Meibomian Gland Score Research Articles

Changes of meibomian gland function and the stability of tear film after long-term wearing orthokeratolog

Objective This study was to observe the meibomian gland scores, the miss rate of meibomian, break-up time of tear film (BUT) changes after long-term wearing orthokeratolog, and to evaluate orthokeratolog impact on meibomian gland function and the stability of the tear film. Methods A prospective case-controlled study was performed.Fifty patients 98 eyes with myopia were enrolled.According to the myopia correction mode, the patients were divided into control group (24 cases) and experimental group (overnight orthokeratolog treatment) group (26 cases). All subjects were underwent the examinations sequentially as follows: evaluation of ocular surface disease symptoms using the Ocular Surface Disease Index(OSDI), lid margin and ocular surface examination by slit lamp microscrope, infrared meibomian photography and BUT.All measurements were repeated at 3 months, 6 months, 24-months follow-up visit.All patients signed informed consent before examination. Results After wearing orthok-contact lens for 24 months, the meibomian gland score was 4.54±1.10 and 2.29±0.75 in the experimental group and control group, respectively, the difference was statistically significant (P 0.05). Conclusions Long-term wearing orthokeratolog has negetive effects on meibomian gland function and the stability of the tear film. Key words: Myopia; Orthokeratolog; Meibomian gland; Meibomian gland scores; Miss rate of meibomian; Break-up time of tear film

A novel system, TearCare®, for the treatment of the signs and symptoms of dry eye disease.

PurposeThe objective of this study was to evaluate the safety and effectiveness of the TearCare® System in adult patients with clinically significant dry eye disease (DED).Patients and methodsThis was a prospective, single-center, randomized, parallel-group, clinical trial. Subjects with DED were randomized to either a single TearCare treatment conducted at the clinic or 4 weeks of daily warm compress (WC) therapy. The TearCare procedure consisted of 12 minutes of thermal eyelid treatment immediately followed by manual expression of the meibomian glands. WC therapy consisted of once daily application of the compresses to the eyelids for 5 minutes. Subjects were followed until 6 months post-treatment. The primary effectiveness end point was defined as change from baseline to 4 weeks for tear breakup time (TBUT). Secondary effectiveness end points included meibomian gland assessment, corneal and conjunctival staining scores, and assessment of dry eye symptoms using validated questionnaires. Safety was evaluated by collecting device-related adverse events, intraocular pressure, and best spectacle-corrected Snellen Visual acuity.ResultsTwenty-four subjects were enrolled and all subjects completed 6 months follow-up. At the 1-month follow-up, TearCare subjects demonstrated an improvement from baseline in mean (±SD) TBUT of 11.7±2.6 seconds compared with an average worsening of −0.3±1.1 seconds for subjects in the WC group (p<0.0001). Significantly greater improvements in the change from baseline in meibomian gland scores, as well as corneal and conjunctival staining scores, were observed in the TearCare group. Subjects in the TearCare group also showed significantly greater improvement in dry eye symptoms as measured by the 3 questionnaires. Both treatments were well-tolerated.ConclusionThe findings of this pilot study suggest that the TearCare System is an effective treatment option for patients with DED, with the effects on the signs and symptoms of DED persisting for at least 6 months.

Prospective evaluation of intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction.

PurposeThe aim of this study was to estimate the efficacy of intense pulsed light (IPL), followed by meibomian gland expression (MGX), for reducing the number and severity of signs and symptoms of dry eye disease (DED) secondary to meibomian gland dysfunction (MGD).Patients and methodsIn a prospective study conducted in two sites, 40 subjects (80 eyes) with moderate to severe MGD were enrolled. Major inclusion criteria consisted of at least two of the following measures being compatible with DED in both eyes: tear breakup time (TBUT), meibomian gland score (MGS), corneal fluorescein staining (CFS), Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, and tear film osmolarity (TFO). Enrolled patients underwent four treatment sessions, 3 weeks apart. Each treatment included the administration of 10–15 pulses of IPL on the cheeks and nose, followed by MGX of the upper and lower eyelids. TBUT, MGS, CFS, SPEED, TFO, and lipid layer thickness (LLT) were measured at baseline (BL) and at 9, 12, and 15 weeks after BL.ResultsDue to different staining methods used for TBUT measurements, TBUT and CFS were analyzed separately for each site. From BL to the final follow-up, the number of signs compatible with DED decreased from 3.3±0.1 to 1.4±0.1. TBUT improved by +93% (n=38; P<0.0001) and +425% (n=42; P<0.0001) for sites 1 and 2, respectively. SPEED, MGS, and CFS improved by −55% (n=80; P<0.0001), −36% (n=80; P<0.0001), and −58% (n=38; P<0.0001), respectively. In 20 eyes with abnormally elevated TFO at BL, TFO improved by −7% (n=20; P<0.005). LLT did not change (n=38; P=0.88).ConclusionIn subjects with moderate to severe MGD, IPL combined with MGX reduced the number and severity of symptoms and signs of DED. Except for LLT, all examined outcome measures significantly improved after 15 weeks. These results support the efficacy of IPL + MGX in relieving both signs and symptoms of DED secondary to MGD.

A Randomized Controlled Trial of Omega 3 Fatty Acids in Rosacea Patients with Dry Eye Symptoms

ABSTRACTObjective or purpose: To evaluate the efficacy of dietary omega-3 fatty acids (O3FAs) in rosacea patients having dry eye symptoms.Methods: A prospective, interventional, randomized, double-masked, placebo-controlled, multi-centric study was done. Symptomatic patients with rosacea were recruited based on their response to (Dry Eye Scoring System, DESS©); a score of 0–3 was assigned to dry eye-related symptoms like ocular fatigue, blurring of vision, itching or burning, sandy or gritty sensation, and redness, respectively (DESS©). Subjects were (n = 130) were randomized to receive either O3FAs (n = 65) or placebo (n = 65) capsules (olive oil) twice daily for 6 months. Patients were evaluated at baseline, 1, 3, and 6 months. Change in subjective dry eye symptoms was the primary outcome measure. Change in meibomian gland score (MGS), Schirmer score, and tear film breakup time (TBUT) were the secondary outcome measures.Results: Repeated-measures ANOVA revealed that there was a significant (p < 0.001) change in symptoms (F(1.506, 88.825 = 315.193), MGS (F(1.336, 78.796 = 84.438), Schirmer score (F(1.322, 78.022 = 86.559), and TBUT (F(1.354, 79.898 = 179.020.559) in O3FA group as compared to placebo group. Post-hoc test revealed that there was a significant change in dry eye symptoms at all points of time; there was a significant change in MGS, Schirmer score, and TBUT also, but only after 3 months of intervention. Linear regression established that symptom severity could significantly predict MGS, Schirmer score, and TBUT. There was a significant change in the slope (intercept) of the regression plots in O3FA group as compared to the placebo group.Conclusion: Rosacea patients with dry eye symptoms have significant improvement in symptoms, MGS, TBUT, and Schirmer score, following dietary intervention with O3FAs for 6 months.

Effect of Lid Debridement-Scaling in Sjögren Syndrome Dry Eye.

To evaluate the effect of lid debridement-scaling (LDS) on dry eye signs and symptoms in subjects with Sjögren syndrome (SS). This prospective randomized controlled study enrolled 14 female subjects with SS. Seven subjects were randomized into the treatment group where they were selected to receive LDS; the remainder did not receive LDS and served as control subjects. Lid debridement-scaling was conducted using a stainless steel golf club spud (Hilco Wilson Ophthalmics, Plainville, MA) on both the upper and lower eyelids of both eyes. Outcome variables were assessed before LDS and again 1 month later. The outcome variables were the Ocular Surface Disease Index (OSDI), Symptom Assessment iN Dry Eye (SANDE) visual analog scores, ocular staining (SICCA OSS [Sjögren's International Collaborative Clinical Alliance Ocular Staining Score]), fluorescein tear breakup time (FLBUT), meibomian gland score (MGS), meibomian gland yielding liquid secretions (MGYLS) score, and line of Marx's (LOM) position. Thirteen subjects completed the study. Data from only the right eye were analyzed. For the control group (n = 6; mean [± SD] age, 62.3 [± 11.6] years), the pre-LDS, post-LDS, and significance level (pre-LDS mean [± SD] vs. post-LDS mean [± SD]; p value) were as follows: OSDI (58.3 [± 22.1] vs. 48.3 [± 29.0]; p = 0.051), SANDE (77.4 [± 22.1] vs. 89.6 [± 32.6]; p = 0.20), SICCA OSS (7.0 [± 4.5] vs. 8.2 [± 3.5]; p = 0.25), MGS (1.3 [± 1.5] vs. 1.0 [± 0.9]; p = 0.75), MGYLS (0.3 [± 0.5] vs. 0.0 [± 0.0]; p = 0.50), FLBUT (2.99 [± 1.54] vs. 2.85 [± 1.79]; p = 0.63), and LOM (2.0 [± 0.0] vs. 2.0 [± 0.0]; p = n/a). For the treatment group (n = 7; mean [± SD] age, 58.0 [± 8.1] years), the pre-LDS, post-LDS, and significance level were as follows: OSDI (63.2 [± 13.3] vs. 46.9 [± 19.4]; p = 0.04), SANDE (72.6 [± 17.1] vs. 77.0 [± 28.0]; p = 0.54), SICCA OSS (6.6 [± 2.9] vs. 5.0 [± 3.9]; p = 0.02), MGS (1.0 [± 1.2] vs. 3.1 [± 1.7]; p = 0.01), MGYLS (0.0 [± 0.0] vs. 0.6 [± 1.0]; p = 0.50), FLBUT (3.13 [± 0.81] vs. 3.45 [± 1.03]; p = 0.53), and LOM (0.9 [± 0.9] vs. 1.0 [± 1.0]; p = 1.00). This pilot study showed that LDS improved symptoms, ocular staining, and meibomian gland function for the group that received LDS. This indicates that LDS can aid in the management of SS dry eye.

Psychometric Properties and Validation of the Standard Patient Evaluation of Eye Dryness Questionnaire

To characterize the psychometric properties of the standard patient evaluation of eye dryness (SPEED) questionnaire and to validate and compare its performance with 4 existing dry eye questionnaires. A total of 50 subjects (40 female and 10 male) were enrolled; of these, 30 were symptomatic and 20 asymptomatic, as determined using the ocular surface disease index (OSDI). This study consisted of 2 visits in which all subjects completed 5 different dry eye questionnaires (SPEED, OSDI, dry eye questionnaire, McMonnies dry eye questionnaire, and subjective evaluation of symptom of dryness) in random order at each visit. Clinical measurements were obtained on the first visit. Repeatability was determined using concordance correlation coefficient; dimensionality was determined using principal component, factor, and Rasch analyses; and validity was determined by comparing SPEED scores with dry eye diagnosis based on OSDI (primarily using receiver-operator curve analysis). The SPEED questionnaire data were found to be unidimensional and repeatable. Three principal components (dryness, burning, and soreness/fatigue) were identified and SPEED between visit concordance correlation coefficient was 0.923 (95% confidence interval, 0.868-0.955). The area under the receiver-operator curves was 0.928. The only clinical measures that correlated "well" with SPEED questionnaire scores were corneal staining (P < 0.05), meibomian gland score (P < 0.05), and meibomian glands yielding liquid secretion score (P < 0.05). The SPEED questionnaire was shown to be a repeatable and valid instrument for measurement of dry eye symptoms. The SPEED score also correlated significantly with ocular surface staining and clinical measures of meibomian gland function.

Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis

Background: Posterior blepharitis is an eyelid disease primarily of the meibomian glands. Bacteria and chronic inflammation are contributing factors for meibomian gland disease, which leads to ocular surface and tear film alterations and chronic patient symptoms. Azithromycin 1.0% ophthalmic solution is a broad spectrum topical antibiotic with anti‐inflammatory properties. The present study evaluates the efficacy of azithromycin 1.0% ophthalmic solution in the treatment of the clinical signs and symptoms, including vision‐related function, associated with meibomian gland dysfunction.Methods: In an open label study, 33 patients with meibomian gland dysfunction were treated with azithromycin 1.0% ophthalmic solution twice a day for two days, then every evening for a total of 30-days. Tear break‐up time, corneal staining, conjunctival staining, Schirmer scores with anaesthetic, meibomian gland score and patient's symptom scores were evaluated at baseline and after 30-days of treatment. The Ocular Surface Disease Index (OSDI) was administered at baseline, after two weeks of treatment and after 30-days of treatment.Results: Twenty‐six of 33 patients completed the study. Tear break‐up time and Schirmer score increased by 52.7 per cent (p < 0.0001) and 24 per cent (p < 0.05), respectively. There was a reduction in corneal and conjunctival staining by 83.2 and 67.9 per cent, respectively (p < 0.0001). Lid margin scores were reduced by 33.9 per cent (p < 0.0001). The patient's symptom score improved from 2.73 at baseline to 2.21 after 30-days of treatment (p < 0.01). The mean OSDI at baseline was 34.44. After two weeks and 30-days of treatment, the ODSI was 14.51 and 13.15 respectively (p < 0.0001).Conclusion: These results demonstrate clinically and statistically significant improvement in the signs and symptoms associated with posterior blepharitis. Based on these results, azithromycin 1% ophthalmic solution offers a viable option for the treatment of posterior blepharitis.

Marx Line: Fluorescein Staining Line on the Inner Lid as Indicator of Meibomian Gland Function

To determine whether the location of a fluorescein-stained line, the Marx line (ML), which runs along the inner eyelid, is correlated with meibomian gland function. Prospective observational case series. After applying fluorescein dye solution to the eye, the ML score was calculated for the outer, middle, and inner thirds of the lower eyelid margin. ML scoring was as follows: 0, entirely on the conjunctival side of the meibomian orifices (MOs); 1, part of the ML touches the MOs; 2, ML runs through all of the MOs; and 3, ML runs on the eyelid-margin side of the MOs. Correlations were calculated between the total ML score and age for 251 randomly recruited subjects without acute ocular surface diseases, and between age and the ML score for the three regions of the lower eyelid. Correlations between the regional ML score and the meibographic score, and the meibomian gland secretion score were also determined. The total ML scores of 15 subjects without meibomian gland dysfunction (MGD) were compared with 15 age-matched patients with MGD. The three regions of the lower eyelid had significantly different ML scores. Strong correlations were found between the ML score and age, the meibographic score, and the meibomian gland secretion score. The total ML score of MGD group was significantly higher than that of the non-MGD group. The strong correlation between the ML score and the meibomian gland scores indicates that the ML score can be used as a simple and rapid screening score for meibomian gland function.