What Is Meibomian Gland Probing (MGP) & Who Would Benefit?

What is Meibomian Gland Probing (MGP)? Who would benefit from MG Probing?

There are various modern office-based therapeutics for treating and managing dry eye disease and ocular surface disease. Meibomian Gland Probing (MGP) is an excellent option for patient struggling with their current condition and seeking breakthrough. MGP works by relieving scar tissue (fibrosis) surrounding the meibomian gland, which allows for proper flow of oil (meibum) and a healthier tear film.

During the session, the doctor will gently probe the opening of the oil gland to break-up the scar tissue and relieve the internal pressure of the oil duct. As the gland is being probed, patients may hear a ‘popping’ noise which indicates successful passage through the scar tissue. There are approximately 25-30 oil glands per eyelid, and each should be probed to optimize the post-treatment outcomes.

Although probing restores the integrity of the duct, we need to target other co-morbidities (or contributing factors) to alleviate patient discomfort and symptoms.

What are symptoms associated with dry eye disease (DED)?

Common symptoms of DED may include one or more of the following: burning, stinging, light sensitivity, redness, vascularization, foreign body sensation, contact lens discomfort, eye pain, lid tenderness, watery eyes, and more.

How is the patient is prepped for Probing? Is the procedure painful?

The doctor will instill one drop of proparacaine anesthetic eye drop followed by a bandage contact lens. The chair may be slightly reclined for comfort, then a compounded numbing ointment will be applied to both the lower and upper eyelids (enough to gently coat the eyelids). After 10-15 minutes, another round of the same numbing ointment may be applied (for added comfort). If the ointment happens to burn, it typically last no more than 60 seconds. Another drop of Proparacaine may be added, if necessary. With this technique, almost all our patients can complete the procedure with minimal to no discomfort.

How long does the procedure take?

Although the probing session itself only takes about 15-20 minutes, we typically set aside 45-60 minutes to answer any questions pre/post-treatment, perform the numbing technique pre-treatment, and take an additional images (ie meibography). Probing can also be performed a separate visit or in combination with other office-based procedures (ie OptiLight IPL, Lipiflow, BlephEx, TearCare, iLux, ZEST, and others)

What to expect post-treatment?

When the procedure is performed by a highly trained dry eye specialist, it is considered safe, effective and there is no downtime. Additionally, nearly all our patients drive themselves to/from their appointments. Patients with eyelid tenderness often feel immediate results and relief, while others may continue to notice improvement for months to come.

What are the side effects?

During the probing session, we can sometimes see a tiny drop of blood (usually one drop or a few drops) due to the highly abnormally vascularized eyelids. These unhealthy, telangiectatic, and leaky vessels run along the opening of the oil glands (gland orifices) or wrap the duct. As we release the invasive scar tissue, stem cell stimulation, proliferation, and activation occur.

How frequently should we perform probing or repeat probing?

It should be performed annually whether the patient has symptoms or just signs of the condition. Patients with ongoing inflammation, severe diagnosis, mechanical eyelid concerns, and significant co-morbidities may require more frequent treatments.

(Some examples of patients to consider for earlier re-probing are those with 1) MGD presenting for cataract or refractive surgery, 2) long-term use of eye cosmetics, 3) chronic topical glaucoma therapy, 4) systemic autoimmune disease, 5) delayed tear clearance, 6) history of exposure to particulate matter, and 7) chemical/thermal injury.)

How long has the procedure been around?

Probing was first performed in mid-2000 and the first paper was published by Dr Maskin in 2010. Since then, dozens of peer reviewed article have been published around the world to support the safety and effectiveness of MG Probing.

Is there a benefit of combining treatment such as OptiLight IPL & Probing (MGP)?

In a recent study (2019), three groups were compared: an IPL only group, an MGP only group, and an IPL+MGP group. The study revealed the combination of MGP+IPL produced the best results in relieving signs and symptoms as well as helping patients attain longer-lasting relief.

How important is it to have the procedure with an experienced doctor?

Gland probing is a highly technical procedure with that required precision to effectively treat and remove the peri-ductal fibrosis. At Beverly Hills Optometry, we proudly have many years of experience (since early 2021) with over tens of thousands of glands probed.

Testimonials:

Alexis L: After undergoing treatment with Dr. Silani and staff for about 2 years, I feel like it's an appropriate time to write about my experience. From the minute I stepped into the office, I felt a huge wave of relief, knowing that my issues with dry eye were both seen and heard. Visits with my previous ophthalmologist felt extremely transactional; a simple diagnosis was made and various prescription drops thrown at me. I showed little to no improvement. However, at Dr. Silani's office, various in-depth tests were done to understand the health of my cornea, glands, and the overall dryness level of my eyes. I learned over the years from Dr. Silani that treatment of dry eye is a multi-step approach which involves not only prescription drops, but treatment devices that help to attack dryness at different angles. After 2 years, I can confidently say that my eyes have improved so much due to the effective and consistent treatment that Dr. Silani has provided. l've tried a bunch of things, but what has seemed to help the most has been IPL, meibomian gland expression, gland probing, eyelid hygiene, and lifestyle changes. I owe it to Dr. Silani's expertise in getting my dry eye under control and ultimately changing my life. What I appreciate the most is his passion for his job and his patients. He is empathetic, kind, and humble. I also appreciate how he proactively keeps up with advances in treatments instead of staying in a comfort zone. He is truly a phenomenal person and I look forward to every visit!

Erin W: I’ve been seeing Dr Silani for years for his dry eye services. He has really changed my life. A few month ago, he recommended another treatment for my eyelids called gland probing. After the procedure, I felt an instant improvement and happy to report (months later) that my eyes are still doing great.

Geo K: Wanted to share my gland probing experience with Dr Silani. For me, it was easier than I expected. His numbing cream worked well. During the procedure, I just felt some slight tugging and pinching but no pain. I had no pain or soreness afterwards. i even ended up driving myself home from the appointment (3 hour drive) with no problem.

Zizi G: I performed IPL of the face/eyelids with gland probing on my left eye yesterday. Both treatments were like going to a relaxing spa, felt fantastic. My left eye is doing much better, less swollen eyelid and eye. I'm looking forward to doing probing on the other eye next month! Thank you so much Dr Silani!

Larry C: I’ve been struggling with Blepharitis and ocular rosacea for years. My symptoms were not easily controlled so my primary eye doctor referred me to see Dr Silani for his expertise in dry eye. After my consult, the doctor shared great insight into my condition and recommended a personalized treatment plan. After reviewing my options and doing some of my own research, I decided to schedule to see him back for OptiLight IPL and Gland Probing. Ive only had 3 IPLs and Probing on my left eye only but I already feel so much better. In fact, I’m scheduled to have Probing on my right eye next week and my fourth IPL next month. Thank you so much Dr Silani, you’ve given me back control of my eyes and my life. Forever grateful.

Allen M: Been struggling with dry eyes, red eyes, halo/glare, swollen eyelids, lots of tearing and I was referred to see Dr Silani for a consult. Within one visit (2 weeks ago) and his combined treatment protocol (deep lid cleaning, heat treatment, IPL and probing), i feel 70-80% better!! Thank you for your expertise and kindness Dr Silani.

Tammy J: I’m an out of state patient and I was referred by my local dry eye doctor to visit Dr Silani in Beverly HIlls for a procedure called meibomian gland probing. Previous to visiting his office, I had a series of IPL treatments and 2 TearCare sessions but my symptoms were still ongoing and my oil glands were not expressing ANYTHING! After having a consult with Dr Silani and same day probing, I started to feel some relief then a week later, my local doctor performed manual expression and incredibly there WAS oil expressing from my glands! Your team was incredible through the whole process. Thank you again so much for your kindness and expertise!!!

Grace W: Dr Silani is truly the best dry eye specialist! At our first visit, he spent more time with me than the last 3 doctors combined. Early on, he developed a custom treatment plan and the combination of OptiLight protocol and Gland Probing has made the biggest difference. Moving to New York but still planning to see him when I’m visit family in LA.

Karleen Video Testimonial (below):

Margaret Video Testimonial (below):

Allen Video Testimonial (below):

Cherie Video Testimonial (below):

Stanley Video Testimonial (below):

List of Research Studies Conducted Globally and Published in Peer-Reviewed Journals, Clinical Trials, Papers Published in Peer-Reviewed Literature:

1) Meibomian Gland Probing in Patients with Meibomian Gland Dysfunction: Nirupama, D., et al., Indian Journal of Clinical and Experimental Ophthalmology 5, no.1 (2019), 78-81.

2) Dynamic Intraductal Meibomian Gland Probing: A Modified Approach to the Treatment of Obstructive Meibomian Gland Dysfunction; Syed, Zeba A., and Francis C. Sutula, Ophthalmic Plastic and Reconstructive Surgery, July/August. 2017, 307-309.

3) Effectiveness of Intraductal Meibomian Gland Probing for Obstructive Meibomian Gland Dysfunction: Sarman, Zuleyha Sik, et al., Cornea, June 2016, 721-724.

4) Intraductal Meibomian Gland Probing in Management of Ocular Rosacea: Wladis, Edward J., Ophthalmic Plastic and Reconstructive Surgery, November-December 2012, 416-418.

5) Efficacy of Physiotherapy and Hygienic Procedures in Treatment of Adults and Children with Chronic Blepharitis and Dry Eye Syndrome: Prozornaia, L.P. and V.V. Brzhevski, Vestnik oftalmologil, May-June 2013, 68-70, 72-73.

6) Analysis of Meibum Before and After Intraductal Meibomian Gland Probing in Eyes with Obstructive Meibomian Gland Dysfunction: Nakayama, Naohiko, et al., Cornea, October 2015, 1206-1208.

7) Efficacy of Intraductal Probing in the Dysfunction of the Meibomian Glands: Cardenas, Diaz, Taimi et al., Revista Cubana de Oftalmologia, [S.1.], v. 30, n. 2, 2017.

8) Intraductal Meibomian Gland Probing for the Treatment of Blepharitis: Fermon, S., Hindi I. Zaga, and Alvarez D Melloni, Archivos de la Sociedad Espanola de Oftalmologi, February 2015, 76-80.

9) A Randomized, Sham-Controlled Trial of Intraductal Meibomian Gland Probing with or without Topical Antibiotic/Steroid for Obstructive Meibomian Gland Dysfunction: Kheirkhah, Ahmad, et al., The Ocular Surface, October 2020, 852-856

10) Effectiveness of Intraductal Meibomian Gland Probing in Addition to the Conventional Treatment in Patients with Obstructive Meibomian Gland Dysfunction: Incekalan, T.K., et al., Ocular Immunology and Inflammation, September 2019, 1345-1351.

11) Clinical Results of Intraductal Meibomian Gland Probing Combined with Intense Pulse Light in Treating Patients with Refractory Obstructive Meibomian Gland Dysfunction: A Randomized Controlled Trial: Huang, X, et al., BMC Ophthalmology, October 2019.

12) Efficacy of Intraductal Meibomian Gland Probing on Tear Function in Patients with Obstructive Melbomian Gland Dysfunction: Ma, Xiao, and Yan Lu, Cornea, June 2016, 725-730.

13) Clinical Research on Intraductal Meibomian Gland Probing in the Treatment of Patients with Meibomian Gland Dysfunction: Dongju, Qin, Liu Hui, and Xu Jianjiang, Chinese Journal Optometry, Ophthalmology, and Visual Science 16, no. 10 (2014), 615-621.