Eyeworld

115 EW CORNEA October 2017 and immediately relieved. Persistent lid tenderness suggests deeper ob- struction requiring probing with a 2-mm or 4-mm probe. pressure as the obstruction is re- lieved, intraductal pressures equili- brate, and meibum flow is restored with relief of tenderness. Lid tenderness is dramatically pops causing an audible and tactile "gritty" sensation. The also patient hears and feels the pops and gritty sensation and can appreciate the instant relief of elevated intraductal EyeWorld: What techniques do you use to identify the gland ori- fice and insert the probe? Dr. Maskin: It is usually not difficult to identify orifices. Some physicians use red-free light to assist. Transillu- mination or meibography can reveal location of glands as well. Rest the tip of the 1-mm probe on the orifice. Using a dart-throwing motion, try to insert the probe into and through the orifice. This is done by holding the probe handle as you would hold a dart and using a short jab motion of 1–2 mm to pene- trate through the orifice into the duct. The probe will enter the duct naturally and the duct itself will guide the probe, similar to your arm entering the sleeve of a shirt. If you meet resistance, try a dif- ferent entry angle for the dart-throw motion. The orifices and distal ducts may be dragged posteriorly or fibro- sed in a way that requires an altered entry angle. EyeWorld: Could the probe create a false passage? Dr. Maskin: Probing does not create a false passage. When you penetrate the orifice and enter the gland, the effect is tantamount to passing your arm into your shirtsleeve. The probe simply follows the duct in the same fashion. EyeWorld: What is the importance of probes being "non-sharp"? Dr. Maskin: Probing is both a first- line treatment as well as a diagnostic test looking at the frequency and type of gland resistance, which may correlate with severity of symptoms. It is important when probing to do so effectively with minimal unnec- essary disturbance of gland tissue. It should be noted that a post-prob- ing confocal microscopy study has shown no degenerative changes in morphology of meibomian gland acinar units or meibomian gland scars. 3 EyeWorld: What are the procedur- al findings of probing? Dr. Maskin: When the probe is inserted through the orifice and into the central duct, you quickly encounter orifice and/or ductal resistance. This resistance may be re- lieved by advancing with the probe, generating an audible and tactile sensation of a "pop" or multiple continued on page 116 Watch a patient's testimonial of this procedure.

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