of a paste-like consistency.
For this reason, probing is best combined with intense pulsed light therapy (which improves gland function) and/or regular meibomian gland expression to expel the poor oils and allow space for better oils to be produced.
With a combined treatment of probing and IPL, about 7/10 patients will see an improvement, with the exact degree ranging from mild to fantastic.
