Evidence Based Approach Dry Eye Meibomian Gland Dysfunction

Size: px

Start display at page:

Download "Evidence Based Approach Dry Eye Meibomian Gland Dysfunction"

Chastity Pitts
5 years ago
Views:

1 Evidence Based Approach Dry Eye Meibomian Gland Dysfunction Copenhagen 2012 Teifi James MBBS DO FRCP FRCS FRCOphth Consultant Ophthalmologist Calderdale Royal Hospital

2 MGD Symptoms

3 Declaration Fees, Hospitality & expenses from Boots Allergan Specsavers EyeCare 3000 Spectrum Thea Bausch & Lomb CIBA / Alcon / Novartis Rotho / Mentholatum / Sooft The EyeBag Company patent and majority shareholding

5 Moll secretions anterior to MGOs

The Dry Eye Pyramid - circa 20 million in UK Intrinsic

blink rate eg Parkinson's Drug action Ro-accutane effect on

in Topical eye treatments Contact lens wear Ocular Surface

6 The Dry Eye Pyramid - circa 20 million in UK Intrinsic Meibomian Gland Dysfunction Lid Aperture disorders eg GO Low blink rate eg Parkinson's Drug action Ro-accutane effect on Meibomian Glands Extrinsic Vitamin A deficiency Preservatives in Topical eye treatments Contact lens wear Ocular Surface Disease Post Corneal / laser surgery HES Sjøgrens Evaporative Millions with dry eye

8 Dry Eye Lacrimal gland dysfunction, Sjogrens - rare Evaporative dry eye very common MGD is the major cause of Dry Eye.

14 Onions Tears?

21 MGD

23 Meibomian seborrhoea

24 MGD pseudoblisters with capped orifices

26 Transient blurred vision Common in MGD Blob of lipid in the tear film

27 Loss of lipid barrier Loss of lid margin hydrophobicity Macerated lid margin water wettable

28 TFOS MGD Report Definition / Classification Anatomy, Physiology, Pathophysiology Tear Film Lipids & Lipid-Protein interactions Epidemiology & Risk Factors Diagnosis Management and Treatment Clinical Trials

29 MGD Aetiology Not clear More research required

30 MGD is The key underlying feature of Dry Eye Post Laser Ocular Dryness Contact Lens Associated Dry Eye Blepharitis Chalazion Stye

31 MGD Tear film has poor quality lipid layer Break Up Time is short. Strategies to restore it. Diagnosis is self-evident. Champagne bubbles on lid edge. Blepharitis & evaporative dry eye.

40 Temperature Dependent Phase Change Lipid composition alters melting point nsaturated FAs Increasing Saturation Wax Esters

41 Omega 3 Oily fish +++ zero butter, red meats or take a supplement Lagad Lacrima

42 Omega 3 GLA (Gamma Linolenic Acid) Anti-inflammatory Nutrient EPA (Eicosapentaenoic Acid) Omega 3 Anti-inflammatory Nutrient

44 Lipid chemistry Meibum is a complex soup of variable lipids and lipid derivatives. The melting point varies according to the exact composition. Properties of fatty acids and their derivative lipids depend on chain length and being unsaturated Unsaturated FAs have a lower melting point than saturated FAs of same length e.g. C18 Stearate ( zero double bonds) melts at 69.6ºC C18 Oleate ( one cis double bond) melts at 13.4ºC

45 Meibomian gland dysfunction and ocular discomfort in video display terminal workers C Fenga1, P Aragona2, A Cacciola1, R Spinella2, C Di Nola1, F Ferreri2 and L Rania2 Eye (2008) 22, 91 95; doi: /sj.eye ; published online 26 October 2007 Results A total of 52 subjects out of 70 (74.3%) had MGD. A statistically significant correlation between the symptoms of ocular discomfort and hours spent on VDT work was observed in the total population (r=0.358; P=0.002; 95% CI ) and in the group of subjects with MGD (r=0.365; P=0.009; 95% CI ). Such correlation was not shown in subjects without MGD. Conclusions The high prevalence of MGD among the subjects with symptoms of ocular discomfort suggests that this diagnosis should be considered when occupational health practitioners encounter ocular complaints among VDT operators. It appears that MGD can contribute to the development of ocular discomfort in VDT operators.

46 Jackson Brown Doctor my Eyes

50 118 Opticians 3 blinks - 2 people 4 blinks - 4 people

51 The near response... Convergence Miosis Accommodation? Decreased blink rate??

52 The rule & Return / blink button & Gamers lose a life or progress to next level

53 ? Melts at 39º C

57 Are you a squeezer?

60 Clinical Handbooks Moorfields Wills Heat Wet Flannel 5mins od / bd Warm compresses 15 mins qid Antibiotics Doxy 100mgs od for 8/52 Tet 250 qid for 6/52 Lubricants prn 4 to 8 x a day

63 The ideal warm compress Must raise lid temperture above 39º C Stay above 39º C for a while Good compliance (nice and easy to use) Affordable (inexpensive) No adverse effects

64 Blephasteam

74 84 Temperature changes of the external and internal eyelids using the MGDRx EyeBag Paramdeep S Bilkhu, BSc (Hons) MCOptom. N, Shehzad A Naroo, BSc (Hons) MSc PhD MCOptom FIACLE FAAO FBCLA James S Wolffsohn, BSc (Hons) MBA PhD FSB MCOptom FAAO FBCLA Aston University, Birmingham, UK Corresponding Author: bilkhups@aston.ac.uk

75 Conclusions: Paramdeep Bilkhu et al The MGDRx EyeBag does produce an increase in external and internal eyelid temperature. Based on the results, either surface of the MGDRx EyeBag can be used but 5 minutes application using the silk surface demonstrates greater increases of eyelid temperature necessary for optimal heating

76 Hot Compress Survey 125 responses

80 Tear replacement!

81 Topical lubricant drops and gels 4 million UK scripts annually for Hypromellose Hyaluronate Polyvinyl alcohol Carbomer Guar Micelle mist / sprays Mucin mimetic agents Autologous Serum

84 Generic Hypromellose 10 mls 2.99 from Amazon per 100 mls 30 per 100 mls

85 No Recipe for hot spoon treatment!

86 Thank You

Understanding the Role of Meibomian Gland Dysfunction in Dry Eyes

Understanding the Role of Meibomian Gland Dysfunction in Dry Eyes The International Dry Eye Workshop separated dry eyes into two main categories in 2007. Aqueous Deficient Dry Eyes as defined by an inability