Eyeworld

6 Early diagnosis and treatment essential for meibomian gland dysfunction and effectively treated earlier in their course, and thermal pulsa- tion is valuable by allowing ear- lier diagnosis and treatment," said Alan Carlson, MD. Symptoms and treatment Patients often have non-obvi- ous symptoms (Figure 1). 2 "The most severe patients with the most clinical findings tend to have chronic disease, and with a longer disease, the symptoms of pain and burning and the classic dry eye symptoms lessen over time," said Edward Hol- land, MD. "This occurs because the chronic patient develops somewhat of an anesthetic cornea." "One of the most telling symptoms for MGD is fluctuat- ing vision because it is insta- bility of the tear film and the higher-order aberrations that come into play, especially when patients say they cannot read for long periods of time," said Marjan Farid, MD. "If clinicians can identify symptoms and help patients realize that they have a disease, there will be more buy-in in terms of treating it," said Preeya Gupta, MD. Early detection enables proactive management of meibomian gland dysfunction E xperts agree that early treatment is optimal in halting meibomian gland dysfunction (MGD). 1 "If we start treating these patients and intervene at an earlier stage of their disease, they are more likely to respond better than if we wait until their glands are atrophied and non-functional," said Alice Epitropoulos, MD. Frank Bowden III, MD, likened MGD early diagnosis and intervention to preventive dental care. "I tell patients that you do not wait until your teeth are loose and your mouth hurts before you start brushing and flossing your teeth," he said. "In that respect, MGD treatment measures when we detect any alteration in meibomian gland structure or function." "Chronic, progressive dis- eases associated with structural damage, such as MGD, are more easily, economically, efficiently, Meibography Summit: Translating knowledge into practice Initiating MGD treatment Douglas Devries, OD, recom- mends baseline meibography in primary care practices, which would lead to earlier treatment in not only surgical candidates but contact lens patients as well. "I think performing base- line meibography will create a paradigm shift toward more proactive care for our patients," he said. Treatment options abound, including artificial tears and lubricants, oral omega fatty acid supplements, lid hygiene, warm hydrating compresses, cyclosporine, lifitegrast, thermal pulsation, topical and oral anti- biotics, and more. William Trattler, MD, typ- ically begins with hypochlorous acid. If patients do not respond, he performs meibography and progresses to other treatments. "Other initial therapies include warm compresses and oral omega-3s," Dr. Trattler said. "I do not think that the DREAM study has convinced me that omega-3s do not have a role in the therapy of MGD." 3 Meibography helps guide treatment. "Prognostically, I know my patients with poor function but good architec- ture respond better to thermal pulsation," said Elizabeth Yeu, MD. Furthermore, irregular steps on meibography indicate a progressive process that needs to be addressed aggressively, she said. Marguerite McDonald, MD, explained that MGD can be treated with hot compress- es and lid scrubs, antibiotic ointment, and oral doxycycline, but the peer-reviewed literature shows that thermal pulsation therapy is more effective. 4 Before thermal pulsation, Terry Kim, MD, performs a manual debridement of the lid margin to remove any mechan- ical obstruction, such as kera- tinization, of the meibomian gland orifices, resulting in im- proved efficacy of the thermal pulsation treatment. Patients are then instructed to continue with maintenance therapy, such as a microwavable mask and lid cleansers. Surgical patients If MGD is not addressed and treated before cataract and refractive surgery, it impacts preoperative measurements and postoperative outcomes and patients may blame their Figure 1. Responses varied regarding the percentage of participants' patients with MGD with non-obvious symptoms. In your clinic, what percentage of patients with MGD have non-obvious symptoms? Meibography Summit Figure 2. Most participants think that symptomatic MGD should be treated before cataract surgery. Should we be treating symptomatic MGD before or after cataract surgery? Meibography Summit

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