Meibomian gland dysfunction may be at root of dry eye

"The role of meibomian gland dysfunction in dry eye is becoming increasing clear, and we believe the vast majority of MGD is non-obvious," he said. "The only way to determine if a meibomian gland is functioning is by expressing it. Expression of the gland should be part of every routine exam, whether the patient has dry eye symptoms or not."

Meibomian gland evaluation is not difficult, according to Dr. Blackie. "You simply need to do a diagnostic expression, which means digitally manipulating the lid margins to express or attempt to express some oil out of the gland orifice," she said. "If no oil is expressed from the orifice, that gland could be considered to be dysfunctional even if the surrounding anatomy of the lid looked totally normal."

"The trouble with our current definition of MGD is that it assumes there will be inflammation," Dr. Korb said. "The new model of non-obvious meibomian gland dysfunction is based on the concept that most of the time, there is no inflammation, therefore you can't see the dysfunction so you must express. It's an idea whose time has come."

There are two basic treatment methods to clear an obstruction in a meibomian gland. Squeezing the gland to express the obstructive material is the most effective, but it's painful for both the patient and practitioner, according to Dr. Korb.

A less aggressive (albeit less effective) therapy involves the use of warm compresses to heat the gland material with the goal of melting or liquefying it, so that it will be expressed naturally during lid blinking or squeezing.

Another therapy option

"You can also try cyclosporine ophthalmic emulsion 0.05% (Restasis, Allergan Inc.) because there are some claims that it can improve the quality of meibomian gland secretion," Dr. Blackie said.

"There's also a reasonable amount of data that systemic antibiotics or topical azithromycin ophthalmic solution 1% (AzaSite, Inspire Pharmaceuticals) can be helpful in the case of meibomian gland dysfunction where you have serious inflammation and infection, but antibiotics don't address the need to remove the obstruction," she added.

Along with removal of the obstruction, treatment should include increasing lipid layer thickness and quality with the goal of reducing mechanical trauma and inflammation and any accompanying lid wiper epitheliopathy.

FYI

Donald R. Korb, OD
Phone: 617/423-6370;
E-mail: drkorb@aol.com

Caroline Blackie, OD, PhD
Phone: 617/423-6370
E-mail: cblackie@tearscience.com

Drs. Korb and Blackie receive research funding from Korb Associates, Boston, MA, and TearScience, Morrisville, NC. Dr. Korb is the inventor of SootheXP (Bausch + Lomb).