I challenge you this new year to turn on your transilluminator and examine the meibomian glands at the slit lamp for all of your patients. The technique is simple—all it takes is a slight flip of the bottom eyelid over the tip of the transilluminator at the slit lamp. In this view, you will see a pink/red glow through the eyelid, and the glands will appear as dark lines perpendicular to the lid margin. With time, you will be more comfortable juggling the focus while maintaining a good light source under the lid.
After the screening, have the conversation about dry eye with your patient. Educate patients about these delicate glands and the big role they play in tear film stability. Remember, education is the first step in treatment.
Meibography equipment options
I have been fortunate enough to have used meibography since the first piece of equipment became mainstream. I was given a tool that allowed me to document the appearance of the glands and monitor them over time, but I also was able to show patients what was hiding in their eyelids.
2018 brings many great devices to image meibomian glands. Here is a quick review of what is currently available:
LipiView II (Johnson & Johnson Vision)
• Large footprint
• Difficult for imaging superior glands
• Great image quality of meibomian glands
• Comparison images stored in the software—great for patient education
• Ability to asses not only gland structure but partial blink rate and lipid layer thickness
• Price: $$$
LipiScan (Johnson & Johnson Vision)
• Smaller footprint
• Portable—great for screening health fairs, etc.
• Easy to image both upper and lower glands
• Great image quality
• Comparison images available—great for patient education
• Price: $$
Related: The changing dry eye dynamic
Keratograph 5M (Oculus)
• Ability to perform other testing—dry eye module with TBUT, topography
• Images both upper and lower glands
• Great photos of eyelashes and lid margin in diffuse white light
• Dry eye report available
• Price: $$$
Meibox (Box Medical Solutions)
• Smallest footprint
• Connects to slit lamp
• Easy to image upper and lower glands
• Image quality can vary based on focus of the instrument
• Price: $
(Key: $=up to $10K, $$=$10K-$20K, $$$=$20K-$40K)
With the list expected to continue to grow, why wait to invest in meibography? This is a great way to set your practice apart from your competition. You do not have to have a dedicated dry eye center to invest in meibography, all you need are patients with meibomain glands.
1. Farid, M. Dry Eye Disease: Let’s Start Thinking Outside of the Artificial Tear Box. American Academy of Ophthalmology. Available at: http://www.aaojournal.org/article/S0161-6420(17)31061-8/pdf. Accessed 1/8/18.
2. Farrand KF, Fridman M, Stillman IO, Schaumberg DA. Prevalence of Diagnosed Dry Eye Disease in the United States Among Adults Aged 18 Years and Older. Am J Ophthalmol. 2017 Oct;182:90-98.