Meibomian Gland Recanalization
Among Dr. Gulani’s proprietary m.o.i.s.t.TM therapy techniques Meibomian Gland recanalization addresses the lipid (oil) layer of your tear film. Meibomian (“my-boh-mee-an”) glands are 20 – 40 toothpaste tube (slightly crooked though) shaped glands, lined along eye lashes in our eye lids which secrete the oil layer of our tear film to prevent evaporation of our tears too quickly by creating surface tension (making a film of water stay vertical despite gravity).
Blockage, disease or inflammation of these glands results in Meibomian Gland Dysfunction (MGD). You can imagine then that a faulty oil layer can allow our tears to evaporate quickly and cause dry eyes (Evaporative kind of dry eye) and in many cases is associated with lid inflammation (Blepharitis).
Most common causes of MGD include, repeated or incorrectly managed lid inflammations including allergies, gender as in more prevalent in females, advancing age, ethnic background as in Asians have a higher propensity. Wearing eye makeup is another contributing cause of MGD. Eyeliner and other makeup can clog the openings of meibomian glands especially if you don’t thoroughly clean your eyelids and remove all traces of eye makeup before sleep. Wearing contact lenses for especially long durations also is a risk factor. Medical situations can also increase the chances of this infliction and history of arthritis, Sjogrens, Thyroid dysfunction, diabetes etc are important and need control for overall success.
With 3 decades of experience in working with dry eye patients from around the world, Dr. Gulani’s clinical acumen along with cutting edge diagnostic technologies including one of the first Oculus Keratographs in the country can detect all levels of dry eyes from quantitative to qualitative whereby he then designs an individual plan of attack for that dry eye patient. With over 3 decades of experience Dr. Gulani uses his personally designed instruments to treat Meibomian Gland Dysfunction with:
- Single probe
- Multiple probes
- Combination with other treatments
Dr. Gulani has been using Meibomian Gland Recanalization (MGR), as a modified meibomian gland probing (MGP) wherein differential probing performed to the endpoint of recanalization as evidenced by release of trapped meibum and insertion of the marked probe. This technique has successfully treated MGD based dry eyes to the point of even converting them into candidates for laser vision and premium cataract surgery.
Besides an array of technologies like LipiView, LipiFlow, iLux, Tearcare, Blephex and IPL to treat dry eyes, Dr. Gulani’s personal experience in using customized, differential Meibomian Gland recanalization technique done in-office in less than 5 minutes with a blunt probe and proprietary numbing gel made in a pharmacy in California has resulted in near 100% success.
This followed by an individually time-planned warm compression of the eyelids and medication protocol of eye drops results in melting and expressing the thickened oil and also changing it chemically to the more user friendly version. No patient has had to undergo repeat MGR treatment because of the role of conscious hygiene and warm compresses that maintains the viability of the meibomian glands long term.
Methods: Meibomian gland recanalization as a part of m.o.i.s.t.™ therapy for dry eye patients involves application of reusable and disposable differential probes to cannulate the meibomian gland ducts thereby removing the obstruction and facilitating the release of meibum. The procedure is done under topical anesthesia involving Proparacaine drops along with application of a topical gel comprising of 8% Lidocaine and Jojoba directly applied to eyelid skin. A dedicated attempt is made to open each and every gland, followed by mechanical compression using specially designed atraumatic forceps to release the initial stagnant and mostly cheesy meibum. This procedure was then followed by a medication protocol of steroid eye drops and azithromycin BID for two weeks along with warm compresses.
Results: 1173 lids of 453 patients underwent MGR at our institute (single surgeon ACG) from 2010 to 2020. Gender distribution for this sample was 31.57% males and 68.43% women. Average age was 56.64 (±4.95) years. Less than 1% of patients complained of a pinching sensation during the procedure while less than 0.5% described pain immediately following the procedure. No patient complained of pain or discomfort from day one. With a follow-up of up to 10 years, over 98% of patients expressed subjective improvement in symptoms which was reflected objectively in the accuracy and consistency of corneal measurements. Thereby resulting in successful and predictable visual outcomes following premium Laser vision and Cataract surgeries.