Surgeons should do meibography before any eye procedure or cosmetic procedure around the eyelids.

 For years I have heard complaints from a variety of patients of how a particular procedure or surgeon “destroyed the eye” or “made me have chronic eye pain” or “feel my eye/around my eye all the time.”

Before meibography, many doctors and surgeons would consider these patients to be exaggerating or have “supratentorial” issues: a code term for this patient might need to see a psychiatrist. 

Note that Dr. Mark Speaker was sued for $1million after LASIK surgery in an airplane pilot with 20/20 (ie essentially perfect vision) post op because of halos and glare and likely a component of dry eye or meibomian gland atrophy. Since they did not have this technology back then, we will never know if the patient was a poor candidate for LASIK to begin with due to pre-existing gland atrophy. 

I suspect many patients who have chronic eye pain or dry eye symptoms before after any eye related procedure  had Pre existing gland atrophy. I have seen such complaints after all types of eye surgery and even cosmetic eyelid surgery, Botox, fillers, and even eyelid tattoo. And it can be debilitating. 

But when I show patients their meibography and explain it usually takes years for the atrophy to occur, they become less litigious towards the surgeon and see they had a higher risk profile going into the procedure that may have been difficult to know ahead of time because the technology may not have been available. And even if the surgeon and patient knew of the added risk, the alternatives are not an option as in the case of cataract surgery where waiting to do the surgery only adds to other risks. 

We still do not have publications to state meibography should be the standard of care prior to any eye surgery. But my recommendation is ideally to have one before any eye or eyelid surgery, even ordinary stye removals. 

Sandra Lora Cremers, MD, FACS