![]() Of these, 7 increased in concentration with treatment and 23 decreased in concentration. “Treatment-induced change was observed for 30 distinct lipids,” Dr. Tear lipids were collected and analyzed at baseline and 12 weeks after treatment, and infrared meibography was utilized to assess meibomian gland dropout and thermography utilized to measure tear evaporation rates. Methods of lid warming in this study included the standard hot towel compress as well as 2 commercially available systems, EyeGiene (Eyedetec Medical, Danville, Calif.) and Blephasteam (Thea, Clermont-Ferrand, France). Subjects with MGD were enrolled approximately half had aqueous deficiency (defined as Schirmers test <8 mm in 5 minutes) and 75% had tear film instability (defined as tear film break-up time <3 seconds). To address this issue, Louis Tong, DM, PhD, and colleagues at the Singapore National Eye Centre conducted a prospective, randomized trial evaluating various methods of lid warming and their effect on lipid levels in meibum. Just how effective is lid warming in patients with MGD? In addition, several products have been developed to standardize and semi- automate the lid warming process. Simply standing under a hot shower may be effective in mild disease. Lid warming can be achieved in a number of ways. Drugs involved include cyclosporine agents such as Restasis (Allergan, Irvine, Calif.), as well as AzaSite (1% azithromycin ophthalmic solution, Akorn Pharmaceuticals, Lake Forest, Ill.), which has shown potential in reports. Products include the Korb MGE (meibomian gland evaluator), LipiView II, and LipiFlow (TearScience, Morrisville, N.C.) MG Expressor Kit (Gulden Ophthalmics, Elkins Park, Pa.) MiBoFlo ThermoFlo (Pain Point Medical Systems, Dallas) and Maskin Meibomian Gland Intraductal Probe (Rhein Medical, St. Treatment for symptomatic MGD can range from lid scrubs to remove lid margin debris and clear the ducts, to lid warming to soften meibum and facilitate its egress from the ducts, to systemic therapy with tetracycline drugs, which are antibiotics but have the benefit of also softening meibum to aid its expression from the ducts. ![]() “Timely intervention of MGD is important because progressive meibomian gland loss occurs with reduced quality and quantity of the meibum normally with age, without initial corresponding increases in dry eye symptoms,” said Nisha Yeotikar, PhD, post-doctoral research fellow, Brien Holden Vision Institute, Sydney, Australia. In MGD, the lipid layer of the tear film is deficient, allowing evaporation of the aqueous layer, which leads to subsequent dryness and the signs and symptoms of ocular surface disease. MGD is thought to be among the most common causes of dry eye syndrome. ![]() In this month’s “Cornea editor’s corner of the world,” Veronica Canton, MD, Louis Tong, PhD, and Nisha Yeotikar, PhD, discuss the details of their studies on the effects of lid warming and changes in various components of lipids expressed from the meibomian glands after treatment. New technologies have emerged to mechanize this process for patients and to standardize the methods by which warm compresses and massage of the lid margins are performed. A mainstay of treatment for MGD is warm compresses in order to soften the meibum such that it may flow out of the meibomian glands better. When this occurs, the patients tears evaporate too rapidly, which appears on slit lamp examination with fluorescein and cobalt blue light as a decreased tear break-up time. In MGD, abnormal meibomian glands that are blocked by thickened meibum secretions or atrophied in advanced cases lead to a deficient lipid layer of the tear film. Improved understanding of meibomian gland dysfunction (MGD), its pathophysiology, and its role in causing dry eye symptoms has led to more management options for patients. For many comprehensive ophthalmologists and even those who are primarily involved in subspecialty tertiary ophthalmic care, at times it feels as if there is a dry eye and blepharitis pandemic.
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