Impacted Foreign Body in Meibomian Gland
The meibomian glands are specialized sebaceous glands that secret lipids (1). What is in this special gland? Oils, salts, water, proteins, DNA/RNA and its own microbiome all show up (2-3) – but not an eyelash!
In the above video snippet, Dr. Fishman shows a cool case of an eyelash (also known as cilium) that somehow migrated into the meibomian gland and was then removed with expression forceps by Dr.F. It was amazing to learn from Mansour and Jawhari (4) that “lash impaction in the meibomian gland” was found in 18 patients out of 70,000 visits. This incidence was surprising (would have guessed rarer) given what forces and alignment would need to be present to have to the eyelash enter the gland. The meibomian gland orifice is only ~30-40 microns in diameter and the surface is often hyper keratinized (5-6).
Dr. Fishman spends a considerable amount of time expressing meibomian glands and often finds interesting and revealing pathology such as the above impacted eyelash. The meibomian glands have received a lot of attention these days! It is the focus of many dry eye treatments from gland expression (iLUX, Lipiflow, MiboFlow) to a dizzying array of new drugs and treatments in the pipeline. Stay tuned for new developments coming out of FishmanVision!
- Obata, Hiroto M.D., Ph.D. Anatomy and Histopathology of Human Meibomian Gland, Cornea: October 2002 – Volume 21 – Issue – p S70-S74 https://doi:10.1097/01.ico.0000263122.45898.09).
- Tsai PS, Evans JE, Green KM, et al. Proteomic analysis of human meibomian gland secretions. Br J Ophthalmol. 2006;90(3):372-377. https://doi:10.1136/bjo.2005.080846
- Jiang X, Deng A, Yang J, et al. Pathogens in the Meibomian gland and conjunctival sac: microbiome of normal subjects and patients with Meibomian gland dysfunction. Infect Drug Resist. 2018;11:1729-1740. Published 2018 Oct 11. https://doi:10.2147/IDR.S162135.
- Mansour AM, El Jawhari KM. Lash Impaction in Meibomian Gland Orifice. Clin Ophthalmol. 2020;14:1245-1247. https://doi.org/10.2147/OPTH.S253263
- Edoardo Villani, Gaia Ceresara, Silvia Beretta, Fabrizio Magnani, Francesco Viola, Roberto Ratiglia; In Vivo Confocal Microscopy of Meibomian Glands in Contact Lens Wearers. Invest. Ophthalmol. Vis. Sci. 2011;52(8):5215-5219. https://doi.org/10.1167/iovs.11-7427.