Meibomian Gland Score Research Articles

Evaluating the role of Demodex infestation and meibomian gland dysfunction in recurrent corneal erosion syndrome.

This investigation aims to observe the effects of demodex infection and meibomian gland function in recurrent corneal erosion syndrome (RCES), as well as the efficacy of intense pulsed light (IPL) in treating RCES. The study enrolled thirty patients diagnosed with RCES (30 eyes) alongside a control group of thirty-one individuals (31 eyes). Both cohorts underwent a series of diagnostic evaluations, including eyelash sampling, Demodex mite enumeration, infrared imaging of the meibomian glands, and blepharolipin scoring. The RCES subjects were further categorized into two subgroups upon stabilization for comparative analysis of treatment outcomes: the RCES-A subgroup received IPL therapy (16 patients), and the RCES-B subgroup was administered medication treatment (14 patients). Post-treatment, all participants were re-evaluated using the initial diagnostic procedures to monitor for recurrence. Preliminary findings indicated significant differences between the RCES and control groups in terms of meibomian gland scores (4 [3.0, 4.0] vs. 2 [1.0, 3.0]), blepharolipin scores (15.5 [11.0, 16.8] vs. 8.0 [5.5, 10.0]), and lid margin scores (3.0 [2.8, 3.0] vs. 2.0 [1.0, 3.0]), with P < 0.01 for all comparisons. Additionally, the Demodex count was significantly higher in the RCES group (8.0 [4.0,9.0]) compared to the control (0 [0, 2]) (Z = - 4.13, P = 0.00), with a Demodex positivity rate of 83.3% in the RCES group versus 38.7% in the control group (χ2 = 7.60, P < 0.01). Post-treatment, the RCES-A subgroup exhibited significant improvements in meibomian gland loss scores, blepharolipin scores, lid margin abnormality scores, and a reduction in Demodex counts (P < 0.01), with a post-treatment Demodex positivity rate of 56.3% (P = 0.11). During the follow-up, the RCES-A subgroup experienced a lower relapse rate compared to the RCES-B subgroup (1 vs. 6 patients). The findings suggest a correlation between meibomian gland dysfunction and Demodex infestation with the incidence of RCES. The application of IPL therapy in combination with meibomian gland massage demonstrates significant potential in enhancing meibomian gland functionality, reducing Demodex counts, and effectively mitigating the recurrence of RCES. Clinical trial registration: https://www.chictr.org.cn/ ChiCTR2000039494 (30/10/2020).

A protocol for a single center, randomized, controlled trial assessing the effects of spectacles or orthokeratology on dry eye parameters in children and adolescents

BackgroundThe prevalence of myopia among adolescents is increasing precipitously in China, and the popularity of orthokeratology (OK) lenses as an effective treatment for controlling myopia progression is rising. This protocol assessed and compared the clinical dry eye parameters in children and adolescents with myopia treated with spectacles or OK lenses. Methods and analysisThis single-masked randomized control trial will include 300 participants (aged 8–17 years) with myopia treated with OK lens (study group) or spectacles (control group). We will record the ocular surface disease index, visual analog scale score, noninvasive tear breakup time, tear meniscus height, meibomian gland score, ocular redness score, visual acuity, tear Matrix Metalloproteinase-9 concentration, tear Lymphotoxin alpha levels at baseline, and after 1-, 3-, 6-, and 12-month. DiscussionThis study will be a standardized, scientific, clinical trial designed to evaluate the dry eye parameters in children and adolescents with myopia treated with OK lenses for myopia control. Ethics and disseminationThis study has been approved by the Ethics Committee of He Eye Specialist Hospital [ethics approval number: IRB(2023)K024.01]. Before participating in the trial, written informed consent will be obtained from all patient's parents or guardians. The findings of this study will be showcased at both local and international conferences and will also be submitted for publication in reputable peer-reviewed journals. Trial registration numberClinicaltrials.gov: NCT06023108 {2a, 2b}

Evidence-Based Strategies for Warm Compress Therapy in Meibomian Gland Dysfunction.

Despite promising results from technological therapies like intense pulsed light application, warm compress therapy is a mainstay in meibomian gland dysfunction (MGD). However, applying warm compresses (WC) to the eyelids is palliative rather than curative and not always dispensed with specific instructions. The range of eyelid warming treatments available and lack of clear directives for use creates uncertainty for patients accustomed to explicit dosage information. This report examines data from clinical studies across the past 20years to identify effective protocols for three types of WC-hot towel, microwavable eye mask, and self-heating eye mask (EM). Literature search for studies on WC and MGD published between 2004 and 2023 in English was conducted. Studies wherein hot towel, microwavable EM, and self-heating EM were used in a treatment arm were included and those wherein they served only as control or were used in conjunction with another intervention were excluded. 20 resulting studies were separated into 3 groups: 5 on temperature profiles of WC, 6 with single application of WC, and 9 with repeated applications. Study methods and outcomes were tabulated, and a qualitative review was performed, attending to WC protocol and efficacy, as indicated by measures of tear film, meibomian gland health, and dry eye questionnaires. Data from the aforementioned studies revealed that each method can achieve target eyelid temperature of 40°C. A single application of WC-ranging from 5 to 20min-can significantly improve tear quality, while repeated applications significantly relieve symptoms associated with dry eyes from MGD and, in most studies, significantly improve meibomian gland health. Hot towels, however, require frequent reheating to maintain eyelid temperatures above 40°C, rendering them relatively ineffective in longitudinal studies. Microwavable EM retain heat well across 10min and were found to improve tear break-up time and/or meibomian gland score. Self-heating EM have variable activation times and were typically applied for longer periods, showing benefits akin to microwavable EM in short-term studies. Studies monitoring compliance indicate greater deviation from protocol with higher application frequencies or longer-term use. Evidence suggests superior heat retention and therapeutic effects on specific contributing factors in MGD (such as Demodex) with moist-heat compress. Considering decreased patience adherence to therapy with increased usage frequencies, and balancing needs to provide succinct instructions for various compress types, an advisable strategy is for patients to apply a moist-heat generating EM (microwavable or self-heating) to each eye for at least 10min, prepared according to manufacturer's instructions.

Dry eye disease as an occupational risk factor in operating room nurses

ABSTRACT Clinical relevance Knowing occupational risks in a multifactorial disease such as dry eye disease is important for disease diagnosis and treatment. Background Dry eye disease (DED) is a multifactorial disease of the ocular surface characterised by tear film instability, adversely affecting visual function and quality of life. The operating room environment has many risk factors for DED such as air conditioning, constant humidity, constant room temperature, intense lighting, surgical smoke, anaesthetic gases and irritating chemicals, and prolonged mask use. This study investigates the ocular surface findings and blink patterns of operating room nurses at risk of DED. Methods A total of 68 nurses (operating room, n = 34; outpatient clinic, n = 34) were included in this study. The diagnosis of DED was assessed using a questionnaire, best-corrected visual acuity, tear break-up time, corneal fluorescein staining, meibomian gland assessment, Schirmer I test. All the tests were conducted in the same area. Results According to the ocular surface disease index, the rate of dry eye symptoms was significantly higher among operating room nurses than among outpatient nurses (70.5% vs 41.1%). Severe dry eye symptoms were more common in the operating room group. The meibomian gland score was higher in the operating room group (29.4% vs 5.9%). The numbers of blinks (30.91 ± 12.81 vs 21.05 ± 7.77) and incomplete blinks (8.76 ± 4.68 vs 5.76 ± 3.20) at rest were higher in operating room nurses. Conclusion The occupational risk for DED was high among operating room staff. National and international standards for the prevention and management of DED in personnel involved in health care services are needed.

The ILux® compared to the mechanical meibomian gland expression for the treatment of moderate and severe meibomian gland dysfunction.

To compare the safety and effectiveness of eyelid treatment with the ILux®-MGD Treatment System in one session versus five sessions of mechanical meibomian gland expression (MMGE) in patients with moderate to severe meibomian gland dysfunction (MGD). A prospective, randomized, open-label, and controlled clinical trial that compared one session of the ILux® MGD Treatment System versus five sessions of MMGE in both eyes of 130 patients aged ≥18y with Ocular Surface Disease Index (OSDI) scores ≥13, total meibomian gland scores (MGS) of <15 in the lower eyelid of each eye, and non-invasive tear break-up time (NI-TBUT) <10s, who were randomized 1:1 to ILux® or MMGE. The mean age was 58±17.49y. Baseline total MGS scores in both treatment groups were comparable. During follow-up, there were significant differences in total MGS and per sector with P<0.001. Multivariate analysis was performed using generalized estimating equations corresponding to the generalized linear model for repeated means to determine the treatment relationship with total MGS, NIBUT, and OSDI. There was a significant difference between ILux® and MMGE (P<0.001) at follow-up from the first to the twelfth month in MGS, NI-BUT, and OSDI scores. No adverse events were reported. ILux® treatment compared to MMGE significantly improves symptoms and signs in patients with moderate to severe MGD for one year without adverse events.

MGrx - A Novel Multi-modal Thermal Device for Treating Moderate to Severe Meibomian Gland Dysfunction and Dry Eye

Background: MGD (meibomian gland dysfunction) is a chronic cause of dry eyes. Thermal expression of the meibomian glands, along with massage and debridement, is an effective treatment for MGD. Objective: We describe a multi-modal thermal device (MGrx) to manage meibomian gland dysfunction (MGD). We observed the efficacy and safety of the MGrx to manage MGD in one 15-minute in-office session. Methods: We enrolled 37 patients in a prospective, open-label trial of the novel MGrx. Patients were enrolled with a Standard Patient Evaluation for Eye Dryness (SPEED) score &gt; 12 or a Tear Breakup Time (TBUT) of &lt; 6 seconds in at least one eye. After screening for eligibility, one 15-minute MGrx treatment was provided to each patient. The patient assessment consisted of a SPEED score, TBUT, and a Meibomian gland score (MGS) obtained pre-treatment and at a follow-up visit 30 days after the treatment. Results: Dry eye symptoms improved in the patient population, as measured by SPEED score, MGS, and TBUT, by 40%, 341%, and 145%, respectively (p&lt;0.05). No adverse reactions were noted among the patients. Conclusion: A single 15-minute MGrx treatment was effective at significantly improving dry eye symptoms secondary to MGD in adult patients, as measured by SPEED score. Additionally, a single MGrx treatment improved meibomian gland function and all measures of MGD in the adult patients treated. Given the relatively low risk and efficient delivery of the MGrx treatment, a single MGrx treatment should be considered as a first-line treatment for MGD.

Short-term application of diquafosol ophthalmic solution benefits children with dry eye wearing orthokeratology lens.

This aim of this study was to evaluate the effect of 3% Diquafosol Ophthalmic Solution (DQS) on children with dry eye from wearing overnight orthokeratology (OrthoK) lenses. Myopic children aged 8-18 years with dry eye syndrome were enrolled in this prospective observational study, and they were grouped according to their OrthoK treatment history for at least 1 year. All participants received DQS 4 times per day for 1 month. The following indicators were measured at baseline 1 month after treatment: the Dry Eye Questionnaire-5 (DEQ-5), non-invasive tear meniscus height (TMH), non-invasive tear film break-up time (first and average, NIBUT-F and NIBUT-A), meibomian gland score (MG score), conjunctival hyperemia redness score (R-scan), and blink pattern analysis. A total of 104 participants (189 eyes) including 40 OrthoK wearers (72 eyes) and 64 Orthok candidates (117 eyes) completed the study. Of all, after DQS treatment for 1 month, DEQ-5 scores reduced from 5.54 ± 3.25 to 3.85 ± 2.98 (t = -3.36, p = 0.00). TMH increased from 0.20 ± 0.05 mm to 0.21 ± 0.05 mm (t = 2.59, p = 0.01), NIBUT-F and NIBUT-A were prolonged from 6.67 ± 4.71 s to 10.32 ± 6.19 s and from 8.86 ± 5.25 s to 13.30 ± 6.03 s (all p = 0.00), respectively. R-scan decreased from 0.69 ± 0.28 to 0.50 ± 0.25 (t = -9.01, p = 0.00). Upper MG scores decreased from 1.04 ± 0.32 to 0.97 ± 0.36 (t = -2.14, p = 0.03). Lower MG scores, partial blink rate, partial blinks, and total blinks did not change significantly. Both break-up time (BUT) and R-scan improved significantly after DQS treatment for 1 month (all p = 0.00) in OrthoK candidates and OrthoK wearers. Among the OrthoK wearers, TMH and dry eye symptoms increased significantly (all p = 0.00) but did not increase in OrthoK candidates (p > 0.05). There were no adverse events related to DQS. Diquafosol Ophthalmic Solution was effective for children wearing overnight orthokeratology in relieving dry eye symptoms and improving ocular surface parameters, which may help improve children's OrthoK wearing tolerance and compliance.

Preoperative Treatment of Meibomian Gland Dysfunction with a Vectored Thermal Pulsation System Prior to Extended Depth of Focus IOL Implantation.

Patients implanted with a range-of-vision intraocular lens (IOL) (multifocal or extended depth of focus, EDOF) may be more susceptible to visual disturbances from poor tear film quality, and prophylactic treatment of meibomian gland dysfunction (MGD) has been recommended. The purpose was to evaluate whether vectored thermal pulsation (LipiFlow™) treatment prior to cataract surgery with a range-of-vision IOL safely improves postoperative outcomes. This is a prospective, randomized, open-label, crossover, multicenter study of patients with mild-to-moderate MGD and cataract. The test group underwent LipiFlow treatment prior to cataract surgery and implantation of an EDOF IOL, while the control group did not. Both groups were evaluated 3months postoperatively, after which the control group received LipiFlow treatment (crossover). The control group was re-evaluated 4months postoperatively. A total of 121 subjects were randomized, with 117 eyes in the test group and 115 eyes in the control group. At 3months after surgery, the test group had a significantly greater improvement from baseline in total meibomian gland score compared with the control group (P = 0.046). At 1month after surgery, the test group had a significant decrease in corneal (P = 0.04) and conjunctival (P = 0.002) staining compared to the control group. At 3months after surgery, the test group had significantly lower incidence of being bothered by halos compared with the control group (P = 0.019). The control group had a significantly lower incidence of being bothered by multiple or double vision compared with the test group (P = 0.016). After crossover, patients had significant improvement in vision (P = 0.03) and total meibomian gland score (P < 0.0001). No safety concerns or relevant safety findings were uncovered. Presurgical LipiFlow treatment of patients implanted with range-of-vision IOLs improved meibomian gland function and postoperative ocular surface health. This supports guidelines recommending proactive diagnosis and management of MGD in patients with cataracts to improve patient experience. The study was registered on www. gov (NCT03708367).

The Effects of Spectacles or Orthokeratology on the Tear Film in Children and Adolescents.

Myopia prevalence among adolescents is increasing annually. While orthokeratology (OK) is effective for controlling myopia progression, it may also be detrimental. We investigated tear film parameters [including tear mucin 5AC (MUC5AC) concentration] in children and adolescents with myopia treated with spectacles or OK compared with those with emmetropia. This prospective case-control study enrolled children (aged 8-12years; 29 and 39 with myopia treated with OK and spectacles, respectively, and 25 with emmetropia) and adolescents (aged 13-18years; 38 and 30 with myopia treated with OK and spectacles, respectively, and 18 with emmetropia). We recorded the ocular surface disease index (OSDI), visual analog scale (VAS) score, tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), meibomian gland score (meiboscore), ocular redness score, and tear MUC5AC concentration in the emmetropia, spectacle (after 12months of spectacle wearing), and OK (baseline, and after 1-, 3-, 6-, and 12-month use) groups. We observed changes from baseline to 12months in the OK group and compared parameters among the spectacle, 12-month OK, and emmetropia groups. The 12-month OK group differed significantly from the spectacle and emmetropia groups in most indicators among children and adolescents (P < 0.05). Differences were not noticeable between the spectacle and emmetropia groups (only PVAS < 0.05 among the children). In the OK group, the 12-month NIBUT was significantly decreased (P < 0.05) in both age groups; the upper meiboscore was increased at 6 and 12months (both P < 0.05) among children; ocular redness scores were higher at 12months than at baseline (P = 0.007), 1month (P < 0.001), and 3months (P = 0.007) among children; and the MUC5AC concentration was decreased at 6 and 12months among adolescents, but only at 12months among children (all P < 0.05). Long-term OK can negatively influence the tear film in children and adolescents. Moreover, changes are masked by spectacle wearing. This trial is registered with "ChiCTR2100049384."

Transcutaneous Radiofrequency-mediated Meibomian Gland Expression is an Effective Treatment for Dry Eye: A Prospective Cohort Trial

Purpose: Meibomian gland dysfunction disrupts tear film homeostasis and results in dry eye syndrome. The objective of this study is to determine whether transcutaneous radiofrequency (RF)-assisted meibomian gland expression, using the Envision platform and Forma-I handpiece is an effective treatment for dry eye syndrome. Methods: A multicenter prospective cohort study of patients with dry eye undergoing RF-assisted meibomian gland expression was completed from October 2019 to June 2022. The study was designed with multiple primary endpoints. These were defined as the change in Standard Patient Evaluation of Eye Dryness (SPEED) score, changes in Ocular Surface Disease Index (OSDI), Tear Breakup Time (TBUT), Corneal Fluorescence Score (CFS), and Meibomian Gland Score (MGS) at 1, 3, and 6 months after treatment. Secondary endpoints were measurements of patients' subjective improvement and subjective satisfaction with the treatment. Results: A total number of 47 patients were enrolled in the study at three separate institutions by three ophthalmologists (oculoplastics, refractive, and general). However, not all subjects had complete data on all observations at all time points following treatment. When a data point was missing, the entire patient’s outcome for that data set was excluded from the analysis. There was a significant improvement in SPEED score from baseline, 15.7 vs 11.4 at 1 month, 9.1 at 3 months, and 9.6 at 6 months (p&lt;0.05). There was also a statistically significant improvement noted for OSDI at all time points measured, 34.5 at baseline vs 25.2 at 1 month, 21.2 at 3 months, and 23.6 at 6 months (p&lt;0.5). CFS was significantly reduced in each eye at all time points following treatment as well, with 80% of eyes responding. TBUT similarly improved after treatment in each eye with an average of 6.3s at 1 month, 7.1s at 3 months, and 7.1s after treatment at 6 months vs 2.8s at baseline. The MGS also showed marked improvement across all time points, 5.6 at baseline vs 19.9 at 1 month, 24.7 at 3 months, and 22.9 at 6 months. Patients noted subjective improvement, with a lack of pain and discomfort from the treatment. Conclusion: This pilot study demonstrates that RF treatment with the Forma-I handpiece along with meibomian gland expression is an effective means to reduce the signs and symptoms of dry eye disease. The data support the conclusion that the treatment is safe and effective, lasting at least 6 months in most patients.

Tear instability in the fellow eye of unilateral nasolacrimal obstruction and resolution with dacryocystorhinostomy

ABSTRACT Purpose To determine the effect of unilateral primary acquired nasolacrimal obstruction (PANDO) on ocular surface parameters in PANDOeyes and fellow eyes and changes in these parameters after dacryocystorhinostomy. Methods Tear osmolarity, tear break-up time (TBUT), Schirmer’s test, Meibomian gland score, and Lissamine Green staining of PANDO eyes and fellow eyes were measured preoperatively and postoperatively at Day 15, 1 month, and 3 months. Lacrimal irrigation and epiphora symptomatology were evaluated at all follow-up visits, and patients who did not meet surgical success criteria were excluded from the study. Results Twenty-nine patients who underwent successful dacryocystorhinostomy surgery were included in the study. Preoperative and postoperative Day 15 Schirmer (p = .019, p = .001) and TBUT (p = .039, p = .043) were significantly lower in the fellow eye compared to PANDO eyes. The differences observed between PANDO eyes and fellow eyes in all other parameters were not significant (p > .05). Preoperatively PANDO eye parameters were normal, whereas TBUT (7.59 ± 5.39 s) and tear osmolarity (308.59 ± 17.32 mOsm/L) values of the fellow eye may be indicative of tear film instability. TBUT and tear osmolarity of the fellow eye showed significant improvement 3 months postoperatively compared to preoperative values (p = .010; p = .027 respectively). Conclusion Schirmer and TBUT values of the fellow eye were significantly lower than PANDO eyes preoperatively, one month after surgery there was no significant difference. TBUT and tear osmolarity of the fellow eyes may be indicative of tear instability preoperatively with improvement 3 months after dacryocystorhinostomy.

Intense pulsed light improves signs and symptoms of dry eye disease due to meibomian gland dysfunction: A randomized controlled study.

PurposeTo compare the safety and efficacy of intense pulsed light (IPL) followed by meibomian gland expression (MGX), against monotherapy of MGX.MethodsPatients with moderate to severe meibomian gland dysfunction (MGD) were 1:1 randomized to 4 sessions of intense pulse light + MGX at 2-week intervals, or 4 sessions of Sham + MGX at 2-week intervals. Both patients and examiners were blinded to the allocation. Outcome measures, evaluated at the baseline (BL) and at a follow-up (FU) conducted 4 weeks after the last IPL session, included fluorescein tear breakup time (TBUT) as the primary outcome measure, OSDI (Ocular Surface Disease Index) questionnaire, Eye Dryness Score (EDS, a visual analog scale (VAS)-based questionnaire), Meibomian gland score (MGS, a score of meibum expressibility and quality in 15 glands on the lower eyelid), daily use of artificial tears, and daily use of warm compresses. In addition, during each treatment session, the number of expressible glands was counted in both eyelids, the predominant quality of meibum was estimated in both eyelids, and the level of pain/discomfort due to MGX and IPL was recorded.ResultsTBUT increased from 3.8±0.2 (μ±standard error of mean (SEM)) to 4.5±0.3 seconds in the control arm, and from 4.0±0.2 to 6.0±0.3 in the study arm. The difference between arms was statistically significant (P < .01). Other signs/symptoms which improved in both arms but were greater in the study arm included MGS (P < .001), EDS (P < .01), the number of expressible glands in the lower eyelids (P < .0001) and upper eyelid (P < .0001), the predominant meibum quality in the lower eyelid (P < .0001) and upper eyelid (P < .0001), and the level of pain due to MGX (P < .0001). Outcome measures which improved in both arms with no significant differences between the two were OSDI (P = .9984), and the daily use of artificial tears (P = .8216). Meibography, daily use of warm compresses, and severity of skin rosacea did not show statistically significant changes in either arm. No serious adverse events were observed. There was a slight tendency for more adverse events in the control group (P = 0.06).ConclusionsThe results of this study suggest that, in patients with moderate to severe symptoms, combination therapy of intense pulse light (IPL) and meibomian gland expression (MGX) could be a safe and useful approach for improving signs of dry eye disease (DED) due to meibomian gland dysfunction (MGD). Future studies are needed to elucidate if and how such improvements can be generalized to different severity levels of MGD.

Comparison of Two Thermal Pulsation Systems in the Treatment of Meibomian Gland Dysfunction: A Randomized, Multicenter Study.

Given the significance of meibomian gland dysfunction subjects in evaporative dry eye, its chronic and progressive nature, limited promising treatment options, and novel treatment techniques are important. This randomized clinical study evaluated the noninferiority of SYSTANE iLux with LipiFlow in meibomian gland dysfunction treatment at 12 months. This study aimed to demonstrate noninferiority of SYSTANE iLux compared with LipiFlow at 12 months after single treatment in meibomian gland dysfunction subjects with evaporative dry eye. In this prospective, randomized, multicenter, assessor-masked, parallel-group trial, subjects (N = 236; aged ≥18 years) with meibomian gland score (MGS) of ≤12 in lower eyelids, noninvasive tear breakup time (NITBUT; first breakup) of <10 seconds, and Impact of Dry Eye on Everyday Life-Symptom Bother (IDEEL-SB) module score of >16 were randomized (1:1) to receive SYSTANE iLux (n = 119) or LipiFlow (n = 117). Subjects attended a total of eight visits, including screening, treatment, and follow-up visits at 2 weeks and at 1, 3, 6, 9, and 12 months/exit, to evaluate change from baseline in MGS, NITBUT, IDEEL-SB module score, and safety outcomes. A total of 227 subjects completed the study (mean ± standard deviation age, 57.3 ± 13.8 years). At 12 months, least squares mean change from baseline in MGS was similar between iLux and LipiFlow (17.4 ± 1.97 vs. 17.8 ± 1.98). Noninferiority of SYSTANE iLux compared with LipiFlow in change from baseline in MGS (95% lower confidence limit of least squares mean difference, >-5), NITBUT (>-2.5 seconds), and IDEEL-SB score (95% upper confidence limit, <12) was achieved at all post-treatment visits. No other serious ocular or device-related adverse events were reported. The treatment outcomes with SYSTANE iLux were noninferior to LipiFlow during the 12-month follow-up in subjects with dry eye-associated meibomian gland dysfunction.

The Effect and the Mechanism of Comprehensive Treatment on the Ocular Surface and the Visual Quality of Online Teachers with a Mild-to-Moderate Dry Eye Condition During the Early Phase of Coronavirus Disease 2019.

ObjectiveTo investigate the effect of comprehensive treatment on ocular surface function and the visual quality of online teachers with a mild-to-moderate dry eye condition during the early phase of coronavirus disease 2019 (COVID-19).MethodsSecondary school online teachers diagnosed with a mild-to-moderate dry eye disease in our outpatient clinic from February to May 2020 were enrolled in this retrospective cross-section study, and all patients received dry eye comprehensive treatment. A questionnaire survey on eye-use habits, visual quality and dry eye-related indicators was collected before and after treatment (2 and 4 weeks). The changes and the correlations between indicators before and after treatment were compared.ResultsA total of 30 patients (15 females and 15 males) were included. After comprehensive treatment, patients had significantly higher central tear meniscus height (TMH), non-invasive first tear film breakup time (NIBUTf) and non-invasive average tear film breakup time (NIBUTav) than those before with statistical significance (P < 0.05). Lower ocular surface disease index (OSDI) and Meibomian gland scores were observed after treatment with statistical significance (P < 0.05). Objective scatter index (OSI), modulation transfer function (MTF) cutoff, strehl ratio (SR), and tear film objective scatter index (TF-OSI) were significantly improved after treatment (P < 0.05). Besides, TF-OSI was positively correlated with the changes in OSDI, Meibomian gland score, eye-use duration and OSI with statistical significance (P < 0.05), while it was negatively correlated with NIBUTf, NIBUTav, the TMH of the central lower eyelid, SR, sleep duration, conjunctival congestion and the MTF cutoff (P < 0.05), respectively. No correlation between TF-OSI and ciliary congestion was found (P > 0.05).ConclusionComprehensive treatment could effectively improve the symptoms and visual quality of online teachers with a mild-to-moderate dry eye condition during the early stage of COVID-19 pandemic.

Assessment of the efficacy of platelet-rich plasma injections in the management of severe dry eye

Purpose This study aimed to assess the efficacy of a platelet-rich plasma (PRP) injection into the lacrimal gland in severe dry eye and to compare it with preservative-free artificial tears. Patients and methods This study included a total of 74 eyes of 40 patients divided into two groups. The intervention group received three PRP injections transcutaneously in the region of the lacrimal gland. The control group was treated with preservative-free artificial tears. Results The intervention group showed improvement in all measured parameters, except the Meibomian gland score, with a statistically significant improvement in the Ocular Surface Disease Index (OSDI) score (P&lt;0.001) and the Schirmer test (P=0.011) and less significant improvement in the ocular surface staining score (P=0.076) and tear breakup time (TBUT) (P=0.09). Compared with the control group, the PRP intervention group showed a statistically significant improvement in the OSDI score (P&lt;0.001), the Schirmer test (P=0.005) and the ocular surface staining score (P=0.013) and less significant improvement in TBUT (P=0.2). Conclusion The use of PRP injections is safe and effective, with improvement in the OSDI, Schirmer test, and ocular surface staining and less improvement in TBUT, but it is not effective in improving Meibomian gland function.

Evaluation of ocular surface and meibomian glands in patients with uveitis related to oligoarticular juvenile idiopathic arthritis.

To evaluate ocular surface changes and meibomian gland scores in patients with oligoarticular juvenile idiopathic arthritis. This prospective study was conducted at Ege University School of Medicine, Department of Ophthalmology. A total of 34 eyes of 17 patients with oligoarticular juvenile idiopathic arthritis and 30 right eyes of 30 age and gender-matched healthy subjects were included. Besides ophthalmic examination Schirmer 1 test, tear film break up time, Oxford staining scale and meibography were performed. There was no statistically significant differences between groups in terms of age, mean intraocular pressure, mean Schirmer 1 test value, tear film break up time and Oxford staining score. The median upper and lower eyelid meiboscore were 1 ± 0.60 (IQR = 1), and 0 ± 0.34 (IQR = 0) in Group 1, and they were 1 ± 0.56 (IQR = 0), 1 ± 0.12 (IQR = 1) in Group 2. Also, mean upper and lower meiboscores were statistically similar (p values 0.068 and 0.545, respectively). However, the median total meiboscore was 1 ± 0.42 (IQR = 1) in Group 1 and 1 ± 0.66 (IQR = 1) in Group 2. The difference was statistically significant (p = 0.041). Aqueous-deficient dry eye is a well-known condition in patients with rheumatologic diseases. However, evaporative dry eye and meibomian glands were not studied earlier. The current study demonstrated that total meiboscores of oligoarticular juvenile idiopathic arthritis patients are higher than normal subjects, which indicates a possible evaporative dry eye tendency in this entity.

Efficacy of Self-Administration of a Personal Mechanical Eyelid Device for the Treatment of Dry Eye Disease, Blepharitis and Meibomian Gland Disease

PurposeA prospective study to evaluate the safety and efficacy of a novel mechanical eyelid device (NuLidsTM by NuSight Medical, LLC, Rancho Santa Fe, CA) used at home for the treatment of dry eye disease (DED), blepharitis (anterior and posterior) and meibomian gland disease (MGD).&#x0D; MethodsSeventy-four (74) eyes of thirty-seven (37) patients were self-treated with the NuLidsTM device at home. Inclusion criteria included blepharitis, MGD and/or DED. After an initial training session, each eyelid was treated for 15 seconds (total of 1 minute per treatment session per day). The following tests were collected before the first treatment and after the final treatment: OSDI survey, BCVA, Tear Osmolarity Test (Tear Lab), Tear Break Up Time (TBUT), Meibomian Gland Score (MGS), Meibomian Glands Yielding Liquid Secre-tions (MGYLS), Sicca Ocular Staining Score. Satisfaction with treatment survey was taken after treatment.&#x0D; ResultsAll measured parameters had a statistically significant improvement. Symptoms improved based on an average decrease in OSDI score from 54.2 ± 19.5 (mean ± SD) to 26.7 ± 18.4 (P &lt; 0.001). Tear osmolarity improved from 315 ± 15.7 to 306 ± 13.9 (P = 0.002). TBUT was noted to improve from pre-treatment of 4.8 ± 1.7 seconds to post-treatment of 7.9 ± 4.1 seconds (P &lt; 0.001). MGS improved from 8.9 ± 5.1 to 7.0 ± 5.9 (P = 0.01). MGYLS improved from 8.7 ± 6.2 to 15.8 ± 6.9 (P = 0.002). Sicca Ocular Staining Score improved from 2.7 ± 2.1 to 1.4 ± 1.5 (P = 0.002).There were no adverse events. No corneal or conjunctival trauma. No patients dropped out of the trial due to discomfort. 91% of participants agreed or strongly agreed that the device was easy and convenient to use. Of those previously using manual lid scrubs, 82% felt the NuLids device was easier and more comfortable to use. 89% described little or no discomfort. 95% were satisfied or very satisfied with the overall treatment.&#x0D; ConclusionsA mechanical device was safely used by patients at home for 1 minute daily for 30 days to treat DED, blepharitis, and MGD. There was a statistically significant improvement in signs and symptoms of DED as shown by improved OSDI, tear osmolarity, TBUT, MGS, MGYLS, and Ocular Staining Score. High patient satisfaction along with the low risk of adverse events supports the use of this device as a valid tool to treat DED, blepharitis, and MGD.

Diagnostic Value of Lip Mucosal Impression Cytology and &lt;i&gt;in vivo&lt;/i&gt; Confocal Microscopy in Primary Sjogren's Syndrome

Background: Labial gland biopsies play a significant role in diagnosing primary Sjogren's syndrome (pSS) but their clinical use is limited because of their invasiveness. We assessed the value of impression cytology (IC) and in vivo confocal microscopy (IVCM) for diagnosing pSS. Methods: Consecutive patients with clinically suspected pSS (n = 102) were enrolled. According to the American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) criteria, all patients underwent labial gland biopsies, serum anti-Sjogren's syndrome A (SSA)/Ro antibody testing, Schirmer's tests (STs), corneal staining and unstimulated whole saliva flow (UWS) determinations. The patients were divided into pSS (n = 28) and control (n = 74) groups, all underwent lip mucosa IC and IVCM analyses. The salivary gland ultrasonography (SGUS) score, ocular surface disease index (OSDI), tear meniscus height (TMH), tear film breakup time (BUT), and meibomian gland score were recorded. The associations between IC/IVCM parameters and clinical/laboratory results were analyzed. Findings: The absolute agreements between lip mucosal IC and the ACR-EULAR criteria (98·04%)/ labial gland biopsy (97·06%) were good. A combination of IC and anti-SSA/Ro antibody determination showed high predictive value for diagnosing pSS. Compared with controls, IVCM revealed significant lip mucosal epithelium thinning and lamina propria atrophy in the pSS group (both, P < 0·001). The sensitivities for diagnosing pSS corresponding to a lamina propria thickness ≤126 μm and a gland diameter ≤90 μm were both 85·71%; the specificities were 90·54% and 100%, respectively. A combination of IVCM results and anti-SSA/Ro antibody results showed high predictive value for diagnosing pSS. Interpretation: Characteristic cellular and morphological changes of lip mucosa in patients with pSS could be detected by IC and IVCM. These noninvasive and easy-to-perform examinations may be an alternative to labial gland biopsies for diagnosing pSS. Funding Statement: This study was supported by a grant from the Beijing Health and Family Planning Commission, Capital’s Funds for Health Improvement and Research [Grant numbers: CFH2018-2-4093]. Declaration of Interests: The authors state: None of the authors have any conflicts of interest to report. Ethics Approval Statement: The study was performed according to the principles of the Declaration of Helsinki and was approved by the Human Research and Ethics Committee, Peking University Third Hospital; written informed consent was obtained from each study participant.

TearCare® system extension study: evaluation of the safety, effectiveness, and durability through 12 months of a second TearCare® treatment on subjects with dry eye disease.

PurposeEvaluation of the safety and effectiveness of a TearCare® retreatment in adult subjects with clinically significant dry eye disease (DED).Patients and methodsThis was an extension of an initial 6-month, prospective, single-center, randomized, parallel-group pilot study. In the initial study, subjects with DED were randomized to either a single TearCare® treatment or 4 weeks of daily warm compress therapy. The extension study involved retreatment of those subjects assigned to the TearCare® treatment group following the initial 6-month end point. At 6 months, subjects were evaluated for the clinical signs and symptoms of DED prior to retreatment in the extension study that would measure the safety, effectiveness, and durability of a TearCare® retreatment for another 6 months through a 12-month end point. The TearCare® retreatment procedure consisted of 12 minutes of thermal eyelid treatment immediately followed by manual meibomian gland clearance. The primary effectiveness end point was the change in tear break-up time (TBUT) from baseline to 1-month follow-up. Secondary end points included meibomian gland scores, corneal and conjunctival staining scores, and assessment of dry eye symptoms. Safety was evaluated through monitoring intraocular pressure, best-corrected visual acuity, and device-related adverse events.ResultsTwelve subjects participated in the 6-month extension study. At 1-month clinic visit following retreatment, a significant improvement from baseline in mean (± SD) TBUT of 12.4 (±3.3) seconds was observed (P<0.001). Significant improvements in the mean change from baseline in meibomian gland scores, corneal and conjunctival staining scores, and symptoms of DED were also observed following retreatment. The second treatment was well tolerated.ConclusionThe findings of the extension study through 12 months suggest that a second TearCare® treatment after 6 months provides additional improvement in the signs and symptoms of DED.

An Eyelid Warming Device for the Management of Meibomian Gland Dysfunction

PurposeTo determine the effectiveness of the MGDRx EyeBag in managing meibomian gland dysfunction. MethodsThis was a prospective, randomized, controlled, observer-masked, bilateral eye study that enrolled 29 participants. Participants were randomized into either the EyeBag group or the control group. The EyeBag group used the EyeBag 10minutes 2x/day, and the control group remained on their own dry eye treatment regimen (if applicable). All participants were observed at baseline, 2 weeks (2wk) and 4 weeks (4wk). At 4wk, participants in the EyeBag group were asked to stop using the EyeBag. All participants were seen again at 8 weeks (8wk). Primary outcomes were the Ocular Surface Disease Index (OSDI), Current Symptoms Questionnaire (CSQ), meibomian gland score (MG score), and non-invasive tear breakup time (NIBUT). ResultsTwenty-five participants completed the study (mean age 38±15 years, 7 male). There was a significant change in OSDI over time for the EyeBag group (mean[lower 95% CI, upper 95% CI], baseline: 39.1[31.1,47.0], 2wk: 26.8[19.7,33.9], 4wk: 26.6[16.5,36.7], 8wk: 27.7[18.4,37.0]; p=0.01), but not in the control group (p=0.22), but no significant difference between groups at all time points (all p>0.27). Symptoms immediately improved after conducting the EyeBag based on at-home CSQ scores (Δ=-5.0 points, p<0.01), but not in the control group. For both groups, there was no significant change (p-value EyeBag,p-value control) in MG score (0.21,0.17) and NIBUT (0.49,0.06) over time. ConclusionsThe EyeBag may relieve symptoms of dry eye, but the effect on meibomian gland function and tear stability when used for only 4 weeks was undetectable.