Dry eye

Concerning the dry eye test to determine staining and tear break up time using Flourescein, what volume should be placed in the eyes.  Some doctors squirt it directly from the bottle and there is extra that drios from the yes, and others use a strip they apply the dye on, whereas I have seen the strip ready to use.  I think the volume would make a difference on the Tear Break Up and any staining observed.  I have the urge to ask the doctor that question but fear they may be offended or questioning their procedure.  Also is there a way to see the oil secretions from the glands and can blocked glands be seen under the slit lamp.  Thanks in advance for your answers.

[John C Hagan III, MD, FACS, FAAO]

The volume or mode of application does not affect the test. In any case after a few blinks the tears distribute themselves over the cornea the same.

Yes oil build up, secretions, lash loss and plugged meibomian glands are easily seen with the slit lamp

JCH MD

[des900]

Concerning meibomian glands secretions, doctor will instruct you to look up & he/she may apply firm pressure typically 10 sec on eyelids to see if glands are working properly.

If you don't want to take this test,ask him to stop before he applies firm pressure on eyes.

[John C Hagan III, MD, FACS, FAAO]

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[chemia]

Then as a follow up to the dye volume question, I read somewhere that typically 3 to 5 microliteres should be used as a drop contains 40 micro and it floods the eye and causes inaccurate tear break up times (greater values).  Therefore the dry eye patients with evaporative dry eyes are missed.  Also, do you believe with time that meibomain glands can atrophy or drop out?
What should be done to keep the glands open and is restasis effective for it?
One more question - is IPL or probing effective for treating blocked glands or not enough research has been done to prove that.