Meibomian Gland Expression Research Articles

Management of Post-LASIK Dry Eye with Intense Pulsed Light in Combination with 0.1% Sodium Hyaluronate and Heated Eye Mask.

IntroductionLaser in situ keratomelieusis (LASIK) is one of the most frequently performed refractive treatments. Dry eye (DE) is common in patients after LASIK and can be bothersome postoperatively. Therapies such as intense pulsed light (IPL), sodium hyaluronate (SH) and heated eye mask (HEM) have been reported to improve signs and symptoms of DE .AimThe purpose of this prospective study was to evaluate and compare the effects of IPL and 0.1% SH (IPL group, 50 eyes) and IPL in combination with 0.1% SH and HEM (IPL + group, 50 eyes) in participants with persistent post-LASIK DE.MethodsThe final analysis included 100 patients (100 eyes) who had LASIK for myopic correction and had been experiencing moderate to severe DE following LASIK for over a year. Participants were randomly assigned to either the IPL group (2 IPL sessions) or IPL + group (2 IPL sessions and daily HEM for 4 weeks), and both groups continued the use of daily 0.1% SH (HYLO-COMOD®) preservative-free eye drops. Non-invasive tear break-up time (NITBUT), tear film lipid layer (TFLL), lower tear meniscus height (LTMH), meibomian gland quality (MGQ), meibomian gland expressibility (MGEx), corneal fluorescein staining (CFS), ocular surface disease index (OSDI) and artificial tear usage (ATU) survey were assessed at baseline (BL) and follow-up at 2 (F1) and 4 weeks (F2).ResultsFollowing the treatment protocol, all dry eye (DE) parameters assessed in this study improved significantly (P < 0.05) in both groups at F2 compared with their respective BL measurements. Inter-group comparison at F2 found significant differences in their NITBUT (IPL: 6.06 ± 0.59 vs. IPL +: 6.67 ± 0.86, P < 0.001), TFLL (IPL: 1.90 ± 0.65 vs. IPL +: 1.60 ± 0.64, P = 0.021), LTMH (IPL: 0.186 ± 0.053 vs. 0.204 ± 0.034, P = 0.003), MGQ (IPL: 1.48 ± 0.54 vs. IPL +: 1.26 ± 0.56, P = 0.026), MGEx (IPL: 1.62 ± 0.53 vs. IPL +: 1.44 ± 0.50, P = 0.038) and OSDI (IPL: 32.54 ± 6.85 vs. IPL +: 29.76 ± 4.74, P = 0.001), while CFS score (IPL: 4.02 ± 0.65 vs. IPL +: 3.96 ± 0.73, P = 0.652) and ATU (IPL: 1.88 ± 0.63 vs. IPL +: 1.72 ± 0.50, P = 0.159) showed no significant difference.ConclusionPost-LASIK DE signs and symptoms can be improved by combining therapies such as IPL, HEM and 0.1% SH. Increased TFLL due to a combination of IPL, 0.1% SH and HEM had a greater positive impact on the subjective and objective DE measurements in participants with persistent post-LASIK DE.

Meibomian Gland Changes in Open-angle Glaucoma Users Treated with Topical Medication.

Glaucoma patients treated with topical hypotensive eye drops often experience changes in the ocular surface, including the lid margin and the meibomian glands. In this study, the clinical parameters of the ocular surface have been analyzed to detect the presence of meibomian gland dysfunction-related dry eye disease. This study aimed to evaluate the meibomian gland dysfunction in glaucoma patients secondary to topical antiglaucomatous treatment. A total of 131 eyes from different patients with open-angle glaucoma treated with topical medication and 92 eyes from different patients with untreated ocular hypertension were consecutively and prospectively enrolled. The structure of the meibomian glands was assessed using noncontact meibography (Keratograph 5M; Oculus, Wetzlar, Germany), and their function was evaluated by measurement of meibomian glands expressibility, the duct appearance, and the Marx line location. Moreover, tear osmolarity measurement, corneal staining score (Oxford scale), and ocular symptom assessment (Ocular Surface Disease Index questionnaire) were performed. We also compared these variables in the glaucoma group according to the presence (or not) of preservative in topical treatment. Meibomian gland depletion was higher in glaucoma patients with topical medication (P < .001). Furthermore, the quantity of meibomian glands and expressibility of meibum in these patients were altered compared with the control group (P < .001 in both cases). In addition, the glaucoma group presented a higher degree of corneal staining as measured with the Oxford scale (P < .001). The Marx line location score was higher (P < .001 in central Marx line and P < .003 in temporal Marx line) in patients using drugs containing preservative than in those having preservative-free treatment. Logistical regression found that Marx line central, Marx line temporal, quantity of meibum expression, and quality of meibum expression have predictive ability to detect meibomian gland dysfunction-related dry eye disease. Glaucoma topical treatments produce meibomian gland dysfunction altering their structure and function, and this condition can be worsened using topical treatments containing preservative.

Ocular Surface Disease Index© and the five-item dry eye questionnaire: A comparison in Indian patients with dry eye disease.

Purpose:To compare the suitability of the Ocular Surface Disease Index (OSDI) and the 5-item Dry Eye Questionnaire (DEQ-5) in Indian patients with dry eyes.Methods:This cross-sectional study evaluated the OSDI and DEQ-5 in patients with tear film abnormalities. Tear film breakup time, tear film height, Schirmer’s I, lissamine green staining, and meibomian gland expressibility were performed on each patient.Results:There were 101 patients with symptoms and/or signs of tear film abnormality. Both OSDI and DEQ-5 questionnaires significantly correlated (ρ = 0.566, P < 0.0001) with each other. The OSDI questionnaire showed a good correlation with all dry eye tests, whereas the DEQ-5 correlated significantly only with the tear film breakup time and the lissamine green score. None of the questionnaires correlated with meibomian gland expressibility. The Bland–Altman analysis revealed a marginal bias (−0.01 unit) for DEQ-5. The DEQ-5 scored higher in patients with mild symptoms. While 101 (100%) patients answered all the questions in the DEQ-5, only 19 (18.8%) patients answered all the questions in the OSDI questionnaire. The least responses were recorded in the vision-function-related and environmental trigger subscales of the OSDI.Conclusion:The OSDI and DEQ-5 scores showed a moderate correlation. The OSDI questionnaire correlated with a higher number of dry eye tests than the DEQ-5. The large number of skipped questions in the vision-function-related and environmental trigger subscales of the OSDI suggests that the questionnaire is not adequately adapted to the Indian population. Patients with a negative OSDI score should be reassessed with the DEQ-5 to exclude symptom positivity.

Treatment efficacy of dietary supplement Licofor for dry eye associated with meibomian gland dysfunction

Objective: To evaluate the clinical efficacy of dietary supplement Licofor in the treatment of dry eye associated with meibomian gland dysfunction (MGD). Methods: This was a prospective, randomized controlled clinical trial. Sixty patients [25 males, 35 females, aged (42±13) years] who had dry eye associated with MGD were recruited in Xiangya Hospital of Central South University from December 2018 to October 2019. The patients were equally divided into two groups: 30 cases (60 eyes) in the experimental group and 30 cases (60 eyes) in the control group. All subjects were treated with eye hot compress, artificial tears and antibiotic ointment. After that, the experimental group and control group were received dietary supplementary Licofor or placebo daily for 12 weeks. The symptoms and signs of dry eye, morphology and function of meibomian gland, and inflammatory response were assessed at the beginning, 4th, 8th and 12th week of treatment. Results: After 12 weeks of treatment, statistically significant improvements in ocular surface disease index (OSDI) scores, tear break-up time (TBUT), corneal fluorescein staining (CFS), the morphology of eyelid margin, meibomian gland orifice, meibomian gland expressibility, meibum quality, and periglandular inflammatory cell density were determined in both groups (all P<0.05). In the Licofor group, the improvement of OSDI scores [16.7 (12.5, 20.8) vs 20.8 (18.8, 22.9), P<0.001], the morphology of eyelid margin, meibomian gland orifice and periglandular inflammatory cell density [443 (318, 513) vs 553 (415, 676)/mm2, P=0.002] were more significant (all P<0.05). Conclusion: The combined treatment of licofor and conventional treatment can significantly improve symptoms of dry eye, the morphology of eyelid margin, meibomian gland orifice, meibum quality, and eyelid inflammation response of dry eye associated with MGD.

A study of meibomian gland and tear film changes in patients with pterygium in a tertiary care centre

To find out the correlation of Meibomian gland and Tear film dysfunction with pterygium. Institution based prospective cross sectional study. 70 (seventy) patients with unilateral primary progressive nasal Pterygium and 70 healthy adults without any ocular pathology were selected as comparison group from the Ophthalmology outpatient department of Calcutta National Medical College and hospital, Kolkata for a duration of 6 months from January 2020 to June 2020. Meibomian gland dysfunction was measured by meibomian gland expression score and lid margin abnormality score. Tear film changes were measured by Ocular Surface Disease Index (OSDI) Score , Tear break up time (TBUT), Tear meniscus height(TMH), Schirmer’s test 1 (ST1) and Corneal flourescein staining in both pterygium and control group and comparisons were done to find out the significance in differences. The Categorical variables were analyzed with the help of Pearson Chi square test, Spearman rho Correlation, Man Whitney U Test and the continuous variables were analyzed with the help of Independent T test and Pearson Correlation coefficient. The level of significance was considered as 95% of confidence interval i.e. P value &amp;#60;0.05. OSDI score, TBUT, meibomian gland expression score, lid margin abnormality score and corneal fluoresce in staining were significantly higher in pterygium group than others (p&amp;#60;0.05) whereas TMH values although showed differences between the two groups but were not statistically significant. ST1 were normal in pterygium group though had significant difference with control. Meibomian gland function was altered in patient with Pterygium which is also associated with uncomfortable ocular symptoms due to tear film abnormalities.

The Effect of Meibomian Gland Dysfunction Treatment on Sleep Quality.

Purpose:To assess the therapeutic efficacy of a combinational therapy, including conventional treatment and intense pulsed light (IPL) technique on sleep quality of patients with meibomian gland dysfunction (MGD).Methods:Fifty participants with a clinical diagnosis of MGD were enrolled in this study. Participants underwent three sessions of IPL therapy. There was a 2-week interval between IPL sessions 1 and 2 and 1 month between sessions 2 and 3. Treatment was supplemented with conventional home-based therapy (including lid hygiene, warm compress, eyelid massage, and lid margin scrub) for MGD. Dry eye symptomatology, tear film, and ocular surface parameters were evaluated at baseline (day 0) and days 15, 45, and 75. Sleep quality was assessed before and after the study using Pittsburgh Sleep Quality Index (PSQI).Results:PSQI components improved significantly at day 75 in comparison with the baseline (all P < 0.05). Ocular Surface Disease Index (OSDI) score, noninvasive Keratograph tear break-up time (NIKBUT), fluorescein tear break-up time (FTBUT), meibomian gland expressibility, meibum quality score, and tear osmolarity improved at follow-up visits (P < 0.05). Younger patients showed more improvement in NIKBUT, sleep quality, and duration (P = 0.024, P = 0.047, and P = 0.008). Sleep latency decreased with increased NIKBUT and FTBUT and decreased OSDI score (P = 0.001, P = 0.005, and P = 0.041).Conclusions:The treatment of MGD is effective for improving sleep quality. Younger patients may preferentially benefit from the treatment.

A Single-center Retrospective Trial of a Blink-assisted Eyelid Device in Treating the Signs and Symptoms of Dry Eye.

SIGNIFICANCEThe clinical features of meibomian gland disease include altered tear film stability, damage to the ocular surface, symptoms of ocular surface irritation, and visual fluctuations. Finding an adequate treatment to alleviate a patient's signs and symptoms is vital to caring for those with dry eye disease resulting from meibomian gland disease.PURPOSEThe purpose of this analysis was to determine whether the controlled heating of meibomian glands with the SmartLid devices (TearCare) combined with evacuation of the liquefied meibum using a handheld clearance assistant would improve a patient's dry eye symptoms (as measured by the Standardized Patient Evaluation of Eye Dryness [SPEED] questionnaire) and signs (as measured by meibomian gland expression [MGE] scores).METHODSThis study involved a retrospective analysis of data gathered in a single-center ophthalmology/optometry practice. The symptom frequency and severity were assessed using the SPEED questionnaire, and the signs were assessed via MGE scores before and after (8 to 12 weeks) treatment. A further analysis evaluating efficacy in subgroups based on age, race, and sex was performed. A statistical analysis was performed with t tests for group comparisons.RESULTSA SPEED questionnaire was answered by 92 patients with dry eye disease. In addition, each patient's meibomian gland function was recorded as MGE scores for each eye (176 eyes). These procedures were completed before and approximately 8 weeks after a single bilateral TearCare treatment. The median total SPEED score was reduced from 16 to 9, and the total MGE scores improved from 5.0 to 9.0 in the right eye and 4.0 to 9.0 in the left eye after a single TearCare treatment.CONCLUSIONSA single TearCare treatment was effective in reducing both the signs and symptoms of dry eye in all subjects.

English

BACKGROUND Meibomian gland dysfunction (MGD) is one of the causes of evaporative dry eye disease. It is the terminal duct obstruction of the Meibomian gland and is associated with glandular secretion changes. These changes lead to decreased amount of lipids secretion which accounts for instability of tear film leading to evaporative dry eye disease. Chronic smoking also causes irritative, burning eyes along with unstable tear film. We wanted to study the corelation of chronic smoking with Meibomian gland dysfunction. METHODS This is a hospital based observational cross-sectional study that enrolled a total of 100 subjects having Meibomian gland disease (MGD), out of whom 61 were smokers and 39 were non-smokers. All enrolled subjects underwent tear film breakup time (TBUT), Schirmer I test (SIT) and slit-lamp microscope examination of lid margin abnormalities, Meibomian gland expression as well as meibum. RESULTS Our study found that the patients with Meibomian gland dysfunction with the history of chronic smoking had a remarkably decreased value of tear film break up time (TBUT), Schirmer’s 1 Test which explains the dry eye symptoms as compared to MGD patients without smoking. No significant differences were seen in lid margin irregularity and meibum secretion. Meibomitis is found in 29 smokers with MGD and 5 non-smokers with MGD which is not significant. CONCLUSIONS Chronic smoking is associated with MGD. KEY WORDS Cigarette Smoking, Meibomian Gland Dysfunction, Tear Film Tests

Comparison of intense pulsed light and near-infrared light in the treatment of dry eye disease: a prospective randomized study.

To compare the efficacy of intense pulsed light (IPL) and near-infrared light (NIL) treatments in alleviating symptoms and signs of dry eye disease (DED). Patients diagnosed with DED at the Peking University Third Hospital Eye Center from January 2019 to October 2019 were randomized to undergo either NIL therapy combined with meibomian gland expression (MGX; NIL Group) or IPL combined with MGX (IPL Group). Treatments were performed three times at 1-month intervals. DED signs and symptoms were evaluated before every treatment. We compared the clinical improvement within and between the groups. Additional comparisons were made according to the meibomian gland (MG) dropout grade. A total of 260 eyes of 130 patients (mean age, 49.68 ± 18.01 years) were included. The dryness and total symptom scores and the MG expressibility and secretion quality (upper and lower eyelids) significantly improved after the three treatments in both groups (p < 0.05). However, IPL had superior efficacy in improving blurred vision, photophobia, burning, increased secretions and the total symptom score at 2 months in patients with more severe MG dropout. Both IPL and NIL treatments were effective in the treatment of DED, but IPL provided greater symptom improvement, particularly in patients with severe MG dropout. NIL can be a new therapeutic option for the treatment of DED.

Effects of lid debris debridement combined with meibomian gland expression on the ocular surface MMP-9 levels and clinical outcomes in moderate and severe meibomian gland dysfunction

BackgroundTo evaluate the effects of lid debris debridement and meibomian gland expression (MGX) on extracellular matrix metalloproteinase-9 (MMP-9) levels and clinical outcomes of moderate and severe MGD.MethodsIn this retrospective case series study, a total 48 eyes of 24 patients with moderate and severe MGD underwent one session of lid debris debridement using the BlephEx combined with MGX. We evaluated the tear film break-up time (TBUT), corneal and conjunctival fluorescein staining scores, Schirmer 1 test, biomicroscopic examination of lid margins and meibomian gland (MG), ocular surface disease index (OSDI) questionnaire score, and extracellular MMP-9 levels using a point-of-care MMP-9 immunoassay device before and 4 weeks after lid debris debridement and MGX. Linear mixed model and generalized estimating equations model were used to evaluate possible differences.ResultsThere were significant improvements in the TBUT (P = 0.002), SICCA and Oxford staining scores (all P < 0.001), lid margin telangiectasia (P < 0.001 for upper and lower eyelids), lid thickness (P < 0.001 for upper and lower eyelids), MG orifice plugging (P < 0.001 for upper and lower eyelids), meibum color (P = 0.026 for upper eyelid, P < 0.001 for lower eyelid), meibum consistency (P < 0.001 for upper and lower eyelids), meibum grade (P < 0.001), MGD stage (P < 0.001), and OSDI score (P = 0.002). MMP-9 immunoassay positivity rate significantly decreased from 83.3 to 50.0% 4 weeks after treatment (P = 0.014).ConclusionsIn patients with moderate to severe MGD, lid debris debridement using the BlephEx combined with MGX improved clinical findings, subjective symptoms, meibomian gland function, along with ocular surface MMP-9 level. We hereby suggest lid debris debridement using BlephEx combined with MGX as an effective clinical strategy for treatment of moderate to severe MGD.

Lateral Canthal Sling Procedure for Meibomian Gland Dysfunction? Results of a Pilot Study

ABSTRACT Background: Involutional changes of lid structures often induce horizontal lid laxity; this can result in a reduction of Meibomian gland expression, potentially leading to symptoms of dry eye. The aim of this study was to evaluate the effect of tightening the lower eyelid via a lateral canthal sling (LCS) procedure on dry eye parameters. Methods: Patients with Meibomian Gland Dysfunction (MGD), lower lid laxity (positive Snap-back Test and positive Pinch Test) and no previous lid surgery were evaluated before and 3 months after LCS procedure for symptoms by OSDI. The fellow eye without surgery functioned as a control group. MGD parameters included lipid layer thickness (LLT), non-invasive breakup time (NIBUT), tear meniscus height, loss of Meibomian glands, lid margin parallel conjunctival folds (LIPCOFs), Schirmer’s test, the number of expressible Meibomian glands as well as quality of Meibum. Results: Fourteen patients (8 men and 6 women; 79.2 ± 4.0 years) were enrolled in this prospective clinical study. After 3 months, the OSDI showed a significant reduction (preop 42.9 ± 24.7; postop 23.8 ± 21.6; p = .002); NIBUT (5.5 ± 2.6 s to 9.9 ± 6.8 s p = .08) and LLT (64.3 ± 30.4 to 74.1 ± 27.8; p = .025) improved, while Schirmer Test (15.3 ± 4.7 mm to 11.9 ± 2.9 mm; p = .03) and tear meniscus height were reduced (0.8 ± 0.3 to 0.6 ± 0.2; p = .05). Meibomian gland loss scored by the meiboscale slightly increased postoperatively (1.2 ± 0.9 to 1.4 ± 0.9; p = .18). The number of expressible Meibomian glands improved (4.4 ± 2.6 to 6.8 ± 2.1, p = .002) as well as the quality of Meibum (0.9 ± 1.0 to 0.5 ± 0.8, p = .04). Snap back test as well the pinch test were negative in all patients postoperatively. Conclusion: Addressing lower lid laxity with an LCS procedure simultaneously enhances tear drainage, reduces tear film volume parameters and increases tear film stability results with an improvement of dry eye symptoms. It is likely that increased lower eyelid tension and thus excretory pressure on the Meibomian glands is responsible for these alterations.

Impact of modulus of elasticity of silicone hydrogel contact lenses on meibomian glands morphology and function

ABSTRACT Clinical relevance: It is important to investigate the effect of modulus of silicone hydrogel contact lens on meibomian glands. Evaluating meibomian gland health and function in follow-up appointments should be considered, with the option of changing lens modulus. Background: To evaluate and compare the effect of modulus of elasticity of silicone hydrogel contact lenses on morphological and functional parameters of the meibomian glands. Methods: A prospective study was conducted on soft silicone hydrogel contact lens wearers of different modulus of elasticity and age and gender-matched controls. Morphological and functional parameters were assessed along with standard patient evaluation of the eye dryness questionnaire. Results: A statistically significant difference was noted in meibomian gland loss in the upper lid (percent) between the low modulus (18.23 ± 6.63) and high modulus group (27.40 ± 10.21) (p < 0.001) and between high modulus (27.40 ± 10.21) and non-contact lens wearers (19.57 ± 7.65) (p = 0.001). The current study reported significantly higher total meiboscore grading in the high modulus group 3 (2-3) compared to the low modulus 2(2-3) (p = 0.007) and non-contact lens wearing groups 2 (2-3) (p = 0.012). Meibum quality was significantly compromised in the high modulus group 1 (0-1) compared to the low modulus 0 (0-0.75) group (p = 0.01). Standard patient evaluation of the eye dryness questionnaire was found to be significantly higher (p = 0.01) in high modulus 4 (2-8) compared to low modulus wearers 2 (2-4). A significant difference was noted (p < 0.001) in corneal staining grading only between high modulus 0 (0-1) and non-contact lens wearers 0 (0-0) group. A positive correlation was noted in the low modulus group between total meiboscore and meibomian gland expressibility (Rs = +0.69, p < 0.001) and also noted between standard patient evaluation of the eye dryness questionnaire scoring and meibomian gland expressibility (Rs = +0.45, p = 0.012) in the high modulus group. Conclusion: Higher modulus of elasticity of silicone hydrogel contact lens may influence meibomian gland morphology and function over a period of contact lens wear.

Changes in ocular surface and Meibomian gland after penetrating Keratoplasty

BackgroundTo acquire desirable outcomes of penetrating keratoplasty (PKP), various factors affecting graft survival, visual function, and subjective symptom should be considered. As ocular surface and meibomian gland function are associated with these factors, this study aims to investigate changes of ocular surface and meibomian gland parameters after PKP.MethodsThis retrospective case series study included 24 eyes of 24 patients who underwent penetrating keratoplasty. Examinations on lipid layer thickness (LLT), meiboscore, tear meniscus area (TMA), tear breakup time (TBUT), corneal fluorescein staining (CFS), Schirmer I test (SIT), Ocular Surface Disease Index (OSDI), and meibomian gland functions were performed before and at 1 week, 1 month, 6 months, and 12 months after surgery.ResultsCompared to baseline (2.9 ± 0.6 s), TBUTs were longer at 1 week (4.4 ± 0.5 s, P = 0.027) and 6 months (4.4 ± 0.5, P = 0.048) after surgery. CFS values improved from baseline (6.5 ± 1.1) to 6 months (3.5 ± 0.6, P = 0.023) and 12 months (3.3 ± 0.7, P = 0.001) after surgery. Meibum quality value worsened at 1 week and 12 months after surgery and meibomian gland expressibility value worsened at 1 week and 6 months after surgery compared to baseline. OSDI scores improved at 6 and 12 months after surgery. Meiboscore showed no change throughout the follow up period. The patients with high preoperative meiboscore had worse meibomian gland expressibility at 6 and 12 months and meibum quality at 6 months postoperatively compared to their baseline and to those of patients with low preoperative meiboscore.ConclusionsAfter penetrating keratoplasty, ocular surface parameters including corneal staining, TBUT, and OSDI significantly improved whereas meibomian gland parameters showed deteriorations, which was marked in patients with high preoperative meiboscore. Thus, perioperative management of MGD is recommended for patients who undergo penetrating keratoplasty, especially in patients with advanced MGD.

Anti-demodectic effects of okra eyelid patch in Demodex blepharitis compared with tea tree oil.

Demodex infection gradually develops to Demodex blepharitis, which is characterized as chronic inflammation of the eyelid and meibomian gland (MG) and ultimately leads to MG dysfunction. In the present prospective study, the anti-demodectic effects of an okra eyelid patch in patients Demodex blepharitis were investigated. A total of 52 patients with Demodex blepharitis with ocular discomfort were recruited. Patients were randomized to receive either an okra eyelid patch treatment (treatment group, n=27) or tea tree oil (TTO) eye care patch treatment (control group, n=25) for three months. The Demodex count, the ocular surface disease index (OSDI) score, MG expressibility (MGE) and meibum quality, Schirmer I test (SIT), tear break-up time (TBUT) and corneal fluorescein staining (CFS) were determined prior to treatment and after 1 and 3 months of treatment. Changes in the parameters were compared between the treatment group and control group after 1 and 3 months of treatment. The average survival time in the okra group was 115.25±11.87 min, which was significantly lower compared with the average ST of 378.75±37.94 min in the blank group (P<0.01). After 3 months of okra eyelid patch treatment, the Demodex count was significantly reduced from 10.15±4.53 to 1.30±1.41 (P<0.01) and the OSDI score of the patients was reduced by 16.84±10.17 (P<0.01). There was no significant difference in the Demodex count (P=0.716) and OSDI (P=0.873) between the treatment and control groups. The rate of complete Demodex eradication in the treatment group (11/27, 40.74%) was slightly lower than that in the control group (12/25, 48%), but there was no significant difference between the two groups (χ2=0.277, P=0.598). Regarding the other ocular parameters, no significant difference was observed in the TBUT, meibum quality and MGE between the two groups (P<0.05). TTO group has a significantly improvement compared with Okra group in terms of SIT (P=0.035) and CFS (P=0.023). In conclusion, okra eyelid patch treatment is able to significantly eradicate ocular Demodex as well as markedly alleviate ocular symptoms. Due to causing less irritation than TTO, the okra eyelid patch may be more suitable for sensitive patients with Demodex blepharitis, such as the elderly and children. The study was registered as a clinical trial in the Chinese Clinical Trial Registry (ChiCTR) in November 2018 (registration no. ChiCTR-1,800,019,466).

Relationship Between Eyelid Pressure and Lacrimal Status in Mild Facial Nerve Palsy.

Purpose: Facial nerve palsy is frequently associated with both epiphora and dry eye, and orbicularis oculi muscle weakness or paralysis is the main cause of these symptoms. Eyelid pressure is a quantitatively measurable parameter for evaluating the tone and function of the orbicularis oculi muscle. The aim of this study was to examine the relationship between eyelid pressure and lacrimal status in patients with mild facial nerve palsy.Methods: This prospective, interventional study included 10 patients with unilateral facial nerve palsy. The severity of facial nerve palsy was determined using the CADS scale (cornea, static asymmetry, dynamic function, and synkinesis). Eyelid pressure was measured using a blepharo-tensiometer. Lacrimal status was quantified through tear meniscus height (TMH), clinical assessment of meibomian gland dysfunction (MGD) (eyelid margin abnormalities, Marx line, meibum expression, and loss of meibomian glands), corneal fluorescein staining, tear break-up time, and Schirmer test I results.Results: All 10 patients suffered from mild facial nerve palsy without eyelid ectropion or entropion, or gustatory epiphora. Lower eyelid pressure during forceful eye closure was significantly decreased in affected eyes (P = 0.007), but upper eyelid pressure during forceful eye closure and static upper and lower eyelid pressure were not significantly different between the affected and unaffected sides (P > 0.050). The TMH, MGD, and dry eye measurements showed no significant difference between the affected and unaffected eyes (P > 0.050).Conclusions: Mild facial nerve palsy is associated with decreased lower eyelid pressure during forceful eye closure. However, no other differences in upper eyelid pressure during forceful eye closure, static eyelid pressure, TMH, MGD, or dry eye disease symptoms were noted. These results imply that eyelid pressure slightly decreases due to mild facial nerve palsy, but this change may be clinically negligible.

Comparative Evaluation in Intense Pulsed Light Therapy Combined with or without Meibomian Gland Expression for the Treatment of Meibomian Gland Dysfunction

ABSTRACT Objective To determine whether the combination of meibomian gland expression (MGX) with intense-pulsed light (IPL) has a better efficacy to treat meibomian gland dysfunction (MGD) than IPL alone. Methods One hundred patients with MGD were randomly divided into three groups: MGX, IPL, and IPL+ MGX. Clinical parameters included the Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), noninvasive keratograph tear breakup time (NIBUT), redness, meibomian gland dropout, tear breakup time (TBUT), corneal fluorescent staining (CFS), eyelid margin score, meibomian gland secretion function, and Schirmer I tests were collected before treatment and at 1 and 3 months after treatment. Compare the indexes of each group before and after treatment and also compare the differences of each group on follow-up. Results Compared to the baseline, OSDI, TBUT, and meibomian gland secretion function in IPL group improved throughout the follow-up period (all P < .05) and part of the meibomian gland secretion function increased continuously. OSDI, TBUT, lower eyelid margin scores, and meibomian gland secretion function in IPL + MGX group improved at the both follow-up visits (all P < .05), and continued improvement in meibomian gland secretion function can be observed. Lower meibomian gland dropout and CFS reduced at 1 month and 3 months respectively in IPL ± MGX group (P = .001,P = .001).Compared to IPL group, only CFS has reduction in IPL + MGX group at 1-month (P < .001), CFS, upper and lower MGYCS were improved at the 3 months (P = .037,P = .014, P = .049). Conclusions MGX may have synergistic effect when combined with IPL therapy, and the effect can last at least 3 months.

Efficacité de la lumière pulsée dans le traitement des sécheresses oculaires sévères par dysfonctionnement meibomien

Dry eye syndrome caused by Meibomian gland dysfunction (MGD) is a common disease in the general population and impairs quality of life. Intense Pulsed Light (IPL) has mainly been used in dermatology for the treatment of skin disorders, and more recently for MGD-related dry eye. The objective of our study is to evaluate the efficacy and tolerability of IPL with the E-Eye® device (E-Swin, Houdan, France) in severe MGD-related dry eye patients. This non-comparative study included 20 patients with MGD-related dry eye with a Break-Up Time (BUT)<10seconds, dry eye symptoms >30mm on a Visual Analog Scale (VAS), and failure of lid hygiene and artificial tears. Treatment consisted of 3 sessions of IPL on D0, D15, and D45 (5 flashes of 13J/cm2 per eye). The following parameters were assessed at each visit and at D75: symptoms graded with a VAS and the Standard Patient Assessment of Eye Dryness questionnaire (SPEED), BUT, corneal fluorescein staining, Meibomian gland expression score, meibography, tear film lipid layer thickness by interferometry and the ocular scattering index by double-pass aberrometry (OQAS). Statistical analysis was performed on the eye most affected at baseline. We included 40 eyes of 20 patients, 15 female and 5 male, mean age 47±15 years (24 to 74 years). The symptoms rated by VAS were severe, averaging 69±25mm. After treatment, there was a statistically significant decrease in symptoms, with a 14mm VAS decrease (55±29mm at D75 versus 69mm at D0, P=0.048) and SPEED score of 3.4 (19.0±6mm versus 22.4±4.6, P=0.03). The number of expressible Meibomian gland ducts increased significantly (from 5.9 to 8.1, P=0.04), lid redness decreased (from 1.4 to 0.6, P=NS) and BUT improved (from 4.2 to 5.9, P=NS). Other parameters remained unchanged. Three patients (15%) complained of transient ocular burning after each treatment. IPL appears to be effective in improving signs and symptoms in patients with severe MGD-related dry eye, with a good safety profile. Its exact mechanism of action remains to be elucidated.

Effects of Intense Pulsed Light on Tear Film TGF-β and Microbiome in Ocular Rosacea with Dry Eye.

PurposeTo assess tear film transforming growth factor-beta (TGF-β) and ocular microbiome changes after intense pulsed light with meibomian gland expression (IPL-MGX) vs only MGX in treating ocular rosacea with dry eye symptoms.MethodsTwenty patients were randomly assigned to IPL-MGX or MGX. Patients were examined, treated, and administered the ocular surface disease index (OSDI) survey every 4–6 weeks for four total treatments. Tear film and conjunctival samples were collected at first and last visits, and analyzed for TGF-β concentration and 16s rRNA amplicon sequencing of ocular microbiome. Wilcoxon Rank Sum and Sign-Rank were used to examine changes from baseline.ResultsOSDI revealed significantly greater improvement in symptoms after IPL-MGX (p=0.030) compared to MGX. There was no significant difference in mean TGF-β1, 2, or 3 concentration after IPL-MGX (p=0.385, 0.709, 0.948, respectively). Quantities of Clostridium, Klebsiella, Brevibacterium, Lactobacillus, Neisseria, Streptococcus, Corynebacterium, Butyricicoccus, and Actinomyces were significantly reduced from baseline in both groups but without a significant difference between the two treatment groups.ConclusionIPL-MGX improved dry eye symptoms more than MGX alone. IPL treatment offered no additional benefit to MGX in decreasing virulent bacteria present on the ocular surface and did not influence TGF-β levels in tears. Prospective studies on IPL-MGX with larger sample sizes are needed to further investigate cytokines and IPL in patients suffering from ocular rosacea with dry eye symptoms.ClinicalTrials.gov IdentifierNCT03194698.

Does Sjogren's syndrome affect only the lacrimal gland in the eye? Time to replace the missing stones

Purpose:This study aimed to reveal the cause of meibomian gland disease and meibomian gland loss in patients with Sjögren's syndrome (SS) as the leading factor for dry eyes.Methods:The study included a total of 30 patients with SS and dry eye symptoms and a control group of 50 age- and gender-matched healthy subjects. The dryness parameters of all the participants were evaluated. At first, meibography was performed to measure meibomian gland loss using noninvasive methods. Later, meibomian gland expression and secretion quality were evaluated using silt-lamp biomicroscopy. Correlations between the measurements were analyzed statistically.Results:In patients with SS, MG loss was significantly greater than in the control group (19.7 ± 71%, 12.7 ± 9.6%, P < 0.001). All dry eye parameters (tear film breakup time, Schirmer's test score, OSDI, stain score, dry eye disease) were statistically significant in the SS group. There was an extremely negative correlation between upper MB loss and BUT (P = 0.08, r: 0.781). There was an extremely positive correlation between upper MB loss and staining (P = 0.015, r: 0.739). An extremely negative correlation was determined between sub-MB loss and BUT (P = 0.18, r:-0.781), and a moderately positive significant correlation was found between sub-MB loss and staining (P = 0.031, r: 0.659).Conclusion:The results of this study demonstrated that patients with SS were at a higher risk of being exposed to meibomian gland loss, which directly leads to the severe dry eye symptoms associated with SS.

Characteristics of tear film lipid layer in young dry eye patients

To investigate the characteristics of subjective symptoms and objective parameters among young patients with dry eye disease (DED) and compare them with those of older patients. We retrospectively enrolled 675 patients with DED who were divided into three age groups (20-41 years [younger], 41-60 years [middle], and >60 years [older]) (n=143, 304, and 228, respectively). Subjective symptoms were evaluated using Standardized Patient Evaluation of Eye Dryness (SPEED) and Ocular Surface Disease Index (OSDI) questionnaires. Aqueous tear secretion was evaluated with the Schirmer test II. The number of expressible meibomian glands was evaluated with a slit-lamp-aided standardized evaluator. Lipid layer thickness (LLT), blink/incomplete blink rates and meibography were measured with the LipiView® II interferometer. The extent of the meibomian gland dropout was graded using a meiboscale. The younger age group had higher subjective symptom severity, as reflected by higher SPEED (p<0.001) and OSDI scores (p=0.051). The SPEED scores negatively correlated with LLT in all patients (r=-0.136, p<0.001). Younger patients also had thinner average LLT (p<0.001), lower meiboscale (p<0.001) and a higher number of expressible meibomian glands (p<0.001). Additionally, they had significantly more total blinks (p<0.001), incomplete blinks (p<0.001), and incomplete blink rate (p=0.006). Manifestations of DED vary with age. In our cohort, younger age patients had more symptoms and blinks, which may have resulted from thinner LLT as the structure and function of the meibomian glands were affected less than in middle and older age patients.