In-office MGD treatments may provide relief but lack formal studies

Take-home message: Surgeons have several in-office treatments available for meibomian gland dysfunction, but there are not many studies to show the long-term effectiveness.

By Vanessa Caceres; Reviewed by Richard S. Davidson, MD

Denver-Although in-office treatments for meibomian gland dysfunction (MGD) can be helpful, patients also need to know that they must take a role in managing this chronic condition, said Richard S. Davidson, MD.

Ophthalmologists must also systematically and consistently follow a treatment plan for patients with MGD to provide relief, said Dr. Davidson, associate professor and vice chairman, University of Colorado Health Eye Center, Denver.

A solid treatment approach for MGD is crucial because the condition may well be the leading cause of dry eye, Dr. Davidson said. These patients often experience discomfort, and they make up a significant portion of office visits.

“We probably all cringe on certain days when we see another burning, itching patient,” Dr. Davidson said.

Additionally, an unhealthy ocular surface can affect surgical outcomes.

At-home treatment has been the mainstay for MGD, and this has included warm compresses, eyelid scrubs, and gland expression performed by the patient, Dr. Davidson said.

However, these treatments come with their own challenges, including poor compliance, inadequate heat levels, and patients only able to self-express the upper portion of the gland.

Overview of in-office treatments

These challenges have led to several in-office treatments for blepharitis that Dr. Davidson outlined.

One such device that helps with making the diagnosis is an interferometer (LipiView, TearScience) that takes precise measurements of tear film thickness, takes dynamic meibomian imaging, and allows the user to quantify lipid level of tear film.

“This is helpful for analytical patients because you can show them a number,” Dr. Davidson said.

The treatment arm of LipiView is Lipiflow, which applies heat to the inner eyelids. The device liquefies meibomian gland contents and facilitates the release of secretion from the meibomian glands. The treatment lasts about 12 minutes.

A couple of studies have analyzed Lipiflow results, including one with 40 eyes in 20 patients that found that meibomian gland secretion scores increased at 1 month and lasted for 3 years.

The same study found that tear breakup time increased from baseline to 1 month but was not that different compared with baseline at 3 years, Dr. Davidson said.

Another treatment for patients with MGD (BlephEx) consists of a medical-grade disposable micro-sponge that is applied to the edge of eyelids and lashes. The device removes debris and exfoliates eyelids. The treatments last about 6 to 8 minutes, and patients must maintain good eyelid hygiene and return for treatment every 4 to 6 months.

“In theory, it looks pretty good, but there is no data to show it’s beneficial,” Dr. Davidson said.

A fourth device (MiBoFlo ThermoFlo, MiBo Medical Group) is a thermoelectric heat pump that liquefies the meibum and facilitates the expression of gland secretions. Heat is applied to the outside of the lids, breaking down hardened material inside the glands. The treatment takes up to 12 minutes each eye.

One study showed improvement in 73% of patients who had had previous Lipiflow, Dr. Davidson said.

Yet, another MGD treatment is intense pulsed light, for which there is a paucity of published data for ophthalmic indications, Dr. Davidson said.

However, some research has shown a reduction in artificial tear usage, a decrease in the Ocular Surface Disease Index score, and a reduction in lid margin edema and vascularity. Patients must return for maintenance treatments every 6 months to a year.

Finally, Dr. Davidson addressed intraductal meibomian gland probing, in which one study reported 96% of the 25 patients included had immediate post-probing relief. However, the treatment can be painful, he added.

One drawback that may hurt in-office treatments for MGD is cost and reimbursement, Dr. Davidson said.

Richard S. Davidson, MD

E: Richard.davidson@ucdenver.edu

This article was adapted from Dr. Davidson’s presentation at Cornea Subspecialty Day during the 2015 meeting of the American Society of Cataract and Refractive Surgery. Dr. Davidson has no financial interest in the subject matter.