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Conservative Treatment of Meibomian Gland Dysfunction

Romero, Juan M. M.D.; Biser, Seth A. M.D.; Perry, Henry D. M.D.; Levinson, David H. M.D.; Doshi, Sima J. M.D.; Terraciano, Anthony M.D.; Donnenfeld, Eric D. M.D.

Eye & Contact Lens: Science & Clinical Practice: January 2004 - Volume 30 - Issue 1 - p 14-19
doi: 10.1097/01.ICL.0000095229.01957.89
ARTICLES
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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.

From the Department of Ophthalmology (J.M.R., H.D.P., A.T.), The New York Eye and Ear Infirmary, New York, NY; and Ophthalmic Consultants of Long Island (S.A.B., H.D.P., D.H.L., S.J.D., E.D.D.), Rockville Centre, NY.

Accepted August 19, 2003.

Address correspondence and reprint requests to Dr. H.D. Perry, Ophthalmic Consultants of Long Island, Ryan Building, Suite 402, 2000 North Village Avenue, Rockville Centre, NY 11570; e-mail: hankcornea@aol.com

Dr. Biser was supported by a fellowship stipend from the Heed Ophthalmic Foundation. This work was funded by the Chairman’s Research Fund, The New York Eye and Ear Infirmary, New York, NY.

© 2004 Lippincott Williams & Wilkins, Inc.