Maskin Probing for Blocked Meibomian Glands
In 2010, Dr. Steve Maskin pioneered the idea of inserting a wire probe into meibomian glands to relieve obstructions that could be causing discomfort and dry eye. Meibomian gland probing is the introduction of a wire instrument to the gland orifice with insertion through the orifice and into the ductal outflow tract.
Probing establishes and confirms with positive physical proof a patent outflow channel including duct and orifice. Probing, by relief of intraductal obstruction, is therefore able to equilibrate intraductal pressures within the duct and promote removal of sequestered and other retained intraductal contents. In summary, initial and maintenance probing: (1) relieves obstruction, (2) maintains patency of outflow channel, and (3) is associated with growth of meibomian gland.
Probing may restore functionality to non-meibum expressing glands, as well as to relieve symptoms of lipid tear deficiency. There is some suggestion that probing can stimulate growth of gland tissue from glands with dropout or atrophy on meibography.
A Jojoba-based anesthetic ointment (JAO) containing 8% lidocaine is applied to the lid margins. The orifices are identified visually and assisted using red-free light or a muscle light for transillumination. Meibography is used prior to the procedure to reveal the location of glands. Then, the stainless steel probe (76 µm in diameter with lengths of 1, 2, 4, and 6 mm) is inserted through the orifice and into the central duct and often generates an audible and tactile sensation of a “pop” or multiple pops causing an audible and tactile “gritty” sensation. The patient hears and feels the pops and gritty sensation and can appreciate the instant relief of elevated intraductal pressure as the obstruction is relieved, intraductal pressures equilibrate, and meibum flow is restored with relief of tenderness.