Table 8.
Specialized and Nonspecialized Tests for MGD and MGD-Related Disease
| Testing Category | Specific Test(s) | Tests for a General Clinic | Tests for a Specialized Unit |
|---|---|---|---|
| Symptoms | Questionnaires | McMonnies; Schein; OSDI; DEQ; OCI; SPEED etc. | McMonnies; Schein; OSDI; DEQ; OCI; SPEED etc. |
| Signs | |||
| Meibomian function | Lid morphology | Slit-lamp microscopy | Slit lamp microscopy Confocal microscopy |
| Meibomian gland mass | — | Meibography | |
| Gland expressibility | Slit-lamp microscopy | Slit lamp microscopy | |
| Expressed oil: quality | |||
| Expressed oil: volume | |||
| Lid margin reservoir | — | Meibometry | |
| Tear Film Lipid Layer | |||
| Thickness | Interferometry | Interferometry | |
| Spread time | Slit-lamp | Slit-lamp | |
| Spread rate | — | Video interferometry | |
| Evaporation | Evaporimetry | — | Evaporimetry |
| Tears | |||
| Osmolarity | Osmolarity | TearLab device, other | TearLab device, other |
| Stability | Tear film | TFBUT; OPI | TFBUT; OPI |
| TFLL | Spread time | Interferometry; spread rate; pattern | |
| Indices of volume and secretion | Tear secretion Tear volume Tear volume Tear clearance |
Schirmer 1 Not available Meniscus height TFI |
Fluorophotometry/FCR Volume by fluorophotometry Meniscus radius of curvature; meniscometry TFI |
| Ocular surface inflammation | Ocular surface staining biomarkers | Oxford scheme; NEI/Industry scheme | Flow cytometry; bead arrays; microarrays; mass spectrometry: cytokines and other mediators; interleukins; MMPs |
Tests of meibomian gland function are presented first followed by those for related disorders such as dry eye. See text for a recommended sequence of performance. DEQ, Dry Eye Questionnaire; FCR, fluorescein clearance rate; MMPs, matrix metalloproteinases; OCI, Ocular Comfort Index; OPI, Ocular Protection Index; OSDI, Ocular Surface Disease Index; SPEED, Standard Patient Evaluation of Eye Dryness; TFBUT, tear film breakup time; TFI, tear film index; TFLL, tear film lipid layer.