Severe Meibomian Gland Loss on Lipiview; Also: What is SPK? Superficial Punctate Keratitis

Severe Meibomian Gland Loss and Dysfunction

I saw an older gentleman with significant redness of both 

eyes with his eyelashes growing abnormally toward his cornea (trichiasis) and significant Corneal SPK (see below).

This is his Right Eye (below on left) with upper lids fipped to see Meibomian glands.  This is his Left Eye (on the right side of screen). He has very few glands left. 

Scroll to the bottom of this post to see what normal should look like. 


I will try IPL first to see if this can save the remaining glands he has as he is 79 and may not tolerate Meibomian Gland probing as the first option. 

This is a startling reminder to not down play dry eye symptoms. 

Sandra Lora Cremers, MD, FACS 

What is SPK? Superficial Punctate Keratitis

He had significant SPK: Superficial Punctate Keratitis which means that the surface of the Cornea is so dry from Inflammation (-itis…thus keratitis: -kera means Cornea), that the Cornea’s surface epithelial cells have died and left a bare area of underlying Bowman’s membrane (the layer under the epithelium). When we put a yellow drop called Fluoresceine, it stains Bowman membrane cells and not healthy epithelial cells. This is how we can see under the microscope that a patient has dry eyes. 

Normal Meibomian Glands should look like “White Piano Keyes Filled with Oil” On Meibography or LipiScan or LipiView Machines seen on bottom left.

Aging, genetics, chronic blepharitis and meibomian gland dysfunction, poor diet, smoking, inflammatory issues and disease, radiation, chemotherapy, previous surgery, and I must add Chronic computer/video game/cell phone use (ie, Computer Vision Syndrome or a new term I will coin called Decreased Blinking Quality Syndrome or Decreased Blinking Rate Syndrome which can happen to even avid readers, skiers, etc)  can destroy these precious glands and cause them to never function again. This loss of meibomian glands, decreases the ability of the tears to lubricate the cornea properly, which then leads to the death of the corneal epithelium, thus giving SPK. The death of the corneal epithelium, though is reversible.

To date, I have had 5 patients whose Meibomian Glands showed “growth” or improvement after LipiFlow or Intense Pulse Light or Meibomian Gland Probing. The current thought, though is that once a meibomian gland is gone, it is gone for good. I hope I am right.

On the right you can see:


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