Lid margin dysfunction is an important factor in the development of dry eye disease.1
The ocular surface encompasses not only the cornea, but the all-important supporting conjunctiva that is divided into the bulbar, limbal, palpebral, forneaceal, and marginal zones. The maintenance of the exquisite architecture of “the margin” is essential to proper tear and surface homeostasis.
Gentle but efficient lid hygiene promotes lid margin wellness.2
The complex lid margin
A brief review of lid margin anatomy and physiology is in order to better appreciate its elaborate complexity.
Let’s assume for this exercise that we have a healthy individual with an intact lid/blink system that effectively spreads the tear film across the ocular surface and efficiently pumps “spent” tears into the nasolacrimal system.
To do this, the lids must have normal tone with neither laxity nor notching and must coordinate with the blink to funnel tears toward the puncta for clearance. The puncta must be patent and large enough to accommodate the tear volume. Conjunctiva must neither billow or be redundant blocking the puncta nor interrupt the tear prism.
Of course, critical to this system are tears of normal composition and volume. When balanced, the tears support the ocular surface with nutrients, growth factors, antimicrobials, and a host of other molecules necessary for continued ocular surface health and function. When altered by disease , the tears can carry a battery of inflammatory agents that can ultimately impact the integrity of every unit of the ocular surface system from the eyelashes to the puncta.