meibomian gland dysfunction
3758326
Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease.
TOPIC To discuss the pathology, causes, and ocular surface impact of meibomian gland disease (MGD) as well as its relationship to dry eye. CLINICAL RELEVANCE MGD is a common disorder with various contributing mechanisms and clinical manifestations. Understanding MGD pathophysiology and its relationship to dry eye is important in order to optimize diagnosis and treatment algorithms. METHODS A review of current literature was performed to discern MGD in terms of pathophysiology, risk factors, and ocular surface impact, and the relationship to dry eye. RESULTS Meibomian gland obstruction and meibocyte depletion are important components of MGD. Many pathologies can disrupt function of meibomian glands, ranging from congenital to acquired causes. Once gland disruption occurs, the quality and quantity of meibum is altered, with a negative impact on the ocular surface. Increased tear evaporation, tear hyperosmolarity, increased ocular surface staining, increased inflammation, symptomatic irritation of the eyelid and globes, as well as decreased visual acuity have all been observed. CONCLUSION MGD leads to changes in meibum quality and quantity that can cause evaporative dry eye and ocular surface disruption, leading to dry eye symptoms in some individuals.
Ophthalmology
Priyanka Chhadva Raquel Goldhardt Anat Galor
53568927
Therapeutic efficacy of intense pulsed light in patients with refractory meibomian gland dysfunction.
PURPOSE To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for treatment of refractory meibomian gland dysfunction (MGD) METHODS Ninety eyes of 45 patients were randomly assigned to receive either the combination of IPL and MGX or MGX alone (control) Each eye underwent eight treatment sessions at 3 week intervals. Parameters were evaluated before and during treatment as well as at 3 11 weeks after the last treatment session. Measured parameters included the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire score, noninvasive breakup time (NIBUT) fluorescein breakup time (BUT) lipid layer grade, lipid layer thickness (LLT) lid margin abnormalities, corneal and conjunctival fluorescein staining (CFS) score, meibum grade, and meiboscore. RESULTS A significant improvement in lipid layer grade was apparent in the IPL MGX group from 6 to 32 weeks after treatment onset (adjusted P 0.001) but was not observed in the control group. The IPL MGX group also showed significant improvements in LLT, NIBUT, BUT, lid margin abnormalities, and meibum grade compared with the control group at 24 and 32 weeks (adjusted P 0.001) as well as significant improvements in the SPEED score at 32 weeks (adjusted P 0.044) and in CFS score at 24 (adjusted P 0.015) and 32 (adjusted P 0.006) weeks. CONCLUSIONS The combination of IPL and MGX improved homeostasis of the tear film and ameliorated ocular symptoms in patients with refractory MGD and is thus a promising modality for treatment of this condition.
The ocular surface
Reiko Arita Shima Fukuoka Naoyuki Morishige
73499902
The optimum temperature for the heat therapy for meibomian gland dysfunction.
PURPOSE Numerous devices have been developed to warm the eyelid as a therapy for Meibomian gland dysfunction. The optimum temperature for such therapy was determined. METHODS Meibum lipid disorder versus temperature was calculated from previously published phase transition parameters measured using infrared spectroscopy. Phase transitions parameters were calculated from meibum obtained from donors with Meibomian gland dysfunction (MMGD) donors who were susceptible to dry eye after hematopoietic stem cell transplantations (MHSCT) and meibum from donors without dry eye (Mn) RESULTS Heating Mn to 40 degC increases the lipid disorder by 20.4% 90% Heating the meibum another 4deg increases the disorder to 95% MMGD is 73.2% disordered with no heating. Heating MMGD to 41.5 degC increases the disorder by 26.8% 90% disordered. Heating MMGD another 5.1 degC increases the disorder to 95% As MHSCT is much more ordered, 56.9% disordered compared with Mn and MMGD, a higher temperature above safety limits, 52 and 59 degC is need to disorder MHSCT to 90 and 95% disorder. CONCLUSIONS Heating the eye lid above the phase transition temperature of meibum increases the disorder of meibum lipid which could ameliorate dry eye symptoms. The optimum temperature for disordering Mn and MMGD to 90% maximum disorder is 40 and 41.5 degC, respectively. Safety issues and discomfort should be considered in obtaining an optimal level of disorder, especially for severe cases of dry eye.
The ocular surface
Douglas Borchman
115197866
Intense Pulsed Light for the Treatment of Dry Eye Owing to Meibomian Gland Dysfunction.
Dry eye disease (DED) is an increasingly common condition and one of the most common complaints of patients. The vast majority of DED is caused by the so called "evaporative" subtype, that is mainly caused by meibomian gland dysfunction (MGD) Intense pulsed light (IPL) devices employ high intensity pulses of polychromatic lights with a broad range of wavelength (515 1200 nm) IPL treatment has been utilized for years in the field of dermatology, and then its use was applied to ophthalmology for the treatment of MGD. Recently, a new device employing IPL was specifically designed for the periocular application. This procedure determines the thermal selective coagulation and ablation of superficial blood vessels and telangiectasias of the eyelids skin, reducing the release of inflammatory mediators and tear cytokines levels, and improving meibomian glands outflow. IPL treatment is noninvasive and easy to perform, lasts for only a few minutes and can be conducted in an office setting. In the present study, 19 patients underwent 3 sessions of IPL treatment. After treatment, both mean noninvasive break up time and lipid layer thickness grade significantly increased, as a result of an improvement of tear film stability and quality, respectively. Conversely, no statistically significant changes were found for meibomian gland loss and tear osmolarity. Furthermore, the vast majority of the treated patients (17/19; 89.5% of the total) perceived an improvement of their ocular discomfort symptoms after IPL treatment. Although IPL treatment provides an improvement of both ocular surface parameters and ocular discomfort symptoms after one cycle of three sessions, regular repeated treatments are usually required to maintain the persistence over the time of its beneficial effects.
Journal of visualized experiments JoVE
Luca Vigo Giuseppe Giannaccare Stefano Sebastiani Marco Pellegrini Francesco Carones
160010768
Meibum Expressibility Improvement as a Therapeutic Target of Intense Pulsed Light Treatment in Meibomian Gland Dysfunction and Its Association with Tear Inflammatory Cytokines
Many recent studies have demonstrated the efficacy of intense pulsed light (IPL) for the treatment of meibomian gland dysfunction (MGD) however, its effective treatment targets have not yet been elucidated. This study aimed to investigate the baseline characteristics associated with an improvement in symptoms after IPL treatment; to examine the course of change in inflammatory tear cytokines, meibomian gland function, and tear stability; and to investigate the correlation between cytokines and ocular surface parameters. Thirty participants underwent three sessions of IPL treatment. During each examination, tear film lipid layer interferometry, meibography, tear meniscus height measurement, tear sampling, and slit lamp examination were performed, and the Ocular Surface Disease Index (OSDI) questionnaire was administered. Meibum quality, meibum expressibility, lid margin abnormality, tear film break up time (TBUT) ocular surface staining, and the OSDI significantly improved after treatment. Poor meibum expressibility and short TBUT were associated with greater recovery in the OSDI after IPL. Tear levels of IL 4, IL 6, IL 10, IL 17A, and TNF a decreased after IPL, and IL 6, and TNF a were correlated with the improvement in meibum expressibility. Therefore, IPL treatment improved meibomian gland function, stabilized the tear film, and decreased ocular surface inflammation. Patients with obstructive MGD and tear instability were more likely to experience an improvement in ocular discomfort after IPL treatment.
Scientific Reports
Moonjung Choi Soo Jung Han Yong Woo Ji Young Joon Choi Ikhyun Jun Mutlaq Hamad Alotaibi Byung Yi Ko Eung Kweon Kim Tae-im Kim Sang Min Nam Kyoung Yul Seo
81157779
Intense Pulsed Light Treatment for Meibomian Gland Dysfunction in Skin Types III/IV.
Background and objective: Several cases of meibomian gland dysfunction (MGD) particularly the moderate to severe ones, are considered intractable by traditional therapy. Intense pulsed light (IPL) therapy has emerged as a new choice for management of MGD in recent years, given that use of lasers and optical treatments is typically challenging in patients with darker skin types. Methods: IPL treatment for MGD is administered in the periorbital area with the thinnest skin in our body, which has an inherent risk of skin side effects. We evaluated the effects and safety of this therapy in Chinese patients with Fitzpatrick skin types III IV. Forty MGD patients were randomly administered IPL treatment with two types of parameters in the left and the right eye. Results: Results revealed that both parameter settings of IPL treatment could gradually and effectively raise the tear breakup time (BUT) and ocular surface disease index (OSDI) score. However, younger patients showed better improvement in BUT (F 19.54, p 0.01) and OSDI (F 9.93, p 0.01) compared with older patients. Conclusions: Overall, results showed that IPL treatment is safe and effective in MGD patients with skin types III IV.
Photobiomodulation, photomedicine, and laser surgery
Dan Li Shi-bin Lin Biao Cheng
67860514
Effect of Intense Pulsed Light Therapy on Tear Proteins and Lipids in Meibomian Gland Dysfunction
Purpose: To assess the effect of a novel intense pulsed light (IPL) therapy on tear proteins and lipids in eyes with Meibomian gland dysfunction (MGD) Methods: Twenty four eyes of 12 patients with MGD were recruited and received five overlapping flashes (565 1400 nm) directed at the lower eyelid. The IPL parameters include intensity: 2.5 to 6.5 J/cm2, voltage: 100 to 240 V, frequency: 50 to 60 Hz, input: 16 W, maximum optical energy: 23 J, pulse duration: <2.0 ms, and repetition time: 1 3.5 s. Tear samples were evaluated immediately before and 2 weeks after IPL therapy and included measurements of protein concentration, electrophoretic mobility by using sodium dodecyl sulfate polyacrylamide gel electrophoresis, lipid profile assessments, and thin layer chromatography (TLC) for phospholipids. Results: Significant improvements were observed in tear protein concentrations and molecular weight after IPL therapy. The most pronounced effect was in the molecular weight of tear lysozyme, lactoferrin, and albumin. Tear lipids showed an improvement in the concentrations of total lipids, triglycerides, cholesterol, and phospholipids. On TLC, the tears in patients with MGD had significantly lower amounts of anionic phosphatidylethanolamine, phosphatidylinositol, and phosphatidylserine but amounts zwitterionic neutral phospholipid phosphatidylcholine were normal. These anionic phospholipids showed obvious recovery after IPL therapy. Conclusion: IPL therapy is effective in eyes with MGD. It improved tear protein and lipid content and composition. The anionic phospholipids were more responsive to IPL therapy than were the other zwitterionic phospholipids.
Journal of ophthalmic vision research
Salwa Abdelkawi Ahmed Ibraheim Mohi Eldin Taher Dina Fouad Ghoneim Abdelhakim Mohamed Safwat
58350634
Meibomian Gland Morphology Is a Sensitive Early Indicator of Meibomian Gland Dysfunction.
PURPOSE To investigate the relationship between meibomian gland (MG) morphology and clinical dry eye tests in patients with meibomian gland dysfunction (MGD) DESIGN Cross sectional study. SUBJECTS Total 538 MGD patients and 21 healthy controls. METHODS MG loss on meibography images of upper (UL) and lower lids (LL) was graded on a scale of 0 (lowest degree of MG loss) to 3. MG length, thickness, and interglandular space in the UL were measured. Clinical tests included meibum expression and quality, tear film break up time, ocular staining, osmolarity, Schirmer I, blink interval timing, and Ocular Surface Disease Index (OSDI) questionnaire. RESULTS Mean UL and LL meibogrades were significantly higher in MGD patients compared to controls (P .001 for UL and LL) The sensitivity and specificity of the meibograde as a diagnostic parameter for MGD was 96.7% and 85% respectively. Schirmer I was significantly increased in MGD patients with meibograde 1 compared to patients with meibograde 0, 2, and 3 in the UL (P .05) MG thickness increased with higher meibograde (P .001) MG morphology correlated significantly but weakly with several clinical parameters (P .05) OSDI did not correlate with any MG morphologic parameter. CONCLUSIONS Grading of MG loss using meibograde effectively diagnoses MGD. Compensatory mechanisms such as increased aqueous tear production and dilation of MGs make early detection of MGD difficult by standard clinical measures of dry eye, whereas morphologic analysis of MGs reveals an early stage of MGD, and therefore represents a complementary clinical parameter with diagnostic potential.
American journal of ophthalmology
Muhammed Yasin Adil Jiaxin Xiao Jonatan Olafsson Xiangjun Chen Neil S Lagali Sten Raeder Oygunn Aass Utheim Darlene A Dartt Tor Paaske Utheim
202003062
Management of Meibomian Gland Dysfunction: A Review.
Meibomian gland dysfunction (MGD) is the leading cause of evaporative dry eye disease and is one of the most common conditions encountered by eye care providers. MGD is characterized by obstruction of the meibomian gland terminal ducts and/or changes in their glandular secretion, resulting in changes in tear film stability, inflammation, and symptoms of irritation. There is no gold standard treatment for MGD, but rather a diversity of options. Conservative measures include warm compresses and lid hygiene, but there is growing interest and need for medical treatments and procedures. Potential medical treatments include antibiotics, non steroidal and steroidal anti inflammatory agents, essential fatty acid supplementation, hormone therapy, and control of Demodex infestation. Procedures include intraductal meibomian gland probing, the use of electronic heating devices, intense pulsed light therapy, and intranasal neurostimulation. We provide an update on MGD treatments based on recent studies.
Survey of ophthalmology
Saama Sabeti Ahmad Kheirkhah Jia Yin Reza Dana
162170597
Human Meibum Cholesteryl and Wax Ester Variability With Age, Sex, and Meibomian Gland Dysfunction
Purpose Relationships between tear film lipid (TFL) layer composition, structure, and function could provide insight into the etiology of dry eye. The molar ratio of cholesteryl ester (CE)/wax ester (WE) was measured in meibum from normal donors (Mn) and compared with meibum from donors with meibomian gland dysfunction (MMGD) Methods CE/WE was measured using nuclear magnetic resonance spectroscopy. Results CE/WE was distributed into two populations with 81% distributed near 0.55 and 19% near 0.3. CE/WE were higher in donors 13 to 19 years old compared with donors 1 to 12 years old and 20 to 88 years old. CE/WE for MMGD was 30% lower, 0.34 0.04, compared with Mn, 0.49 0.04. There were no sex differences in CE/WE. There were no significant racial differences between the CE/WE ratios for Asians and Caucasians. The CE/WE ratio was higher for blacks and lower for Hispanics compared to Caucasians. Due to the small number sampled, confirmation of the later racial results is needed. The packing of CE and WE in the TFL layer was proposed. Conclusions Although MMGD contains much less CE than Mn, factors other than the CE content, such as the levels of saturation and/or proteins, may be responsible for the higher order of MMGD. In addition to saturation, CE could contribute to the increase in order of Mn between 0 and 20 years of age. Observed changes in the meibum content of CE alone is not likely to influence tear film stability.
Investigative ophthalmology visual science
Douglas Borchman Aparna Ramasubramanian Gary N Foulks