Epitropoulos outlines four MGD misses
- Alice Epitropoulos said clinicians miss meibomian gland dysfunction when disease looks subtle, patients lack symptoms, doctors skip gland expression, or allergies mask it. - She said three quick checks—gland expression, corneal staining, and tear break-up time—can uncover dysfunction that disrupts tear-film lipids and blurs vision. - The warning targets cataract and dry-eye care, where early obstruction can progress before symptoms appear. (ophthalmologytimes.com)
Meibomian gland dysfunction happens when eyelid oil glands stop releasing the clear oil that slows tear evaporation and keeps vision stable. (aao.org) (ophthalmologytimes.com) Alice Epitropoulos, an ophthalmologist writing in Ophthalmology Times, said clinicians commonly miss the condition for four reasons: it can look nonobvious, patients may have no symptoms, doctors may not express the glands, and allergies can confuse the picture. (ophthalmologytimes.com) Her June 3, 2023 post describes nonobvious meibomian gland dysfunction as a hyposecretory obstructive form that may show little inflammation at the slit lamp even while the tear-film lipid layer is failing. (ophthalmologytimes.com) Symptoms are an unreliable screen in early disease. Epitropoulos wrote that glands can already be obstructed before patients report dryness, irritation, or fluctuating vision. (ophthalmologytimes.com 1) (ophthalmologytimes.com 2) That matters in preoperative eye care because the glands supply the tear film’s outer oil layer, and unstable tears can make corneal measurements and visual quality less dependable. (aao.org) (crstoday.com) The anatomy is simple but easy to overlook in a busy clinic. A normal eye has about 45 to 70 meibomian glands across both lids, and less than half are actively yielding liquid secretions at a given time, Epitropoulos wrote. (ophthalmologytimes.com) Her practical fix is direct testing, not guesswork. She said clinicians should express the glands, stain the cornea, and measure tear break-up time to see whether oil quality and gland output are supporting the tear film. (ophthalmologytimes.com) She also pointed to formal dry-eye workflows that put gland expression in the core exam, including the CEDARS algorithm and the American Society of Cataract and Refractive Surgery Cornea Committee’s “look, lift, pull, push” sequence. (ophthalmologytimes.com) Allergy can further muddy the diagnosis because antihistamines and other medications may worsen evaporative dry eye while the patient and doctor focus on itching and redness. (ophthalmologytimes.com) Epitropoulos’s broader argument is that obstruction is easier to manage before glands atrophy. In a separate 2023 Ophthalmology Times piece, she wrote that early-stage disease often has normal-looking imaging even when gland function is already impaired. (ophthalmologytimes.com) The takeaway is narrow and practical: if clinicians want fewer missed cases, they have to press on the glands and look at the tear film before symptoms force the issue. (ophthalmologytimes.com)
