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Underutilized manual expression improves symptoms of MGD
Although patient discomfort is a factor, the procedure can provide relief.
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One-time manual expression using forceps shows significant improvement of symptoms at 2 weeks and 1 month in patients with meibomian gland dysfunction compared to control eyes, according to research conducted by Leslie O’Dell, OD, FAAO, and Milton M. Hom, OD, FAAO.
Forced expression dates back to the late 1800s as a method to treat meibomian gland dysfunction (MGD), O’Dell told Primary Care Optometry News in an interview. This study examined the impact of manual expression on symptoms and clinical findings.
A total of 24 patients an average age of 63.5 years had in-office manual expression performed on one eye in a private clinical setting. External heat was applied to both eyes using a commercially available eyelid warming mask for 10 minutes prior to expression, according to the study.
O’Dell explained the procedure: “External heat was applied using Tranquileyes (Eye Eco) for 10 minutes followed by one drop of TetraVisc (tetracaine 0.5%, Cynacon/OcuSoft) to the eye undergoing expression. Manual expression was performed at the slit lamp using the Maskin Meibum Expressor (Rhein Medical) on the bottom eyelid first, moving distal to proximal, with pressure applied to each meibomian gland for a few seconds. Expression was repeated for the superior eyelid by everting the lid and again using the expressor.”
Subjective endpoints were patient questionnaires using both Standard Patient Evaluation of Eye Dryness (SPEED) survey and the Ocular Surface Disease Index (OSDI). The objective endpoint assessed meibomian gland function using the Meibomian Gland Yielding Liquid Secretion Score, which did not improve across the study.
Symptoms improved with in-office manual expression despite no objective improvement, according to researchers.
The SPEED scores went from a baseline mean of 16.08 (SD 6.46) to a 1-month mean of 7.76 (SD 6.3) in treated eyes compared to a baseline mean of 12.24 (SD 6.54) to a 1-month mean of 10.16 (SD 8.08), O’Dell said. The OSDI scores went from a baseline mean of 37.93 (SD 24.58) to a 1-month mean of 21.23 (SD 19.1) in treated eyes vs. a baseline mean of 31.37 (SD 22.9) to a 1-month mean of 26.46 (SD 21.0) in control eyes.
“Understanding the role MGD plays in the dry eye diagnosis is a growing area with a big disconnect in understanding and treatment patterns between the average OD and the ‘experts,’” O’Dell explained. “At a minimum, every eye exam should include transillumination at the slit lamp to evaluate the meibomian gland structure and expression to evaluate function.”
Manual expression is not without its drawbacks, however. Patient discomfort is a real concern, she said.
“This is a very uncomfortable procedure for patients even when topical anesthesia is used,” O’Dell noted. “There is some concern of potential harm to the glands themselves from the force used with a metal-on-metal expression.
“With meibography now available in private practices as well as research centers,” she continued, “we will hopefully gain a wealth of knowledge about changes the glands have over time with our treatments, medication and even environmental risks in the form of reduced blink rates.”
Another drawback is the time constraints to a practice. O’Dell reported that the treatment is time consuming, as each eye needs to be heated to liquefy the meibum adequately for manual expression. – by Abigail Sutton
- Reference:
- O’Dell L, Hom MM. Does in-office manual expression for meibomian gland dysfunction work? Optom Vis Sci. 2015;92:e-abstract.
- For more information:
- Leslie O’Dell, OD, FAAO, can be reached at: lodell@dryeyecenterofpa.com.
Disclosure: O’Dell reports no relevant financial disclosures.