Abstract

Although the pathophysiology of meibomian gland dysfunction (MGD) remains incompletely understood, many treatment options have recently become available. According to an international workshop report, treatment selection for MGD should be based on a comprehensive stage classification dependent on ocular symptoms, lid margin abnormalities, meibum grade, and ocular surface staining. However, it is often difficult to evaluate all parameters required for such classification in routine clinical practice. We have now retrospectively evaluated therapeutic efficacy in MGD patients who received five types of treatment in the clinic setting: (1) meibocare (application of a warm compress and practice of lid hygiene), (2) meibum expression plus meibocare, (3) azithromycin eyedrops plus meibocare, (4) thermal pulsation therapy plus meibocare, or (5) intense pulsed light (IPL) therapy plus meibocare. Patients in each treatment group were classified into three subsets according to the meiboscore determined by noncontact meibography at baseline. Eyes in the IPL group showed improvement even if the meiboscore was high (5 or 6), whereas meibocare tended to be effective only if the meiboscore was low (1 or 2). The meiboscore may thus serve to guide selection of the most appropriate treatment in MGD patients. Prospective studies are warranted to confirm these outcomes.

Highlights

  • Meibomian gland dysfunction (MGD) is the leading cause of dry eye [1] and has a prevalence that varies widely from 3.5% to 70% according to age, sex, and ethnicity [2]

  • Diagnosis of MGD is largely made on the basis of the combination of subjective symptoms and the findings of slitlamp microscopy [9], but the guidelines for treatment selection according to disease severity are not clear

  • We have performed a retrospective assessment of the efficacy of five different types of treatment based on the meiboscore for MGD patients who attended Itoh Clinic

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Summary

Introduction

Meibomian gland dysfunction (MGD) is the leading cause of dry eye [1] and has a prevalence that varies widely from 3.5% to 70% according to age, sex, and ethnicity [2]. MGD is diagnosed on the basis of subjective symptoms, lid margin abnormalities, the condition of the gland orifices, and meibum grade [9] Approaches such as conventional meibography and confocal microscopy for observation of the morphology of meibomian glands as well as tear interferometry for evaluation of gland function are available [9], but they are not widely adopted in the clinic. Noncontact meibography is a recently developed noninvasive method that allows relatively rapid imaging of meibomian glands [10] with high reproducibility and which yields images convincing to patients of the need for treatment [11] It is widely adopted in clinical practice for evaluation of meibomian gland–related diseases. The efficacy of each treatment was reevaluated from the viewpoint of noninvasive meibography grading (meiboscore) at baseline [10]

Experimental Section
Patients and Treatment
Clinical Examinations
Patient Characteristics
Treatment Efficacy
Treatment Efficacy According to the Meiboscore
Discussion
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