WHAT IS MEIBOMIAN GLAND DYSFUNCTION AND POSTERIOR BLEPHARITIS?
Meibomian gland dysfunction (MGD) is the most common form of eyelid margin disease causing eyelid inflammation and making dry eye symptoms worse. Meibomian glands are small vertical oil-producing sacs that reside within the eyelid tissue that have small openings running along the eyelid margin. The role of these natural oils is to coat the surface of our tear fluid and reduce the evaporation of the watery tear fluid layer. If poor quality or insufficient oils are present, then the watery component of the tear fluid evaporates at a far greater rate, causing the common symptoms of dry eyes.
WHAT ARE THE SYMPTOMS OF MGD and POSTERIOR BLEPHARITIS?
Dry or gritty feeling, burning sensation, itchiness, watering, light sensitivity, crusting on eyelids, red eyes, sticky tears, filmy vision, intermittent blurring vision.
HOW IS MGD DIAGNOSED?
MGD can be diagnosed based on a understanding of the presenting symptoms and careful examination of the meibomian glands using a high powered microscope with infrared illumination. Examination of the meibomian glands by meibography ensures an accurate diagnosis can be made and also review of the glands can detect any worsening of the glands.
TREATMENT OPTIONS FOR MEIBOMIAN GLAND DYSFUNCTION and POSTERIOR BLEPHARITIS
Blephasteam moisture chamber treatment
Blephasteam is an in-office proceedure that we perform for those with mild to moderate MGD. Blephasteam is a medical device that delivers moist heat to the eyelids in a perfectly controlled manner. The device is capable of maintaining a constant 42 degrees of heat to the eyelids for 10 minutes, which is sufficient to melt the obstructed wax like oily secretions within the meibomian glands. The oily meibum secretion is then expressed with gentle massage and the eyelids are cleansed thoroughly. Each treatment session takes a total of 20-30 minutes. Typically after the initial treatment, a second treatment is performed one month later, then another 3 months later. and initially more than one treatment may be required to give many months of ocular comfort. This proceedure is performed in conjunction with warm compresses at home.
Warm compress therapy at home
This is a home-based proceedure that is typically performed twice daily, usually as part of a maintainence eyelid cleansing routine. We recommend warm compresses using a heated Bruder Eye Mask which provides consistent moist heat over the eyelids for 10 minutes. A warm face-cloth can not reproduce the ideal length of heating time required to the eyelid surface. The Bruder Eye Mask contains MediBeads which absorb and then release moist heat directly to the oil glands of the eye lids. The eye mask can be re-used and is simply heated in a microwave. The heating and massage treatment promotes the secretion of natural oils from the meibomian glands, helping improve tear surface quality and reducing eyelid inflammation. This is followed by cleansing of the eyelid margins to remove any residual oils and crusting or flaking.
Eyelid cleansing at home
Sterilid is a foam spray that cleanses oily deposits from the eyelid margins and helps remove unwanted bacteria. Sterilid is pH balanced to the skin and is very gentle on the eyelid surface whilst effectively cleansing the area. This proceedure of warming, massage, followed by cleansing is an important ongoing routine required to manage the symptoms of blepharitis, however as symptoms improve the frequency of lid cleaninsing may be reduced.
Omega-3 oils have been shown to significantly improve MGD and dry eye symptoms. The essential fatty acids contained within omega-3 capsules provide an anti-inflammatory effect which helps reduce the inflammation associated with blepharitis and dry eye. A second benefit of these essential fatty acids is the improvement in quality of oils secreted by the meibomian glands. This improves overall tear quality and reduces the effects of evaporation from the tear surface. Theratears Nutrition contains two types of omega-3s derived from flaxseed oil and fish oil. Theratears Nutrition also contains Vitamin E which helps prevent oxidation of the omega-3 oils and helps the efficient metabolism of omega-3 in the body.
Optimel Manuka Honey
Optimel ophthalmic ointment gel and Optimel eye drops contain antibacterial manuka honey. Typically patients with tear deficiency and meibomian gland dysfunction have an over growth of natural bacteria on the lid margin. Optimel specifically reduces this overpopulation of bacteria and improves the health of the eye and lid surfaces while reducing inflammation. Optimel is available in two strengths, with the ointment being used for more advance lid disease. Some stinging is noted on application of the ointment, which disappears after 60 seconds. The eye drop form is half the concentration of the ointment gel form and is generally well tolerated. As this Optimel eye drops and gel are often not readlly avaiable from all pharmacies, this practice always holds stock of both Optimel Manuka Honey eye drops and Optimel Manuka Honey gel.
Artificial tear therapy
Lubricant eye drops are specifically formulated to restore the electrolyte balance in the natural tear film and form a moisturising cushion over the eye surface. Restoring electrolyte balance reduces the high salt concentration found with dry eyes and in turn reduces the stinging and burning often associated with dry eyes. The moisturising cushion provides a smooth surface for the eyelid surface to glide over. Some lubricant drops help provide addtional lipids that help minimise the evaporation of tears. To get the best results from lubricant drops, the regular application over an extended period of time will provide the greatest benefits. To see which drops will provide the best results for you, an eye examination is required.