Identification of MGD in dry eye patients and its treatment in the practical clinical setting & The Austrian perspective on MGD

Abstract

AbstractMGD can be found in about 70% of patients with ocular discomfort as evaluated in a large clinic‐based population of Austria. It is characterized by a continuum of clinical severity. Especially discrete cases are often underestimated und receive not enough attention. In patients with ocular discomfort it is important to investigate the blinking action, the lid margins (crusts, vascularisation, Marx line, meibomian orifices) and also to perform the expression of the meibomian glands. Tear deficiency is often accompanied with MGD therefore the function of the lacrimal glands should be tested. To evaluate the damage of the ocular surface, staining with fluorescein and lissamine green are recommended. Further important diagnostic measures are the evaluation of the lipid layer and the examination of the meibomian glands with meibography. Although there is an overlap between different subtypes of dry eye, proper diagnostic evaluation is important to identify adequate therapeutic treatments that would best target the underlying dysfunctions. The most commonly recommended treatment option for every stage of MGD remains eyelid hygiene that should be performed on a regular basis. Eyelid warming to melt the meibum and eyelid massage to express secretion shall prevent obstruction of the terminal ducts. To improve compliance special devices that are more convenient for the patients can be used. Instillation of artificial lubricants, especially with lipid containing components may stabilize the tear film. Essential fatty acids, topical and systemic antibiotics and other anti‐inflammatory medication are further important therapeutic options.