Current and Emerging Therapeutic Strategies for the Treatment of Meibomian Gland Dysfunction (MGD)

Abstract

Meibomian gland (MG) dysfunction (MGD) is a multifactorial, chronic condition of the eyelids, leading to eye irritation, inflammation and ocular surface disease. Initial conservative therapy often includes a combination of warm compresses in addition to baby shampoo or eyelid wipes. The practice of lid hygiene dates back to the 1950s, when selenium sulfide-based shampoo was first used to treat seborrhoeic dermatitis of the eyelids. Today, tear-free baby shampoo has replaced dandruff shampoo for MGD treatment and offers symptom relief in selected patients. However, many will not achieve significant improvement on this therapy alone; some may even develop an allergy to the added dyes and fragrances in these products. Other manual and mechanical techniques to treat MGD include MG expression and massage, MG probing and LipiFlow(®). While potentially effective in patients with moderate MGD, these procedures are more invasive and may be cost prohibitive. Pharmacological treatments are another course of action. Supplements rich in omega-3 fatty acids have been shown to improve both MGD and dry eye symptoms. Tea tree oil, specifically the terpenin-4-ol component, is especially effective in treating MGD associated with Demodex mites. Topical antibiotics, such as azithromycin, or systemic antibiotics, such as doxycycline or azithromycin, can improve MGD symptoms both by altering the ocular flora and through anti-inflammatory mechanisms. Addressing and treating concurrent ocular allergy is integral to symptom management. Topical N-acetylcysteine and topical cyclosporine can both be effective therapeutic adjuncts in patients with concurrent dry eye. A short course of topical steroid may be used in some severe cases, with monitoring for steroid-induced glaucoma and cataracts. While the standard method to treat MGD is simply warm compresses and baby shampoo, a more tailored approach to address the multiple aetiologies of the disease is suggested.

Neuropathic Corneal Pain

“…In refractory cases, procedures including intraductal MG probing, thermal pulsation devices, and intense pulse light therapy may be of benefit. 95–96,97 In addition, treatment of blepharitis, including recognition and treatment of demodex blepharitis may remove inciting stimuli. Moreover, addressing other co-morbidities, such as ocular allergies, conjunctivochalasis, exposure keratopathy, and essential blepharospasm are important steps in mitigating patient symptoms.…”

Non Antimicrobial Effects of Antibacterial Agents

“…Minosiklinin, antikollajenaz aktivitesi ve anti-enflamatuvar özelliklerinden dolayı RA tedavisinde kullanılabileceği öngörülmekteyken, doksisiklin 100 mg/gün ve minosiklin 50 mg/gün dozlarında ve 2-3 ay süreyle kullanılmasının, hem antienflamatuvar etkileri hem de bakteriyel kolonizasyonu azaltmaları nedeni ile kronik Meibomian bezi disfonksiyonunda uzun süreli iyileşmeye neden olduğu bildirilmiştir [21,22] .…”

Modern Therapeutic Approaches for Noninfectious Ocular Diseases Involving Inflammation

“…IL-1 and TNF-α) were lower in treated animals, suggesting that omega-3 fatty acids can alter the pro-inflammatory milieu and lessen the signs of dry eye. [91,93,102,113] …”

“…[114] This particular medical device uses a 12-minute vectored thermal pulsation (VTP) treatment that applies heat to the eyelid while also applying pressure to the outer eyelids to enable the release of meibum (oil like substance found in the tears). [113,115] A clinical trial revealed that LipiFlow was able to improve symptoms of ocular irritation, and subsequently in 2011, the FDA approved LipiFlow as a medical device. [116,117] Although the treatment is an effective therapy for some patients, it is still not widely available due to its high cost.…”