Topical Azithromycin Therapy for Meibomian Gland Dysfunction: Clinical Response and Lipid Alterations [Evaluation of short-term effect of intense pulsed light combined with meibomian gland expression in the treatment of meibomian gland dysfunction]. Intense Pulsed Light Applied Directly on Eyelids Combined with Meibomian Gland Expression to Treat Meibomian Gland Dysfunction. Long-Term Effects of Intense Pulsed Light Combined with Meibomian Gland Expression in the Treatment of Meibomian Gland Dysfunction. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Evaluation of the Safety and Effectiveness of Intense Pulsed Light in the Treatment of Meibomian Gland Dysfunction Effects of topical loteprednol etabonate on tear cytokines and clinical outcomes in moderate and severe meibomian gland dysfunction: randomized clinical trial. A Novel Thermodynamic Treatment for Meibomian Gland Dysfunction Therapeutic efficacy of intense pulsed light in patients with refractory meibomian gland dysfunction. Prevalence of asymptomatic and symptomatic meibomian gland dysfunction in the general population of Spain. Low-concentration homogenized castor oil eye drops for noninflamed obstructive meibomian gland dysfunction. Analysis of Cytokine Levels in Tears and Clinical Correlations After Intense Pulsed Light Treating Meibomian Gland Dysfunction. Randomised masked clinical trial of the MGDRx eyebag for the treatment of meibomian gland dysfunction-related evaporative dry eye A Randomized, Controlled Treatment Trial of Eyelid-Warming Therapies in Meibomian Gland Dysfunction Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction A randomized, double-masked study to evaluate the effect of omega-3 fatty acids supplementation in meibomian gland dysfunction The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (an AOS thesis). Increase in Tear Film Lipid Layer Thickness Following Treatment with Warm Compresses in Patients with Meibomian Gland Dysfunction A New System, the LipiFlow, for the Treatment of Meibomian Gland Dysfunction Minocycline controls clinical outcomes and inflammatory cytokines in moderate and severe meibomian gland dysfunction. Evaluation of an automated thermodynamic treatment (LipiFlow®) system for meibomian gland dysfunction: a prospective, randomized, observer-masked trial. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction.
Purpose : Meibomian gl and dysfunction ( MGD ) is a common clinical problem that is often associated with evaporative dry eye disease . Alterations of the lipids of the meibomian gl and s have been identified in several studies of MGD . This prospect i ve , observational , open-label clinical trial documents the improvement in both clinical signs and symptoms of disease and spectroscopic behavior of the meibomian gl and lipids after therapy with topical azithromycin ophthalmic solution . Methods : Subjects with symptomatic MGD were recruited . Signs of MGD were evaluated with a slit lamp . Symptoms of MGD were measured by the response of subjects to a question naire . Meibum lipid , lipid-lipid interaction strength , and conformation and phase transition parameters were measured using Fourier transform infrared spectroscopy . Results : In subjects with clinical evidence of MGD , changes in ordering of the lipids and result ant alteration of phase transition temperature were identified . Topical therapy with azithromycin relieved signs and symptoms and restored the lipid properties of the meibomian gl and secretion toward normal . Conclusions : Improvement in phase transition temperature of the meibomian gl and lipid with the determined percent trans rotomer composition of the lipid strongly suggests that the ordering of the lipid molecules is altered in the disease state ( MGD ) and that azithromycin can improve that abnormal condition toward normal in a manner that correlates with clinical response to therapy Objective : To explore short-term effect of intense pulsed light ( IPL ) combined with meibomian gl and expression in treating meibomian gl and dysfunction ( MGD ) . Methods : This study was a prospect i ve , r and omized , double-masked , controlled study . Forty-four MGD patients were enrolled in the study and received three consecutive IPL treatments with an interval of 4 weeks . One eye of each patient was r and omly assigned as the study eye receiving the IPL therapy with an energy of 14 - 16 J/cm(2 ) , and the fellow eye was as the control eye receiving a placebo therapy with 0 J/cm(2 ) . Meibomian gl and expression was immediately performed after the IPL treatment in both eyes . Efficacy was evaluated through assessment of the meibomian gl and yielding secretion score ( MGYSS ) , SPEED question naire , tear film break-up time ( TBUT ) , cornea fluorescein staining and infrared meibography . Safety was evaluated through best spectacle corrected visual acuity , intraocular pressure , slit lamp examination and fundus examination . These examinations were performed before and after each treatment . Results : Significant improvements were observed in the MGYSS and TBUT after IPL treatments ( P<0.05 ) . The improvements compared to the baseline of MGYSS at the upper eyelid in the treatment eyes were significantly higher than those in the control eyes after the first treatment ( Z=-2.036 , P=0.003 ) . The improvements compared to baseline of MGYSS at the lower eyelid and the TBUT in the treatment eyes were significantly higher than those in the control eyes after the second treatment ( Z=-2.999 and -2.036 , respectively P=0.007 and 0.042 , respectively ) . SPEED and cornea fluorescein staining were decreased in both eyes after IPL treatments , but there was no statistical difference between the two eyes . No obvious complication was observed in the study . Conclusions : IPL treatment combined with meibomian gl and expression is an efficient and safe therapy , and can increase meibomian gl and yielding secretion , increase the TBUT , relieve the symptoms and repair the corneal epithelium defects for MGD eyes . ( Chin J Ophthalmol , 2017 , 53 : 675 - 681 ) OBJECTIVE To determine the efficacy and safety of intense pulsed light ( IPL ) applied directly on the eyelids and meibomian gl and expression ( MGX ) in treating meibomian gl and dysfunction ( MGD ) . BACKGROUND IPL application on the periocular skin effectively improves meibomian gl and secretion and tear film break-up time ( TBUT ) in patients with MGD/dry eye . METHODS This prospect i ve , r and omized , double-masked , controlled study involved 44 patients . One eye was r and omly selected for IPL treatment ; the other served as a control . Study eyes received three IPL treatments at 4-week intervals ; IPL was applied directly on the eyelids , and the eye was protected with a Jaeger lid plate . Control eyes received sham IPL treatments . Both eyes received MGX and artificial tears . Meibomian gl and yielding secretion score ( MGYSS ) , TBUT , St and ard Patient Evaluation of Eye Dryness ( SPEED ) , cornea fluorescein staining ( CFS ) , meibography , best corrected visual acuity ( BCVA ) , intraocular pressure ( IOP ) , and fundus examination were performed . RESULTS Compared to the baseline , MGYSS , TBUT , and SPEED and CFS scores improved in the study eyes , while only SPEED and CFS scores improved in the control eyes ( p < 0.001 for all ) . Changes in MGYSS and TBUT were higher in the study eyes than in the control eyes ( p < 0.05 ) , but changes in SPEED and CFS scores were similar ( p > 0.05 ) . BCVA and IOP improved in both the study and control eyes ( p < 0.05 ) . Five patients experienced mild pain and burning during IPL treatment . One patient suffered partial eyelash loss . CONCLUSIONS IPL combined with MGX safely and effectively treated MGD OBJECTIVE To evaluate the long-term effects of intense pulsed light ( IPL ) combined with meibomian gl and expression ( MGX ) in the treatment of meibomian gl and dysfunction ( MGD ) . BACKGROUND Although IPL has been proven to be effective in the treatment of MGD , any report regarding its long-term efficacy is unavailable by now . METHODS The r and omly selected study eye received a series of three IPL treatments that were applied directly on eyelids with an interval of 4 weeks ( treatment energy , 14 - 16 J/cm2 ) . The control eye received three sham IPL treatments ( 0 J/cm2 ) . MGX was performed on both eyes . Meibomian gl and yielding secretion score ( MGYSS ) and tear film break-up time ( TBUT ) were evaluated at baseline and at 1 , 3 , 6 , and 9 months after treatments . RESULTS In the study eyes , MGYSS of both the upper and lower eyelids and TBUT improved at 1 , 3 , 6 months after treatments ( p < 0.01 ) . MGYSS in lower eyelids continued to improve at 9 months ( p < 0.05 ) . The changes in MGYSS and TBUT after treatment were larger in the study eyes than in the control eyes at 1 , 3 , 6 months ( p < 0.01 ) , but no difference at 9 months ( p > 0.05 ) . The percentage improvement in the MGYSS of lower eyelids after treatment was higher than that of upper eyelids . CONCLUSIONS Three consecutive IPL treatments combined with MGX  improved MG secretion function and TBUT by 6 months after treatment in MGD patients . The improvement in MG secretion function was greater in the lower eyelid than in the upper eyelid OBJECTIVE The purpose of this study was to determine the clinical benefits of intense-pulsed-light therapy for the treatment of dry-eye disease caused by meibomian gl and dysfunction ( MGD ) . BACKGROUND DATA MGD is the leading cause of evaporative dry eye disease . It is currently treated with a range of methods that have been shown to be only somewhat effective , leading to the need for advanced treatment options . METHODS A retrospective noncomparative interventional case series was conducted with 91 patients presenting with severe dry eye syndrome . Treatment included intense-pulsed-light therapy and gl and expression at a single outpatient clinic over a 30-month study . Pre/post tear breakup time data were available for a subset of 78 patients . For all patients , a specially developed technique for the treatment of dry eye syndrome was applied as a series of monthly treatments until there was adequate improvement in dry eye syndrome symptoms by physician judgment , or until patient discontinuation . RESULTS Primary outcomes included change in tear breakup time , self-reported patient satisfaction , and adverse events . Physician-judged improvement in dry eye tear breakup time was found for 68 of 78 patients ( 87 % ) with seven treatment visits and four maintenance visits on average ( medians ) , and 93 % of patients reported post-treatment satisfaction with degree of dry eye syndrome symptoms . Adverse events , most typically redness or swelling , were found for 13 % of patients . No serious adverse events were found . CONCLUSIONS Although preliminary , study results of intense-pulsed-light therapy treatment for dry eye syndrome caused by meibomian gl and dysfunction are promising . A multisite clinical trial with a larger sample , treatment comparison groups , and r and omized controlled trials is currently underway Purpose . This study aims to explore the safety and efficacy of a novel treatment-intense pulsed light ( IPL ) in MGD eyes . Methods . This study is a prospect i ve and open label study . Forty eyes of 40 MGD patients were recruited in the study and received 4 consecutive IPL treatments on day 1 , day 15 , day 45 , and day 75 . Ten ocular surface symptoms were evaluated with a subjective face score at every visit . Best spectacle corrected visual acuity , intraocular pressure ( IOP ) , conjunctival injection , upper and lower tear meniscus height ( TMH ) , tear break-up time ( TBUT ) , corneal staining , lid margin and meibomian gl and assessment s , and meibography were also recorded at every visit , as well as the adverse effects on the eye and ocular surface . Results . Significant improvements were observed in single and total ocular surface symptom scores , TBUT , and conjunctival injection at all the visits after the initial IPL treatment ( P < 0.05 ) . Compared to baseline , the signs of eyelid margin , meibomian gl and secretion quality , and expressibility were significantly improved at every visit after treatments . There was no regional and systemic threat observed in any patient . Conclusion . Intense pulsed light ( IPL ) therapy is a safe and efficient treatment in relieving symptoms and signs of MGD eyes PURPOSE To assess tear cytokine levels and clinical outcomes in moderate and severe meibomian gl and dysfunction ( MGD ) after 2 months of treatment with topical loteprednol etabonate and eyelid scrubs with warm compresses vs eyelid scrubs with warm compresses alone . DESIGN R and omized controlled trial . METHODS Patients with moderate and severe MGD were r and omized into 2 groups : topical loteprednol etabonate and eyelid scrubs with warm compresses ( Group I , 34 eyes ) or eyelid scrubs with warm compresses ( Group II , 36 eyes ) . We evaluated cytokine levels , tear film break-up time ( TBUT ) , corneal and conjunctival fluorescein staining , biomicroscopic examination of lid margins and meibomian gl and s , and the Ocular Surface Disease Index before initiating treatment and 1 month and 2 months after treatment . RESULTS There were significant decreases in the levels of interleukin (IL)-6 , IL-8 , and IL-1β in Group I , and IL-6 and IL-8 in Group II . Moreover , the observed decreases of these cytokines in Group I were attributed to a remarkable decrease between treatment and 1 month after treatment . In Group I , there were improvements in all of the clinical outcomes , with prominent improvement in TBUT , corneal and conjunctival fluorescein staining , and meibum quality after 1 month of treatment , compared with Group II . An improvement in meibomian gl and expressibility and MGD stage reduction were more remarkable in Group I. CONCLUSIONS Topical loteprednol etabonate and eyelid scrubs with warm compresses were tolerated and efficacious for the treatment of moderate and severe MGD . We suggest that such beneficial effects could manifest after 1 month Purpose : To evaluate a novel thermodynamic treatment for obstructive meibomian gl and dysfunction ( MGD ) . Material s and Methods : Fourteen adult subjects ( 10 females , 4 males , mean age = 54.2 ± 9.6 yr ) were recruited in a multi-center , feasibility clinical trial in Durham and Cary , North Carolina and Boston , Massachusetts . Inclusion criteria included : previous diagnosis of moderate to severe dry eye ; dry eye symptoms for at least three months prior ; daily topical lubricant use ; and evidence of meibomian gl and ( MG ) obstruction in the central five gl and s of both eyes lower eyelids . Exclusion criteria included : history of recent acute or chronic ocular inflammation or infection and lid surface abnormalities affecting lid function . The treatment : the device heats the palpebral surface of upper and lower eyelids while simultaneously applying grade d pulsatile pressure to the outer eyelid for 12 min , thereby expressing the MGs during heating . One eye was r and omly selected to undergo additional manual heated expression with another treatment device . Results : The mean MG secretion score , tear break-up time , corneal staining score , number of MGs yielding liquid secretion and symptom scores all improved significantly from baseline to 1 week . This was maintained through the 3-month follow-up . There was no statistically significant difference in any outcome between the automated device treatment only and the additional heated manual expression . Conclusion : The combination of heat applied to the palpebral surface , while simultaneously expressing MGs during a single 12-minute treatment , was effective , in this feasibility study , in treating obstructive MG dysfunction and dry eye signs and symptoms for the 3-month study period PURPOSE To evaluate the efficacy and safety of intense pulsed light ( IPL ) combined with meibomian gl and expression ( MGX ) for treatment of refractory meibomian gl and dysfunction ( MGD ) . METHODS Ninety eyes of 45 patients were r and omly assigned to receive either the combination of IPL and MGX or MGX alone ( control ) . Each eye underwent eight treatment sessions at 3-week intervals . Parameters were evaluated before and during treatment as well as at 3 - 11 weeks after the last treatment session . Measured parameters included the St and ard Patient Evaluation of Eye Dryness ( SPEED ) question naire score , noninvasive breakup time ( NIBUT ) , fluorescein breakup time ( BUT ) , lipid layer grade , lipid layer thickness ( LLT ) , lid margin abnormalities , corneal and conjunctival fluorescein staining ( CFS ) score , meibum grade , and meiboscore . RESULTS A significant improvement in lipid layer grade was apparent in the IPL-MGX group from 6 to 32 weeks after treatment onset ( adjusted P < 0.001 ) but was not observed in the control group . The IPL-MGX group also showed significant improvements in LLT , NIBUT , BUT , lid margin abnormalities , and meibum grade compared with the control group at 24 and 32 weeks ( adjusted P < 0.001 ) as well as significant improvements in the SPEED score at 32 weeks ( adjusted P = 0.044 ) and in CFS score at 24 ( adjusted P = 0.015 ) and 32 ( adjusted P = 0.006 ) weeks . CONCLUSIONS The combination of IPL and MGX improved homeostasis of the tear film and ameliorated ocular symptoms in patients with refractory MGD and is thus a promising modality for treatment of this condition PURPOSE To describe epidemiologic characteristics of asymptomatic and symptomatic meibomian gl and dysfunction ( MGD ) in a general adult population in northwestern Spain . METHODS A total of 1155 subjects aged 40 years and older were selected by an age-stratified r and om sample procedure in O Salnés , Spain . A st and ardized symptoms question naire was administered and a comprehensive ophthalmic evaluation , which included ocular surface tests , was carried out . Absent , viscous , or waxy white secretion upon digital expression , lid margin telangiectasia or plugging of the meibomian gl and orifices was considered evidence of MGD . The prevalence and associations of asymptomatic and symptomatic MGD , and their effects on the ocular surface , were investigated . RESULTS From 937 eligible subjects , 619 ( 66.1 % ) participated ( mean age [ SD ] , 63.4 [ 14.5 ] years ; range , 40 - 96 ; 37.0 % males ) . The prevalence of asymptomatic MGD was 21.9 % ( 95 % confidence interval [ CI ] , 18.8 - 25.3 ) . This prevalence increased with age ( P = 0.000 ) and was higher in males than in females ( P = 0.003 ) . The prevalence of symptomatic MGD was 8.6 % ( 95 % CI , 6.7 - 10.9 ) . This prevalence also increased with age ( P = 0.000 ) but was not associated with sex . Abnormal tear breakup time and fluorescein staining prevalence estimates were higher among asymptomatic subjects . After controlling for age and sex , asymptomatic MGD was associated with diabetes ( adjusted odds ratio [ OR(a ) ] 2.23 ) and cardiovascular disease ( OR(a ) 1.80 ) , and symptomatic MGD with rosacea ( OR(a ) 3.50 ) and rheumatoid arthritis ( OR(a ) 16.50 ) . CONCLUSIONS Asymptomatic MGD is more common than symptomatic MGD . Symptomatology is not associated with secondary damage to the ocular surface . Some systemic diseases may lower whereas others may raise the risk of developing symptoms . Symptom-based approaches do not seem appropriate for MGD estimation OBJECTIVE We developed low-concentration homogenized castor oil eye drops for the treatment of patients with noninflamed obstructive meibomian gl and dysfunction ( MGD ) , a major cause of lipid-deficiency dry eye , and assessed the safety , stability , and efficacy of the eye drops . DESIGN R and omized , double-masked , placebo-controlled crossover clinical trial . PARTICIPANTS Forty eyes of 20 patients with noninflamed MGD . METHODS After a preliminary study of eye drops containing castor oil , 2 % castor oil and 5 % polyoxyethylene castor oil ( emulsifier ) were mixed to formulate homogenized oil eye drops . The patients were assigned r and omly to receive oil eye drops or placebo six times daily for 2 periods of 2 weeks each . MAIN OUTCOME MEASURES At the end of each treatment period , we assessed symptoms , tear interference grade , tear evaporation , fluorescein and rose bengal scores , tear break-up time ( BUT ) , and meibomian gl and orifice obstruction . Safety and stability tests were also performed . RESULTS Symptom scores , tear interference grade , tear evaporation test results , rose bengal scores , tear BUT , and orifice obstruction scores after the oil eye drop period showed significant improvement compared with the results after the placebo period . No complications attributable to the eye drops were observed . The oil eye drops were stable when stored at 4 degrees C. CONCLUSIONS The results indicate that castor oil eye drops are effective and safe in the treatment of MGD . The possible mechanisms of this treatment are improvement of tear stability as a result of lipid spreading , ease of meibum expression , prevention of tear evaporation , and the lubricating effect of the oil eye drops PURPOSE To investigate the change from baseline of inflammatory markers in tears of dry eye disease ( DED ) subjects owing to meibomian gl and dysfunction ( MGD ) after intense pulsed light ( IPL ) treatment  and meibomian gl and expression ( MGE ) compared to sham treatment , and the correlations with ocular surface parameters . DESIGN R and omized , double-masked , controlled study . METHODS Those r and omized into the active treatment arm received 3 consecutive treatments ( 14∼16 J/cm2 ) approximately 4 weeks apart in the periocular region . Control eyes received 3 treatments in the same intervals of 0 J/cm2 . Tear sample s in all eyes were collected and analyzed at baseline , week 12 , and /or week 4 for interleukin (IL)-17A , IL-6 , and prostagl and in E2 ( PGE2 ) . The correlations between cytokines and ocular surface parameters were analyzed before and after IPL treatment . RESULTS All of the inflammatory markers declined in value compared to baselines . IL-17A and IL-6 showed statistically significant decreases compared to sham treatment at each measured time point . PGE2 showed statistically significant decreases compared to sham at week 12 . Results showed that the expressions of IL-17A and IL-6 correlated well with ocular surface parameters of the lower eyelid before IPL . The changed values of IL-6 and PGE2 in tears correlated with the changed values of partial ocular surface parameters after IPL treatment in study eyes , respectively . CONCLUSIONS The study results suggest that IPL can significantly reduce inflammatory markers in tears of patients suffering with DED owing to MGD after IPL treatment . These findings indicate that IL-17A and IL-6 play roles in the pathogenesis of DED owing to MGD , and the reduction of the inflammatory factors is consistent with the improvement of partial clinical symptoms and signs Background / aims To investigate the efficacy and safety of the MGDRx EyeBag ( The Eyebag Company , Halifax , UK ) eyelid warming device . Methods Twenty-five patients with confirmed meibomian gl and dysfunction (MGD)-related evaporative dry eye were enrolled into a r and omised , single masked , contralateral clinical trial . Test eyes received a heated device ; control eyes a non-heated device for 5 min twice a day for 2 weeks . Efficacy ( ocular symptomology , non-invasive break-up time , lipid layer thickness , osmolarity , meibomian gl and dropout and function ) and safety ( visual acuity , corneal topography , conjunctival hyperaemia and staining ) measurements were taken at baseline and follow-up . Subsequent patient device usage and ocular comfort was ascertained at 6 months . Results Differences between test and control eyes at baseline were not statistically significant for all measurements ( p>0.05 ) . After 2 weeks , statistically significant improvements occurred in all efficacy measurements in test eyes ( p<0.05 ) . Visual acuity and corneal topography were unaffected ( p>0.05 ) . All patients maintained higher ocular comfort after 6 months ( p<0.05 ) , although the benefit was greater in those who continued usage 1–8 times a month ( p<0.001 ) . Conclusions The MGDRx EyeBag is a safe and effective device for the treatment of MGD-related evaporative dry eye . Subjective benefit lasts at least 6 months , aided by occasional retreatment . Trial registration number NCT01870180 Abstract Aim The main treatment for meibomian gl and dysfunction ( MGD ) , a major cause of dry eye , is eyelid warming . Lack of compliance is the main reason for treatment failure . This has led to the development of eyelid-warming devices that are safe , effective and convenient . To obtain robust evidence demonstrating their efficacy , the authors conducted a 3-arm r and omized clinical study . Methods The authors conducted a 3-month assessor-blinded , r and omized , controlled trial of patients from the Singapore National Eye Centre experiencing at least one of eight dry eye symptoms ‘ often ’ or ‘ all the time ’ . Patients who wore contact lenses , had an active infection or known diagnosis of thyroid dysfunction and rheumatoid arthritis were excluded from the study . MGD participants were r and omly assigned to warm towel ( n = 25 ) , EyeGiene ® ( Eyedetec Medical Inc. , Danville , CA , USA ) ( n = 25 ) and Blephasteam ® ( Spectrum Thea Pharmaceuticals LTD , Macclesfield , UK ) ( n = 25 ) treatments . The primary efficacy and safety outcomes included the proportions of participants with improved symptoms and changes in best corrected visual acuity ( BCVA ) , respectively . Other outcomes included tear break up time ( TBUT ) , Schirmer test , corneal fluorescein dye staining and number of visibly occluded meibomian gl and ( MG ) orifices . Results The study population was 53.5 ± 11.1 years old and predominantly Chinese . For severity of symptom after 3 months of treatment , 78.3 % Blephasteam ® participants reported improvement compared to 45.5 % warm towel participants ( p = 0.023 ) . The corresponding proportions for improvement in the frequency of symptoms were 82.6 % and 50.0 % , respectively ( p = 0.020 ) . The proportions of improvement of symptoms in EyeGiene ® patients were not significantly different from warm towel intervention . At 1 month of treatment , the crude odds ratio of improvement of severity of irritation for Blephasteam ® compared to control was 3.0 ( 95 % CI 0.88–10.18 ) . However , the odds ratio adjusted by age was 5.67 ( 1.30–24.66 ) . The lid-warming treatments did not significantly change the TBUT , Schirmer test results or number of visibly occluded MGs in the study period . All treatment modalities did not worsen BCVA after 3 months . Conclusion Blephasteam ® is more effective than warm towel for MGD treatment , with warm towel and EyeGiene ® being comparable effective . Older age might predict for treatment efficacy . All studied therapies were safe for visual acuity ( VA ) for 3 months of treatment The aim was to evaluate the efficacy of periocular intense pulsed light therapy combined with meibomian gl and expression for chronic dry eye due to moderate to advanced meibomian gl and dysfunction Background Dysfunction of the meibomian gl and ( MG ) is among the most frequent causes of ophthalmological symptoms . The inflammation seen in meibomian gl and dysfunction ( MGD ) is part of its pathogenesis , and evidence of the antioxidant-inflammatory properties of omega-3 fatty acids suggests this to be an appropriate treatment for MGD . Objective We aim ed to assess the effectiveness of omega-3 fatty acids versus placebo , in improving the symptoms and signs of MGD . Methods We conducted a r and omized and double-mask trial of 3 months duration . We enrolled 61 patients who presented with symptomatic MGD and no tear instability ( defined as tear breakup time [ TBUT ] < 10 seconds ) . Participants were r and omly assigned to two homogeneous subgroups . For patients in group A , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus a placebo oral agent . For patients in group B , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus oral supplementation with omega-3 fatty acids . We performed the following tests : ( 1 ) TBUT ; ( 2 ) Schirmer I test ; ( 3 ) Ocular Surface Disease Index © ( OSDI © ; Allergan , Inc. , Irvine , CA , USA ) ; ( 4 ) MG expression ; ( 5 ) evaluation of lid margin inflammation ; and ( 6 ) interpalpebral and corneal dye staining . Results After 3 months of evaluation , the mean OSDI , TBUT , lid margin inflammation , and MG expression presented improvement from the baseline values , in group B ( P < 0.01 , P < 0.001 , P < 0.0001 , P < 0.0001 , respectively ) . The Schirmer test results were also improved and statistically significant ( P < 0.01 ) . Conclusion Oral omega-3 fatty acids , 1.5 grams per day , may be beneficial in the treatment of MGD , mainly by improving tear stability PURPOSE Blepharitis and meibomian gl and dysfunction ( MGD ) are common sources of complaints from patients . To evaluate the effect on ocular symptoms , ocular findings , and serum and meibomian gl and contents , patients with blepharitis and MGD were prospect ively evaluated to determine the effects of dietary supplementation with omega-3 fatty acids . METHODS In a prospect i ve r and omized placebo-controlled masked trial , patients with simple obstructive MGD and blepharitis , who had discontinued all topical medications and tetracyclines  , received oral omega-3 dietary supplementation consisting of two 1000-mg capsules 3 times a day . Patients were examined every 3 months for 1 year with the Ocular Surface Disease Index ( OSDI ) objective clinical measures , including tear production and stability , ocular surface and meibomian gl and health , and biochemical plasma , red blood cell ( RBC ) , and meibum evaluation . Primary outcome measures were change in tear breakup time ( TBUT ) , meibum score , and overall OSDI score at 1 year . RESULTS At 1 year , the omega-3 group had a 36 % and 31 % reduction in their omega-6 to omega-3 fatty acid ratios in RBCs and plasma , respectively ( P = .3 ) , whereas the placebo group demonstrated no change . At 12 months , the omega-3 group had an improvement in TBUT , OSDI score , and meibum score . Changes in meibum content were observed in the omega-3 group ( P = .21 ) ; the level of meibum saturated fatty acids decreased . CONCLUSIONS This trial demonstrated a decrease in the RBC and plasma ratios of omega-6 to omega-3 in patients taking omega-3 dietary supplementation  , as compared to controls , and improvements in their overall OSDI score , TBUT , and meibum score . This is the first demonstration of an induced change in the fatty acid saturation content in meibum as a result of dietary supplementation with omega-3 fatty acids Purpose . Warm-compress therapy applied to the skin of the closed eyelids has been recommended as a treatment for meibomian gl and dysfunction ( MGD ) . Previous studies have evaluated the effects of warm-compress therapy on tear-film fluorescein break-up time and tear evaporation rate . The purpose of this study was to determine if tear-film lipid layer thickness ( TFLLT ) was altered following 5 , 15 , and 30 minutes of warm , moist compress therapy . Methods . Twenty patients with a diagnosis of dry eye associated with MGD and a baseline TFLLT of ≤ 90 nm ( baseline difference between experimental and control eyes ≤ 25 nm ) were studied . The skin of the closed eyelids of one eye of each subject was treated for a total of 30 minutes with a compress saturated with warm ( 40.0 ± 2.0 ° C ) water used as a compress ; and the skin of the closed eyelids of the contralateral control eye was treated for a total of 30 minutes with a compress saturated with room-temperature ( 24.0 ° C ± 1.0 ° C ) water used as a compress . The subjects ’ eyes were r and omized into experimental and control eyes . TFLLT was measured at the following time points : 5 , 15 , and 30 minutes during the 30-minute treatment period , and after 5 minutes following the 30-minute treatment period . Results . The mean baseline TFLLT of the experimental eye prior to treatment with a warm , moist compress was 57.8 ± 12.9 ( st and ard error ) nm ; after 5 minutes of treatment , TFLLT was 105.8 ± 23.7 nm ; after 15 minutes of treatment , 117.8 ± 26.4 nm ; after 30 minutes of treatment , 121.5 ± 27.1 nm ; and after 5 minutes following the 30-minute treatment , 96.0 ± 21.5 nm . The mean baseline TFLLT of the control eye prior to treatment with a room temperature , moist compress was 63.0 ± 14.1 nm ; after 5 minutes of treatment , TFLLT was 63.8 ± 14.3 nm ; after 15 minutes of treatment , 62.3 ± 13.9 nm ; after 30 minutes of treatment , 64.5 ± 14.4 nm ; and after 5 minutes following the 30-minute treatment period , 58.5 ± 13.1 nm . Using a paired- data t- test , the results demonstrated a significant increase in mean TFLLT in the experimental eye after 5 minutes ( P < 0.001 ) , 15 minutes ( P < 0.001 ) , and 30 minutes ( P < 0.001 ) of treatment , and after 5 minutes following the 30-minute treatment period ( P < 0.001 ) when compared to baseline TFLLT . In comparison , there was no significant increase in TFLLT of the control eye after 5 minutes ( P = 0.79 ) , 15 minutes ( P = 0.77 ) , and 30 minutes ( P = 0.81 ) of treatment , and after 5 minutes following the 30-minute treatment period ( P = 0.20 ) when compared to baseline TFLLT . Conclusions . Warm , moist compress therapy applied to the skin of the closed eyelids increases TFLLT for subjects with MGD by more than 80 % , 5 minutes after initiating treatment and an additional 20 % after 15 minutes of treatment . This study supports clinical experience and previous reports on warm , moist compress therapy as an effective treatment for meibomian gl and dysfunction Purpose To evaluate the safety and effectiveness of the LipiFlow System compared to the iHeat Warm Compress ( WC ) for adults with meibomian gl and dysfunction ( MGD ) . Methods This was a non-significant risk , prospect i ve , open-label , r and omized , crossover multicenter clinical trial . One hundred thirty-nine subjects were r and omized between LipiFlow ( n=69 ) and WC control ( n=70 ) . Subjects in the LipiFlow group received a 12-minute LipiFlow treatment and were reexamined at 1 day , 2 weeks and 4 weeks . Control subjects received a 5-minute iHeat treatment with instructions to perform the same treatment daily for 2 weeks . At 2 weeks , they crossed over ( LipiFlow Crossover ) and received the LipiFlow  treatment . Effectiveness parameters : meibomian gl and ( MG ) assessment , tear break-up time ( TBUT ) and dry eye symptoms . Safety parameters : adverse events , ocular health exam , ocular surface staining , intraocular pressure , visual acuity and discomfort . Results LipiFlow result ed in significant improvement ( P < 0.05 ) in MG secretion at 2 and 4 weeks ( mean ± st and ard deviation at baseline = 6.3 ± 3.5 ; 2 weeks = 14.3 ± 8.7 ; 4 weeks = 16.7 ± 8.7 ) ; and TBUT at 2 and 4 weeks : ( at baseline = 5.5 ± 2.9 ; 2 weeks = 6.9 ± 5.0 ; 4 weeks = 7.4 ± 5.5 ) . There was no significant change in MG secretion or TBUT in the control group . LipiFlow result ed in a greater significant reduction in dry eye symptoms than the iHeat WC . The crossover group demonstrated similar significant improvement 2 weeks post-treatment with the LipiFlow . There was no significant difference between groups in the incidence of non-serious , device-related adverse events . Conclusion The LipiFlow System was significantly more effective than iHeat WC . These results support its safety and effectiveness in the treatment of MGD and dry eye symptoms PURPOSE To assess clinical outcomes and tear cytokine levels in patients with moderate and severe meibomian gl and dysfunction ( MGD ) after treatment with oral minocycline and artificial tears versus artificial tears only . DESIGN Prospect i ve , r and omized clinical trial . METHODS Sixty eyes of 60 patients with stage 3 or 4 meibomian gl and dysfunction were enrolled . We evaluated the tear film break-up time , Schirmer test results , corneal and conjunctival fluorescein staining results , biomicroscopic examination results of lid margins and meibomian gl and s , and tear cytokine levels before and after 1 month and 2 months of oral minocycline and artificial tears ( group 1 ) or artificial tears only ( group 2 ) . Tear sample s were collected and analyzed using a BD Cytometric Bead Array ( BD Bioscience , San Jose , California , USA ) for detection of interleukin (IL)-1β , IL-6 , IL-7 , IL-8 , IL-12p70 , IL-17α , interferon-γ , tumor necrosis factor-α , and monocyte chemotactic protein-1 . The Wilcoxon signed-rank test , Mann-Whitney U test , generalized linear model , and linear mixed model were performed . RESULTS Patients in group 1 showed statistically significant improvement in all clinical signs and symptoms after 1 month and 2 months of treatment . Patients of group 1 showed more significant improvement compared with those in group 2 . Patients in group 1 also showed statistically significant reductions in IL-6 , IL-1β , IL-17α , tumor necrosis factor-α , and IL-12p70 after 2 months of treatment . CONCLUSIONS Oral minocycline can provide clinical benefits in treating moderate and severe meibomian gl and dysfunction by reducing inflammatory cytokine levels PURPOSE To compare the effectiveness of a single LipiFlow ( ® ) treatment with combined lid warming and massage in patients with meibomian gl and dysfunction ( MGD ) . METHODS In this prospect i ve , r and omized , crossover , observer-masked clinical trial , subjects were r and omized to receive either a single 12-min LipiFlow-LipiFlow Thermal Pulsation ( LTP ) system treatment or to perform combined twice-daily lid warming and massage for 3 months . All subjects were examined before , and 1 and 3 months after initiation of treatments . Investigated parameters included subjective symptoms , lipid layer thickness , meibomian gl and assessment , tear break-up time , tear osmolarity , corneal and conjunctival staining , Schirmer test values , and tear meniscus height . RESULTS A total of 31 subjects completed the 3-month follow-up . At 1 and 3 months , patients in the LipiFlow treatment group had a significant reduction in Ocular Surface Disease Index ( OSDI ) scores compared with those in the lid-margin hygiene group . Both treatments produced a significant improvement in expressible meibomian gl and s compared to the baseline parameters , but no significant difference was noted between the two groups . The other investigated objective parameters did not show a significant difference . CONCLUSION Results of our study show that a single LipiFlow treatment is as least as effective as a 3-month , twice-daily lid margin hygiene regimen for MGD . However , the present study was observer-masked only , and therefore a placebo effect may have confounded any improvements in subjective symptoms and other parameters in both groups PURPOSE To evaluate the effect of intense pulsed light ( IPL ) applied to the periocular area for meibomian gl and dysfunction ( MGD ) in a prospect i ve , double-masked , placebo-controlled , paired-eye study . METHODS Twenty-eight participants underwent IPL treatment  , with homogeneously sequenced light pulses delivered to one eye and placebo treatment to the partner control eye at 1 , 15 , and 45 days following baseline ( BL ) evaluation . Lipid layer grade ( LLG ) , noninvasive tear break-up time ( NIBUT ) , tear evaporation rate ( TER ) , tear meniscus height ( TMH ) , and subjective symptom score using visual analogue scales ( VAS ) were compared with BL and control values at each visit . RESULTS Lipid layer grade improved significantly from BL to Day ( D ) 45 in the treated eye ( P < 0.001 ) , but not the control eye ( P = 0.714 ) , with 82 % of treated eyes improving by at least one LLG . Noninvasive tear break-up time also improved significantly from BL to D45 in the treated ( P < 0.001 ) but not in the control eye ( P = 0.056 ) and was significantly longer than in the treated eye at D45 ( 14.1 ± 9.8 seconds versus 8.6 ± 8.2 seconds , P < 0.001 ) . The tear evaporation rate was not different in the treated eye compared with the control eye at any visit . Tear meniscus height did not change from BL in either eye ( P > 0.05 ) . Visual analog scale symptom scores improved from BL in the treated ( P = 0.015 ) , but not the control eye ( P = 0.245 ) , with 86 % of participants noting reduced symptoms in the treated eye by D45 . CONCLUSIONS Intense pulsed light with multiple sculpted pulses shows therapeutic potential for MGD , improving tear film quality and reducing symptoms of dry eye . ( https://www.anzctr.org.au number , ACTRN12614000162617 . )
No quantitative synthesis was attempted for either mebiomian plugging or meibomian secretion scores and no significant changes were observed with any other outcome parameter .
Conclusion : Only the systemic antimicrobials were found to improve the clinical features of meibomian gl and dysfunction .
Varying effects of different therapeutic agents ( heat therapies , omega-3-fatty acids and castor oil ) were identified for MGD but the risk of bias pertaining to r and omization and allocation concealment was found to be associated with most of the current RCTs .
Introduction : Meibomian Gl and Dysfunction ( MGD ) is a common , often overlooked , chronic condition affecting eyes for which various therapies are being evaluated .
Considering the absence of a systematic review and meta- analysis , the present review was carried out .