Purpose. To evaluate the effectiveness of lid hygiene and preservative-free artificial tears for the treatment of meibomian gland dysfunction (MGD) during a 6-week period.
Methods. Suitable patients with MGD were educated about their disease and instructed to begin a regimen of lid hygiene, which included the application of a heated saline solution and the use of nonpreserved artificial tears. Baseline measurements obtained at the time of enrollment included basic tear secretion test, tear breakup time, a questionnaire grading MGD symptoms (i.e., burning, irritation, itching, sharp pains, foreign body sensation, and hazy vision), and lid margin slitlamp photographs. All measurements except for basic tear secretion were repeated at the 6-week follow-up visit. Photographs were unlabeled, and two cornea specialists graded them in a masked fashion for the presence of lid erythema, irregularity, thickness, meibomian gland capping, and telangiectasis.
Results. Thirty-seven patients with a clinical diagnosis of MGD were enrolled, and 26 patients (70%) completed the study. Initial measurement of basic tear secretion averaged 17 mm and was more than 10 mm in 81% of eyes. The tear breakup time was prolonged by an average of 3.4 seconds; in 30% of cases, it was normalized to 10 seconds or more. Symptoms improved in 88% of cases; among those, symptoms were graded mild or less in 83%, and none in 39%. Photographs before and after treatment were not significantly different.
Conclusions. In this noncontrolled case-cohort study of selected patients with MGD, lid hygiene and preservative-free artificial tears significantly improved tear breakup time and relieved symptoms of the condition.
Meibomian gland dysfunction (MGD), a condition associated with obstruction and inflammation of the meibomian glands, is a widespread and chronic problem that is seen frequently in general ophthalmology, cornea, and external disease practices. It is probably the most common cause of posterior blepharitis and may also be the most common factor in exacerbating dry eye symptoms in patients predisposed to dry eyes. 1-6 Lid hygiene is currently the mainstay of treatment for MGD. 2-4 Other widely recommended therapies for MGD include oral tetracycline, doxycycline, or minocycline; topical erythromycin or bacitracin; and topical steroids. 3,4,7,8 For refractory cases, topical cyclosporine can be used. 9,10 The cost and side effects associated with some of these medications make them a poor choice for long-term treatment in patients with mild to moderate cases of MGD.
Conservative treatment-specifically, the use of lid hygiene and artificial tears-is a popular treatment for MGD. Such treatment has been shown to be useful when applied to associated eyelid disorders such as chalazion, against which conservative management was 83% effective in one study. 11 Another study addressed conservative treatment of MGD in patients with contact lens intolerance. 12 Two studies examined the effect of warm compresses on objective findings in the tear film layer. 13,14 However, to our knowledge, no study has yet formally attempted to evaluate the clinical and symptomatic effectiveness of standard conservative management (warm soaks and artificial tears) for patients with a chief complaint of MGD. To address this issue, we performed a case-cohort prospective study on the effect of lid hygiene and preservative-free artificial tears on MGD in a large, urban, general ophthalmology clinic.