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Hashemi Eye Care - Neuroscience Institute and Research Center

MMP-9 Testing (InflammaDry)

A rapid in-office test that detects elevated levels of MMP-9, an inflammatory marker, in the tears to help diagnose inflammatory dry eye disease.

5 min read

MMP-9 testing (commonly performed with the InflammaDry test) is a rapid, in-office diagnostic test that detects elevated levels of matrix metalloproteinase-9 (MMP-9)—an inflammatory marker—in your tears. Elevated MMP-9 indicates that inflammation is contributing to your dry eye disease, which helps guide treatment toward anti-inflammatory therapies.

Key Takeaways

  • Detects inflammation in the tears (MMP-9 levels)
  • Rapid results—available in about 10 minutes
  • Simple, in-office test—similar to a pregnancy test format
  • Positive result suggests inflammatory dry eye
  • Guides treatment toward anti-inflammatory therapies
  • Often used alongside Schirmer, TBUT, and osmolarity

Why It's Done

MMP-9 testing is performed to:

  • Determine if inflammation is contributing to dry eye
  • Guide treatment decisions—especially whether to use anti-inflammatory drops
  • Assess patients with dry eye syndrome
  • Evaluate meibomian gland dysfunction (MGD)
  • Monitor treatment response (inflammation reducing)
  • Support comprehensive dry eye diagnosis

What Is MMP-9?

Matrix metalloproteinase-9 is:

  • An enzyme produced during inflammation
  • Released by stressed ocular surface cells
  • Elevated in inflammatory dry eye disease
  • A biomarker that confirms inflammation is present
  • Normally present in low levels but rises with disease

What to Expect

Before the Test

  • Don't use eye drops for at least 2 hours before the test
  • Remove contact lenses
  • No other special preparation needed

During the Test

  1. A small sample collector (resembling a soft dabber) is gently touched to the inside of the lower eyelid
  2. The sample absorbs a small amount of tear fluid
  3. The collector is placed into a test cassette with solution
  4. Wait approximately 10 minutes for results
  5. Results appear as lines on the test strip

After the Test

  • Resume normal activities immediately
  • No discomfort or recovery needed
  • Results discussed right away

Understanding Results

How to Read Results

The test works similarly to a home pregnancy test:

Result Meaning
Positive (red line + blue line) MMP-9 elevated (≥ 40 ng/mL)—inflammation present
Negative (blue line only) MMP-9 normal—inflammation not detected
Invalid (no blue line) Test didn't work properly—needs to be repeated

What a Positive Result Means

  • Inflammation is actively contributing to your dry eye
  • Anti-inflammatory treatment is likely needed
  • May indicate moderate to severe disease
  • Treatment should address the inflammatory component

What a Negative Result Means

  • Inflammation is not the primary driver
  • Other factors (meibomian gland dysfunction, aqueous deficiency) may predominate
  • Doesn't rule out dry eye—just the inflammatory component
  • Other treatments may be more appropriate

MMP-9 in Context

Part of Dry Eye Workup

MMP-9 testing is typically done alongside:

Test What It Measures
MMP-9 Inflammation
Schirmer test Tear production (quantity)
TBUT Tear stability
Tear osmolarity Tear concentration
Meibography Meibomian gland structure

Treatment Implications

If MMP-9 is positive:

If MMP-9 is negative:

Frequently Asked Questions

Is the test uncomfortable?

Minimally. You'll feel a brief, light touch on the inside of your lower eyelid. It's not painful and takes only a second to collect the sample.

How accurate is InflammaDry?

InflammaDry has good sensitivity (85%) and specificity (94%) for detecting elevated MMP-9. A positive result reliably indicates inflammatory dry eye.

Can MMP-9 levels change?

Yes. With effective anti-inflammatory treatment, MMP-9 levels should decrease. Repeat testing can confirm that treatment is reducing inflammation.

Why test for inflammation if I already know I have dry eye?

Knowing whether inflammation is present changes the treatment approach. If MMP-9 is positive, anti-inflammatory medications are likely to help. If negative, other approaches may be more effective.

Does insurance cover MMP-9 testing?

Coverage varies by insurance plan. Some plans cover it as part of dry eye diagnosis. Check with your provider about costs.

Can I do this test at home?

No. MMP-9 testing requires proper sample collection and is performed in the doctor's office as part of a clinical evaluation.

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