Photography of the Lid Margin and Other Structures

OSDx provides magnified imaging of the lid margin and adjacent external ocular structures. White-light photography is particularly useful for documenting clinically visible lid-margin disease, while magnified white-light and infrared imaging can also be used for detailed observation and research.

How to do the test

  1. Always attach the diffuser before lid-margin imaging.
  2. Use low illumination; the default value on the illumination slider is recommended.
  3. Position and focus the lid margin or other structure of interest in the live video window.
  4. When imaging the upper lid margin, ask the patient to look down.
  5. The portion of the live image lying inside the yellow square is displayed at higher magnification in the analysis window on the right.
  6. Once the area of interest is well focused, click the Bluetooth switch or press any key on the keyboard to capture a still image.
  7. Review the captured image and save it with the examination. The image may also be saved separately to the local filesystem when required.
Tip: Good documentation depends more on sharp focus, consistent positioning and low, diffuse illumination than on maximum brightness.

Why lid-margin imaging matters

Squamous / anterior blepharitis

White-light magnified photography can document lid-margin erythema, lash-base debris, scales and crusting. Serial images are useful when following change after lid-hygiene or other treatment.1,2

Meibomian gland dysfunction

Visible lid-margin findings may include plugged or altered meibomian orifices, margin irregularity, vascularity or telangiectasia and other changes associated with MGD. Photography provides a permanent clinical record that can complement functional and gland-imaging tests.2,3

Demodex blepharitis

Magnified white-light imaging can document collarettes or cylindrical cuffs at the lash bases, a particularly important clinical sign of Demodex blepharitis, and can help demonstrate their distribution and change during follow-up.2,4

White-light magnified imaging
White light gives a natural view of surface colour and texture and is therefore the preferred mode when documenting visible lid-margin pathology. It can be useful for:
  • lid-margin erythema and thickening;
  • squames, crusting and lash-base debris;
  • Demodex-associated collarettes/cuffs;
  • meibomian orifice plugging, pouting or distortion;
  • lid-margin telangiectasia and vascular changes;
  • lash abnormalities such as loss, misdirection or focal debris;
  • small lesions or structural abnormalities of the lid margin and adjacent periocular surface.
Infrared magnified imaging
Infrared illumination provides a different contrast from visible-light photography and can reveal surface and subsurface patterns without bright visible illumination. In OSDx, magnified IR imaging is best considered an observational and research tool rather than a stand-alone validated diagnostic test.

Possible areas of clinical or research interest include comparison of vascular and pigment-independent structural detail, observation of meibomian orifices and adjacent lid-margin anatomy, assessment of structures that are difficult to photograph comfortably under brighter visible illumination, and longitudinal image analysis where consistent acquisition can be maintained.
Imaging other structures
The magnified imaging window may also be used to photograph other externally visible ocular structures when clinically relevant—for example lashes, punctal region, periocular skin, exposed conjunctival areas and focal surface lesions.

These images are principally intended for documentation, comparison and research. Their clinical interpretation should be based on the complete examination rather than the photograph alone.
Role in follow-up and research
Standardised serial photography can make subtle changes easier to demonstrate than narrative descriptions alone. Potential applications include documenting response of squamous blepharitis to lid hygiene, reduction or recurrence of Demodex collarettes, evolution of lid-margin vascularity, changes around meibomian gland orifices and correlation with tear-film, meibography or symptom measures.

Because image appearance depends on illumination, focus, magnification and positioning, research comparisons should use as consistent an acquisition technique as possible.

Clinical note: Lid-margin photography complements slit-lamp examination; it does not replace direct clinical examination, meibomian gland expression, microscopy when required, or other dry-eye investigations.

Selected references

  1. Putnam CM. Diagnosis and management of blepharitis: an optometrist's perspective. Clinical Optometry. 2016.
  2. American Academy of Ophthalmology. Blepharitis Preferred Practice Pattern®. 2024.
  3. Kaur K, et al. Meibomian Gland Disease. StatPearls. Updated 2024.
  4. Demodex blepharitis literature describing lash-base collarettes as a characteristic clinical finding.