meibography

Meibography is an imaging modality used to visualize the Meibomian glands within the tarsal plates of the eyelids. It provides information about gland morphology, including dropout, atrophy, tortuosity, and ductal dilation, features commonly associated with Meibomian gland dysfunction (MGD) and evaporative dry eye.

Most commonly performed with infrared light, meibography is typically non-invasive and can be performed with non-contact devices integrated into a slit lamp or with dedicated instruments such as LipiView or Keratograph systems. An alternative approach uses anterior segment optical coherence tomography (OCT) to obtain cross-sectional views of the glands.

During the examination, the eyelids are everted to expose the Meibomian glands. The patient may be asked to blink normally while images are captured for the upper and lower lids. In many settings no topical anesthesia is required; the procedure is quick and usually well tolerated.

Interpretation relies on grading scales that quantify gland loss. A commonly used system assigns meiboscores from 0 to 3 per lid (0 = no loss, 1 = mild loss, 2 = moderate loss, 3 = severe loss), with total scores summing across lids. The presence and extent of dropout are correlated with MGD severity but do not always predict symptoms.

Clinical use includes confirming suspected MGD, monitoring progression, and guiding treatment decisions such as lid hygiene, warm compresses, meibomian gland expression, lipid-containing artificial tears, anti-inflammatory therapies, and selective phototherapy. Limitations include dependence on tear film quality, variable image clarity, and the fact that structural loss does not directly measure gland function.