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EW CORNEA 116 October 2017 the now patent outflow channel and through the orifice. EyeWorld: What about hemor- rhages? Dr. Maskin: Dot hemorrhages fre- quently appear at the orifice. These hemorrhages are self-limited and do not need pressure or any treatment. EyeWorld: Is MGD something a tech could do? EyeWorld: Is trapped meibum released? Dr. Maskin: As the intraductal obstruction is relieved, you frequent- ly see sequestered meibum release along the wire probe to exit through Dr. Maskin: I can see the day when a trained physician assistant could do it. EyeWorld: Is there any way to inject medication into glands after probing? Dr. Maskin: Yes. With 110 and 152 µm tubes, we can deliver medica- tion directly inside the gland, such as dexamethasone or small particle suspensions. Injections directly into the gland enable targeted treatment of gland dysfunction as well as re- moval of stagnant secretions with an irrigation or lavage approach. Early studies suggest we have found an ad- junct microtube injection treatment to prolong onset of recurrent intra- ductal obstruction and reduce orifice hemorrhage upon retreatment probing. This would be meibomian gland orifice and duct reconstruc- tion. We are also exploring the use of probing with adjunctive injection therapies to further stimulate gland growth and restore a full, functional, healthy, and resilient meibomian gland lid population. EyeWorld: What should you be looking for on follow-up visits? Dr. Maskin: It is important to remember that MGD with progres- sive gland atrophy can and will occur at a subclinical level without symptoms. Patients with symptoms relieved after probing who have become asymptomatic need to be monitored on every visit to detect early reobstruction with progres- sion of disease even if the patient is symptom-free. This can include checking for lid tenderness and ex- pressible glands on every exam plus meibography every few months. Symptom relief from MGP should last about 1 year. If symptoms reap- pear earlier or if there is a decrease in the number of expressible glands or increase in lid tenderness, there is an unrecognized or inadequately treated local, regional, or systemic comorbid disease. Probing provides positive physical proof of paten- cy, but once achieved the patent outflow channel must be defended against all comorbid sources of inflammation that would reobstruct the outflow tract. EW References 1. Maskin SL. Intraductal meibomian gland probing relieves symptoms of obstructive meibomian gland dysfunction. Cornea. 2010;29:1145–52. 2. Maskin SL. Intraductal meibomian gland probing: A paradigm shift for the successful treatment of obstructive meibomian gland dysfunction. In: Kazuo Tsubota, ed. Diagnosis and Treatment of Meibomian Gland Dysfunc- tion. Tokyo, Japan: Kanehara;2016:149–167. 3. Dongju Q, et al. Clinical research on intraductal meibomian gland probing in the treatment of patients with meibomian gland dysfunction. Chin J Optom Ophthalmol. 2014;16:615–21. 4. Syed ZA, et al. Dynamic intraductal mei- bomian probing: A modified approach to the treatment of obstructive meibomian gland dysfunction. Ophthal Plast Reconstr Surg. 2017;33:307–309. 5. Maskin SL, et al. Growth of meibomian gland tissue after intraductal meibomian gland probing in patients with obstructive meibo- mian gland dysfunction. British J Ophthalmol. 2017 June 7. Epub ahead of print. Editors' note: Dr. Maskin owns patents on devices and methods of intraductal meibomian gland diagnosis, treat- ments, and topical therapies. He has financial interests with Rhein Medical (St. Petersburg, Florida). Contact information Maskin: drmaskin@tampabay.rr.com Live Demonstrations of the APX Pupil Expander and the Kitaro Kit STOPLOSS JONES TUBES MORCHER EYEJET Exclusive Partner of Morcher Put an end to the high loss rate of ordinary Jones Tubes Visit Us at AAO Booth 1945 FCI-Ophthalmics.com Meibomian continued from page 115 Complete distal obstruction (left), as indicated by the orange band around the meibomian gland illustration, and complete proximal obstruction (right) show two different types of gland atrophy that could result from an obstruction and subsequent meibum buildup and pressure. Source: British Journal of Ophthalmology/Steven Maskin, MD See Dr. Maskin release trapped meibum with meibomian gland probing.

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