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    In-office treatments for MGD may provide relief

    Patients must play a role in care; surgeons need a systematic treatment approach

    Take-home message: Surgeons have several in-office treatments available for meibomian gland dysfunction.



    Denver—Though in-office treatments for meibomian gland dysfunction (MGD) can be helpful, patients also need to know that they must take a role in managing this chronic condition, said Richard S. Davidson, MD.

    Ophthalmologists must also systematically and consistently follow a treatment plan for patients with MGD to provide relief, explained Dr. Davidson, associate professor and vice chairman, University of Colorado Health Eye Center, Denver.

    A solid treatment approach for MGD is crucial because the condition may well be the leading cause of dry eye, Dr. Davidson said. These patients often experience discomfort, and they make up a significant chunk of office visits.

    “We probably all cringe on certain days when we see another burning, itching patient,” Dr. Davidson said.

    Additionally, an unhealthy ocular surface can affect surgical outcomes.

    At-home treatment has been the mainstay for MGD, and this has included warm compresses, eyelid scrubs and gland expression performed by the patient, Dr. Davidson said.

    However, these treatments come with their own challenges, including poor compliance, inadequate heat levels, and patients only able to self-express the upper portion of the gland.

    Treatments in office

    These challenges have led to several in-office treatments for blepharitis that Dr. Davidson outlined.

    One such device that helps with making the diagnosis is an interferometer (LipiView, TearScience) that takes precise measurements of tear film thickness, takes dynamic meibomian imaging, and allows the user to quantify lipid level of tear film.

    “This is helpful for analytical patients because you can show them a number,” Dr. Davidson said.

    The treatment arm of LipiView is Lipiflow, which applies heat to the inner eyelids. The device liquefies meibomian gland contents and facilitates the release of secretion from the meibomian glands. The treatment lasts about 12 minutes.

    A couple of studies have analyzed Lipiflow results, including one with 40 eyes in 20 patients that found that meibomian gland secretion scores increased at 1 month and lasted for 3 years. The same study found that tear break up time increased from baseline to 1 month but was not that different compared with baseline at 3 years, Dr. Davidson said.

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