MEIBOMIAN GLAND DYsfunction.pptx

Meibomian gland dysfunction

1. MEIBOMIAN GLAND Dysfunction Muhammad Magdy Abd Elrazeq MSc ophthalmology FICO

2. Meibomian gLANDS Meibomian glands are large sebaceous glands present in eyelids which secrete lipids that form the superficial layer of tear film to protect evaporation of the aqueous phase. There are about 25-40 glands in the upper eyelid and about 20-30 in the lower eyelid.

3. The International Workshop on Meibomian Gland Dysfunction: Recommended definition of Meibomian gland dysfunction (MGD) : is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion. This may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease. The International Workshop on Meibomian Gland Dysfunction 2011

4. POSTERIOR BLEPHARITIS??!! Posterior blepharitis is a term used to describe inflammatory conditions of the posterior lid margin, of which MGD    is only one cause. Other causes include infectious    or allergic    conjunctivitis and systemic conditions such as acne rosacea.

5. EPidemiology MGD is an underdiagnosed and undertreated disease and asymptomatic MGD is more common than the symptomatic MGD.It is estimated that 70% of Americans over the age of 60 have MGD.

6. RISK FACTORS Aging Sex hormone deficiency Contact lens wear, chronic blepharitis, eyelid tattooing, trachoma, aniridia Drugs : Isotretinoin , Antihistaminics ,Hormonal replacement therapy, antibiotics, antidepressants Demodex blepharitis Atopy , Steven johnson syndrome , Polycystic Ovary syndrome , Sjogren’s syndrome ,hypertension

7. PATHOPHYSIOLOGY MGD is a highly complex disease condition that is associated with or caused by several host, microbial, hormonal, metabolic and environmental factors.

8. Symptoms Redness. Tearing Irritation. Photophobia. Blurring of vision Eyelids crusting and sticking.

9. Symptoms Symptoms commonly worsen in the morning and patients have exacerbations and remissions.

10. DIAGNOSIS The diagnosis of MGD is based on examining the altered anatomical features such as terminal duct obstruction, gland drop out, qualitative and quantitative changes in meibum and pathological events leading to MGD. The International Workshop on Meibomian Gland Dysfunction recommended several diagnostic tests for MGD and proposed two approaches for diagnosing symptomatic MGD-related disease. For asymptomatic adults, performing gland expression with digital pressure to the central lower lid followed by assessing ocular surface damage is recommended. Presence of ocular surface damage or anatomical changes warrants Meibomian gland functionality should be assessed.

11. STAGING

12. Management Blepharitis is a chronic condition with frequent exacerbation. Currently, standard therapy is directed at control of symptoms and inflammatory signs. A Cochrane review evaluated 34 chronic blepharitis intervention studies and found no strong evidence to suggest that any of the studied treatments resulted in a cure. General treatment : Eyelid hygiene , warm compresses and scrubs. Eyelid hygiene should be continued after acute exacerbations resolve.

13. Medical Therapy Topical treatment : Azithromycin 1.5% eye drops 2 times daily for 5 days. Topical steroids: Short courses of topical steroids have been found beneficial for symptomatic relief in cases with clinically significant ocular inflammation. Lubricants (artificial tears) : lipid containing eye drops ,if more than 4 times daily better to use preservative free eye drops.

14. Medical Therapy Oral antibiotics : Doxycycline 100 mg / day. Should be avoided during pregnancy and lactation and children. Erithromycin can be used in children. Azithromycin

15. Other lines of treatment Omega 3 fatty acids. Intraductal meibomian gland probing to reopen MG orfices mechanically

16. Other lines of treatment Demodex treatment : Tea tree oil : blephademodex Ivermectin Blephex

17. LIPIFLOW LipiFlow ® ( TearScience ®, Morrisville, NC, USA) is a thermal pulsation system that applies heat and pressure to the eyelid tissue simultaneously to express the meibomian glands. Cost issues and Efficacy limit Access to treatment.

18. Intense pulsed Light IPL Intense pulsed light (IPL) is  a relatively novel treatment for DED due to MGD . The technique has been used in dermatology for over a decade for the treatment of rosacea, acne and skin lesions like benign cavernous hemangioma and telangiectasia. The technique uses a polychromatic light with a wavelength spectrum of 500–1200 nm which is directed to the skin and absorbed by chromophores such as melanin, hemoglobin and water with the development of heat, thus inducing blood vessels ablation

19. Prognosis Blepharitis is a chronic condition that has periods of exacerbation and remission. Patients should be informed that symptoms can frequently be improved but are rarely eliminated. 

20. Take HOME MESSAGE Don’t underestimate MGD. Inform patient about chronicity , remissions and exacerbations.