Eyeworld

SEPTEMBER 2019 | SUPPLEMENT TO EYEWORLD | 9 "I am now a huge believer in microblepharoexfoliation," said Elizabeth Yeu, MD. "I think that it is a treatment for MGD, especially for those who have good, healthy architecture but you can tell that there is a bit more turbid meibum, so the patient is in the earlier stages of MGD." Dr. Epitropoulos added that blepharoexfoliation not only helps with OSD, it also helps reduce the risk of en- dophthalmitis by reducing or eliminating the overgrowth of bacteria on the lid margins. Dr. Yeu also recommend- ed mechanical thermal pulsa- tion or thermal therapy to the lid. "My preferred choice is thermal pulsation," she said. "I think it does the most accu- rate melting of the meibum to the posterior lamella, followed by graded or gradual evacua- tion." In patients with a fair complexion with rosacea who have agreed to thermal pulsation, Frank Bowden, MD, offers intense pulsed light therapy (IPL), finding it to be a very helpful adjunctive measure. For a subset of patients with more advanced MGD, Dr. Matossian performs thermal pulsation once a year, with IPL at the 6-month mark. "It is potentiating the effect and keeping those glands evacuated with an anti-inflammatory approach through the IPL," she said. Dr. Farid has found that oral doxycycline can be help- ful in patients with rosacea. "In the preoperative setting, it works well to help decrease inflammation quickly," she said. Using an electrothermal device that heats the eyelid for 15 minutes followed by meibomian gland expression during a clinical study, William Trattler, MD, was impressed with how it facilitated expres- sion. "I was shocked when I was manually expressing these glands how much I was getting out," he said. There- fore, he also began manually expressing the glands after thermal pulsation. Dr. Karpecki thinks blepharoexfoliation is critical and most effective, but man- ual debridement of the lower eyelid during a follow-up examination is helpful. "You start nasally and move away, and you go across the lower eyelid in one direction," he said. Advancing understanding Dr. Holland thinks the ASCRS algorithm brings MGD to the forefront. "I hope we can get clinicians to think about MGD, diag- nose MGD, and start treating MGD," he said. n References 1. Lemp MA, et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31:472–478. 2. Choi MB, et al. Lid hygiene versus lid hygiene and microblepharoexfoliation (BlephEx) in the treatment of Demodex folliculorum blepharitis. 2019 ASCRS ASOA Annual Meeting. 3. Jones L, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15:575–628. 4. Epitropoulos AT, et al. Effect of oral re-esterified omega-3 nutritional supplementation on dry eyes. Cornea. 2016;35:1185–1191. 5. Smith SG. Investigational study, 3:1 rT omega-3 (1690 mg EPA/560 DHA) (abstract). 2013 ASCRS ASOA Sympo- sium & Congress. 6. Starr CE, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45:669–684. 7. Nichols KK, et al. The internation- al workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52:1922– 1929. Figure 1. Meibography Summit participants responded to the question: What is the role of in-office devices for the treatment of MGD? I provide them as primary therapy for all of my MGD patients I provide them as primary therapy for most of my MGD patients I use them for patients with significant and/or late stage disease I use them rarely I do not use in-office treatments 50% 50% 0% 0% 0% What is the role of in-office devices for the treatment of MGD?

• Blank Page
• Blank Page (1)