Lid scraping, also known as lid margin debridement or lid exfoliation, is a relatively recent addition to the treatment paradigm of MGD and dry eye. Its first reference in the peer-reviewed literature as a treatment option for these conditions was in 2013. Its premise is to remove any physical barriers that may interfere with meibum delivery not only to the lid margin, but also to the tear film.
The anterior lid margin, aside from the meibomian gland orifices and lashes, is histologically identical to the cornified epidermis of the skin. It, therefore, naturally accumulates keratin, devitalized cells, and extracellular debris, all of which are capable of obstructing the migration of meibum to the tear film. With age, the Line of Marx (LOM), a linear pattern of staining in the region of the mucocutaneous junction, thickens, heightens, undulates, and often displaces anterior to the meibomian gland orifices. These changes are purported to be secondary to an osmotic gradient within the tear meniscus that alters the cellular morphology over decades. Similar to above, the elevated ridge of cells in this area obstructs meibum migration.
Full lid margin debridement entails scraping of both the keratinized lid margin (from the mucocutaneous junction to the base of the lashes) and the thickened LOM to facilitate meibum delivery to the tear film. Shown in our instructional video is the former, as the latter is most effective with lissamine green to allow visibility of the LOM. The technique, however, is identical. Korb and Blackie performed this procedure on 16 symptomatic MGD patients and found that symptoms and meibomian gland expressibility were significantly improved one month post treatment compared to 12 untreated controls.
What’s the best part about this procedure? Visit your eyecare professional, they have all the tools needed, a spatula, spud, or even a product like a Q-tips Precision Tips Cotton Swab wet with saline. .
Blepharitis and Meibomian Gland Dysfunction accounts for a high percentage of dry eye patients who are no longer responsive to eye drops, steroid drops, antibiotics. The tremendous amount of inflammation from dry eyes has shut down the normal tear functions.
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