title: Development of the 4-3-2-1 meibum expressibility scale.
abstract: OBJECTIVE
  With increased interest in the assessment of meibomian gland dysfunction and evaporative dry eye, there remains a deficit in simple, clinically applicable grading scales for gland expression. A new scale to assess meibum expressibility is described.
  
  
  METHODS
  A meibum expressibility scale was developed using a new standardized meibomian gland expression device, which provides constant pressure along the inferior lid. For the scale development, 30 patients (53.0±8.49 years; 93.33% female) with mild-to-moderate dry eye were compared with 13 normal, non-dry eye subjects (25.6±4.3 years; 46.1% female) using the meibum expression device developed by Korb and Blackie. The device was placed 4 glands lateral to the inferior punctum and 1 mm below the lash line and was held stable for 15 sec. The glands expressing meibum were counted. The weighted κ statistic was used to evaluate the extent of agreement, and a receiver operating characteristic curve was created to test the proposed scale.
  
  
  RESULTS
  The mean number of glands that expressed from the worse lid in the normal group was 3.54±1.61, whereas 1.53±1.28 glands expressed in the dry eye group. In the dry eye group, 1 subject showed 5 glands expressing, and 29 demonstrated scores of 4 or less. In the normal group, 3 or more glands were expressible in 11 of 13 subjects.
  
  
  CONCLUSIONS
  A 4-3-2-1 scoring system is proposed, whereby 4 or greater=normal expressibility, 3=mildly reduced expressibility, 2=moderately reduced expressibility, and 1 or lesser=severely reduced expressibility. Further validation of the scale is warranted.
authors.affiliation: College of Optometry, The Ohio State University, USA.
authors.forename: Jillian F
authors.initials: JF
authors.lastname: Meadows
authors.forename: Padmapriya
authors.initials: P
authors.lastname: Ramamoorthy
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Nichols
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Nichols
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003228:Conjunctiva / Q000378:metabolism; D003315:Cornea / Q000378:metabolism; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D019793:Fluorescein / Q000378:metabolism; D006801:Humans; D050356:Lipid Metabolism; D008086:Lissamine Green Dyes / Q000378:metabolism; D008297:Male; D008537:Meibomian Glands / Q000378:metabolism* / Q000473:pathology; D008875:Middle Aged; D009994:Osmolar Concentration; D010865:Pilot Projects; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013666:Tears / Q000737:chemistry / Q000502:physiology
chemical_list: D008086:Lissamine Green Dyes; D019793:Fluorescein