Device‐assisted therapies in MGD

Abstract

AbstractMeibomian gland dysfunction (MGD) is the most frequent cause of evaporative dry eye disease (DED). Until now, the only available treatments were as follows: warm compresses, massage, omega 3, and antibiotics. As a result, multiple devices have appeared in the marketplace designed to use heat and pressure to alleviate MG blockages, as well as to remove residue along the lid margins. The mechanism of action of Lipiflow®, Miboflo®, iLux® and Jett Plasma Lift® is thermal expression. The Lipiflow® consists of a console and a single‐use sterile device that uses sensor‐regulated heat and peristaltic motion to evacuate obstructed meibum. One section of the device goes behind the eyelids, providing the warmth; an outer section gently massages the lids against the inner section. Its effects last usually 12 months. Jett Plasma Lift also remove keratinized material from de lid margin. ILux® system is not available in Europe.​Intense pulsed light (IPL) was originally developed for use in dermatology. Brief, powerful bursts of light at specific wavelengths (in this case, between 500 and 800 nm) cause changes in blood vessels near the surface of the skin, raise skin temperature and eliminate problematic flora on the skin and eyes, all of which may have a beneficial effect on meibomian gland dysfunction. Closing the abnormal vessels decrease inflammation and oxygen supply to meibocytes (they work in anaerobic conditions). Usually four sessions are needed. Expression with forceps and the treatment directly of the lids improve results. There are multiple platforms and not all are the same. BlephEx® produces microblepharoexfoliation. It's typically repeated at four to six‐month intervals. It is useful for anterior blepharitis. Rexon‐Eye® is an electro‐medical device for the treatment of DED. The applied electrical stimulation is based on the principle of quantum molecular resonance. Transferring energy to biological tissues in the form of high frequency oscillating electrical fields biostimulate the lachrymal and the MG. Thus, it is helpful for evaporative and aqueous‐deficient DED.​The use of these devices reset the MG. They should be used on the glands before they atrophy. A combination of these treatments will probably work best for difficult patients. Independent clinical trials and studies comparing these devices and the new coming instruments are needed.