Table 11.
Based on Meibomian Gland Expression |
Grades and comments |
Methods: A plus Ba or Bb |
A. Meibum quality: LL or UL, central 8 glands |
0 = clear fluid |
1 = cloudy fluid |
2 = cloudy particulate fluid |
3 = inspissated, like toothpaste. |
Ba. Meibum expressibility: LL or UL, central 8 glands |
0 = all glands expressible |
1 = 3–4 glands expressible |
2 = 1–2 glands expressible |
3 = no glands expressible |
Bb. Meibum expressibility: LL nasal or central eight glands |
The MGYLS score is the number of Meibomian Glands of eight, Yielding Liquid Secretion. |
Assessment by gland expression |
≤20 years: A score of greater than 1 for quality or expressibility (A; B) is abnormal. |
>20 years: A score of 1 for either quality or expressibility is acceptable as normal; a score of 1 for both, or of >1 for either, is abnormal. |
For research and some clinical trial purposes, the utility of this approach would be enhanced by generating a composite score derived from the expression of the LL, UL nasal and central zones. |
Based on Meibomian Gland Dropout |
Meibography: The technique of meibography offers an excellent opportunity to refine the quantification of gland loss by digitizing the images. It should be noted that estimates of 'gland loss' are based on an assumption of the original size of ea ch gland. Therefore estimates of residual gland area will be more accurate, although relevant to a particular individual. There is a need for detailed age/sex stratified information about gland area. |
A precise description of any technique proposed must be given. For example, if the term 'partial gland loss' is used, this must be defined. An estimate of loss is based on the presumed, intact length of each gland. Training would be enhanced by the use of videos showing both the performance of the technique of method of scoring in use. |
Either contact or noncontact meibography can be used. |
Method C: LL 15 glands: A partial gland is one that is incomplete and present in clumps or clusters. |
1 = no partial glands (PGs) |
2 = <25% PGs |
3 = 25%–75% PGs |
4 = >75% PGs |
An aggregate score from the combined LL/UL would expand the scale |
Method D: (nasal half, lower eyelid)* |
0 = no dropout |
1 = ≤25% |
2 = ≤50% |
3 = ≤75% |
4 = ≤100% |
Based on Meibography |
≤20 years. Method C. Normal is 0 |
>20 years. Method C. 1 = ≤25% is acceptable as normal; >1 is abnormal |
Diagnosis of MGD-related disease, including dry eye: |
In the general clinic. See Table 8 |
In a specialized clinic. See Table 8 |
MGD Criteria for Specific Purposes
|
de Paiva et al.106 have also devised a composite score including lids signs and expressibility, with a scale range of 0–11.