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    A stepwise approach to diagnosing MGD

    Such a protocol betters documentation, clinical tracking, and foundation for treatment

    Focusing on dry eye management is a great practice builder, but is not without challenges. These challenges lie in making the proper diagnosis, implementing new technology, properly training staff, developing an effective treatment plan and the time it takes to properly educate patients. 

    When facing any challenge, establishing and following a set protocol helps. The Tear Film and Ocular Surface Society (TFOS) Workshop on meibomian gland dysfunction (MGD) helped to organize the evaluation of a patient when MGD is suspected, listing the appropriate tests needed for proper diagnosis.1 (Table 1) Let’s go through each one and create a step-by-step approach to a vast and complicated disease, MGD. For all testing, be sure to develop a standard of care that is universal for every patient encounter to track improvement during subsequent exams.

    Related: Using warm compresses to treat MGD

    Understanding the definition of MGD is the foundation. Through the work of TFOS, MGD was formally defined as a “chronic, diffuse abnormality of the meibomian gland, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion. It may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease.”1

    Step 1: History

    Questionnaires can expedite your history intake. These can be validated surveys, such as the Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation of Eye Dryness (SPEED) questionnaires, as well as customized questionnaires. Here are a few important questions to ask for all patients—symptomatic or not. 

    • How do your eyes feel in the morning when you are waking? For some patients, morning complaints clue us into other potential problems with demodex blepharitis, nocturnal lagophthalmos, and recurrent corneal erosion high on the list of differentials.

    • How long can you read or use a computer before your vision blurs or you become aware of your eyes? 

    More from Dr. O'Dell: Using the SPEED questionnaire to identify dry eye

    Because a lot of patients coming in for an exam are already using an over-the-counter drop or have tried one, also ask if the drop she is currently using provides some relief to her symptoms. 

    For a contact lens patient, the questions can seem endless:

    • What brand of lens is he wearing?

    • What’s the replacement schedule for the lenses?

    • How compliant is he to replacement and cleaning?

    • What does he use for disinfecting his lenses?

    • How often does he sleep in lenses?

    • Is he aware of the lens during the day?

    • Is his vision stable even with blinking?

    Related: Why the tear film matters

    When reviewing medications and other systemic conditions that contribute to MGD, ask if the patient is also experiencing dry mouth symptoms. For many dry eye sufferers, taking the time to talk about their symptoms is like opening Pandora’s box. Once you have a chance to take back over control of the conversation, you can start your examination. 

    Next: Take a step back

    Leslie E O’Dell, OD, FAAO
    Leslie E. O’Dell, OD, FAAO, is the director of Dry Eye Center of PA and Wheatlyn Eye Care in Manchester, PA. Dr. O’Dell lectures ...

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