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    Pros and cons of available MGD treatments

    Sometimes heat and blinking aren’t enough


    Heat therapy

    In many cases, blinking exercises may not be enough, particularly when atrophy has already occurred in the meibomian glands and patients are already feeling the results of evaporative stress on their ocular surface.

    In those cases, the use of heated eye masks are a good treatment option. Heat therapies for MGD are effective only if the glands are consistently heated to at least 45° C (113° F).6

    To ensure compliance with treatment, offering devices, such as a Bruder eye mask, for sale in your office is the best course of action.

    Again, when I use this as a method for treatment, I will schedule a quick follow-up visit after one month of daily use to ensure a patient has been compliant and to address any further symptoms she may be experiencing.

    Beyond blinking, heat masks

    Clearly not every patient you encounter is going to respond well to blinking exercises and daily heat treatments. Some patients are unable or unwilling to comply, and some have progressed to far in their disease. In those cases, there are other treatments available.

    The most common adjunctive therapy still used for treatment of meibomian gland lid disease is low-dose oral doxycycline. The properties of doxycylcine help to reduce inflammation in the eyelid tissue and ultimately assist the gland’s function over time.7

    However, the drug is sometimes not tolerated by patients7 and isn’t encouraged for use in younger patients. As we screen for and see MGD at a younger age, it may not be a great treatment method for proactive practitioners.

    For patients who struggle with compliance or who have been suffering from meibomian gland-related dry eye disease for extended periods of time, more advanced methods of treatment are available.

    TearScience LipiFlow thermo-pulsation is one such treatment. One study showed that one treatment of LipiFlow was as effective as three months of twice-daily lid warming and massage.8 For a non-compliant patient or someone looking for more immediate relief, LipiFlow may be a great option.

    Unfortunately the cost of a single LipiFlow treatment is about 35 times more expensive than purchasing and using a heat mask. The cost may be a major deterrent to some patients.

    Clare Halleran, OD
    Dr. Halleran is a 2010 graduate of Southern California College of Optometry with an interest in dry eye research. [email protected]


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    Optometry Times A/V