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Educational Moments® On Clinical Topics

How to manage patients with Meibomian Gland Dysfunction (MGD)

Published on Jun 5, 2018
13 Minutes Read

What you need to know


Slit Lamp Viewing:

• Diffuse beam • Medium magnification (16x) • Direct illumination

 

 

Diagnostic expression

  1. Count the number of visibly capped glands
  2. Grade meibum quality.

Use finger, Q-tip or Meibomian Gland Evaluator (MGE) to assess 5 glands in each of 3 areas: nasal, central and temporal. Look for number of glands releasing meibum and grade meibum quality (0-45 score). Maximum score is 45 across 15 glands.

NOTE: this is a reverse scale where the highest ‘grade’ is given to the best appearance:

  • Grade 3 Liquid, clear
  • Grade 2 Liquid milky
  • Grade 1 Thick (toothpaste/ inspissated)
  • Grade 0 No secretions

Incidence:

  • 4 – 20% (Caucasian population) to over 60% (Asian population);
  • Increases with age, blepharitis and rosacea

Aetiology:

  • Chronic, diffuse abnormality of meibomian glands (MG), with duct obstruction and/ or qualitative/quantitative changes in glandular secretion.
  • Progressive inflammatory process associated with blepharitis, mechanical trauma, lowering temperature of eyelids, microbial contamination, CL wear and make-up.

Symptoms:

  • Ocular discomfort
  • Dryness
  • Irritation & itching
  • CL intolerance
  • Smeary vision (greasy lenses)
  • Photophobia

Signs:

  • Absent or cloudy meibomian gland secretions on gland expression
  • Frothy tears with reduced tear film quality and break up time
  • Thickened lid margins with distorted, possibly capped, meibomian glands
  • Marginal dry eye signs (inferior corneal staining, recurrent corneal erosions) clinically apparent inflammation and ocular surface disease
  • Discrete lipid deposits or greasy lipid layer over lens surface


What you need to recommend to your patients

Management

  • Explain chronic nature of condition to patient
  • Manage ≥ grade 2 or if symptoms
  • Lens wear can be continued if tolerated
  • Daily eyelid hygiene including warming with proprietary masks followed by moderate to firm massage and expression of MG secretions
  • In office microblepharon exfoliation
  • Device assisted thermal pulsation and expression in office
  • Consider CLs with shorter replacement frequency
  • Artificial tears
  • Advice on diet (increase omega-3 fatty acid intake), effect of work/ home environments on tear evaporation and possible drying effect of certain systemic medications
  • If severe, systemic tetracyclines may be necessary

Prognosis

Generally good resolution of symptoms and improvement in tear quality following treatment.

Differential Diagnosis:

 


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Further reading

  • Arita R et al. Meibomian Gland Dysfunction and Contact Lens Discomfort. Eye Contact Lens 2017 Jan; 43(1): 17-22
  • Blackie C et al. The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye. Clin Ophthalmol 2016; 10: 1385-1396
  • Geerling G et al. Emerging strategies for the diagnosis and treatment of meibomian gland dysfunction: Proceedings of the OCEAN group meeting. Ocul Surf 2017; 15: 179-192
  • Lam P et al. A Review on Evidence-Based Treatments for Meibomian Gland Dysfunction. Eye Contact Lens 2020; 46: 3-16.
  • Schaumberg D et al. (2011) The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci 2011; 52(4): 1994-2005
  • Siddireddy J et al. The eyelids and tear film in contact lens discomfort. Cont Lens Ant Eye 2018; 41(2) 144-153
  • Siddireddy J et al. Predictive Potential of Eyelids and Tear Film in Determining Symptoms in Contact Lens Wearers. Optom Vis Sci 2018; Nov 95(11): 1035-1045
  • Siddireddy J et al. The Effect of Microblepharon Exfoliation on Clinical Correlates of Contact Lens Discomfort. Optom Vis Sci 2019; 96(3): 187-199
  • Siddireddy J et al. Effect of Eyelid Treatments on Bacterial Load and Lipase Activity in Relation to Contact Lens Discomfort. Eye Contact Lens 2020; 46(4): 245-253
  • Tichenor A et al. Effect of the Bruder moist heat eye compress on contact lens discomfort in contact lens wearers: an open-label randomized clinical trial. Cont Lens Ant Eye 2019; 42: 625-32

Important Safety Information:

ACUVUE® Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Contact lenses should not be used in case of eye infections or any other eye conditions, or in case of a systemic disease that may affect the eye. For complete information, including contraindications, precautions and adverse reactions, please consult the Instructions for Use or visit our J&J website www.jnjvisionpro.co.uk

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