Dr. Korb
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Boston, MA and Morrisville, NC—Meibomian gland evaluation should be a routine part of every optometric examination, as most cases of meibomian gland dysfunction
(MGD) are non-obvious, according to Donald R. Korb, OD, Korb Associates, Boston, MA, and chief technology officer of TearScience, Morrisville, NC. Non-functional meibomian glands
are often the trigger that starts a cascade of events leading to chronic dry eye symptoms in patients, Dr. Korb said.
"The role of meibomian gland dysfunction in dry eye is becoming increasing clear, and we believe the vast majority of MGD
is non-obvious," he said. "The only way to determine if a meibomian gland is functioning is by expressing it. Expression of
the gland should be part of every routine exam, whether the patient has dry eye symptoms or not."
Dr. Blackie
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"If we perform diagnostic meibomian gland expression on all patients regardless of their symptom status, we could very well
preempt a dry eye condition from developing in many patients," said Caroline Blackie, OD, PhD, a clinical research scientist at Korb Associates and TearScience.
Dr. Blackie also said that "early intervention, when there are few to no clinical signs, will likely lead to much better outcomes
than delaying treatment until there is frank inflammation."Meibomian gland evaluation is not difficult, according to Dr. Blackie. "You simply need to do a diagnostic expression, which
means digitally manipulating the lid margins to express or attempt to express some oil out of the gland orifice," she said.
"If no oil is expressed from the orifice, that gland could be considered to be dysfunctional even if the surrounding anatomy
of the lid looked totally normal."
A new paradigm for dry eye
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MGD is a process of obstruction. The gland becomes obstructed internally, and the dysfunction is only recognized if there
is inflammation associated with the obstruction.
"The trouble with our current definition of MGD is that it assumes there will be inflammation," Dr. Korb said. "The new model
of non-obvious meibomian gland dysfunction is based on the concept that most of the time, there is no inflammation, therefore
you can't see the dysfunction so you must express. It's an idea whose time has come."
There are two basic treatment methods to clear an obstruction in a meibomian gland. Squeezing the gland to express the obstructive
material is the most effective, but it's painful for both the patient and practitioner, according to Dr. Korb.
A less aggressive (albeit less effective) therapy involves the use of warm compresses to heat the gland material with the
goal of melting or liquefying it, so that it will be expressed naturally during lid blinking or squeezing.
Another therapy option
"You can also try cyclosporine ophthalmic emulsion 0.05% (Restasis, Allergan Inc.) because there are some claims that it can
improve the quality of meibomian gland secretion," Dr. Blackie said.
"There's also a reasonable amount of data that systemic antibiotics or topical azithromycin ophthalmic solution 1% (AzaSite,
Inspire Pharmaceuticals) can be helpful in the case of meibomian gland dysfunction where you have serious inflammation and
infection, but antibiotics don't address the need to remove the obstruction," she added.
Along with removal of the obstruction, treatment should include increasing lipid layer thickness and quality with the goal
of reducing mechanical trauma and inflammation and any accompanying lid wiper epitheliopathy.
FYI
Donald R. Korb, OD
Phone: 617/423-6370;
E-mail: drkorb@aol.com
Caroline Blackie, OD, PhD
Phone: 617/423-6370
E-mail: cblackie@tearscience.com
Drs. Korb and Blackie receive research funding from Korb Associates, Boston, MA, and TearScience, Morrisville, NC. Dr. Korb
is the inventor of SootheXP (Bausch + Lomb).
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