A Review on Evidence-Based Treatments for Meibomian Gland Dysfunction

Abstract

Objectives: To evaluate recent studies on available therapies for meibomian gland dysfunction (MGD). Methods: A literature search on recent publications, within the last five years, concerning treatment options for MGD was performed. Results: A total of 35 articles were reviewed after curation by the authors for relevance. In general, all modalities of treatments were shown to have clinical efficacy in alleviating dry eye signs and symptoms, although the extent of improvement and persistency of outcomes varied between the different treatments. Evidence from published studies demonstrate that thermal pulsation produces the longest lasting effect per treatment, but it also incurs the highest per-treatment cost. Reusable methods for warm compress with lipid/semi-fluorinated alkane-containing eye drops are recommended as first-line treatment for mild-to-moderate dry eye patients, because this option is most technically feasible and cost-effective in clinical practice. Intense pulsed light (IPL) therapy and thermal pulsation may be suitable as second line for patients unresponsive to warm compress therapy; however, their respective limitations need to be considered. For refractory MGD with features of periductal fibrosis or severe blepharitis, supplementary treatment with meibomian gland probing or oral antibiotics may be used. Conclusions: All eight forms of treatments, including self-applied eyelid warming, thermal pulsation, IPL, MG probing, antibiotics, lipid-containing eye drops, and perfluorohexyloctane, were effective against MGD, although with varying extent of clinical improvements. A better understanding on the mechanisms of actions may guide physicians to make better treatment decisions targeting the root causes.

Safety and Efficacy of an Augmented Intense Pulse Light Protocol for Dry Eye Syndrome and Blepharitis

“…In a review of eight different treatments for dry eye, meibomian gland expression and thermal pulsation appeared to be effective in treating dry eye symptoms; further, Vegunta et al showed that patients who failed to improve with thermal pulsation treatment alone improved significantly with IPL treatment. 23,24 The high-intensity red (560-580 nm) to infrared (580-1200 nm) wavelengths of light in our BBL protocol may also be improving the disease by reducing harmful bacteria and Demodex mite infestation. 12,13 This technology, however, has the capacity to harm.…”

Treatment of contact lens related dry eye with intense pulsed light

“…A longer treatment period of 2-3 months would provide a better prospective on the signs and symptoms of DE. Additionally, dose and duration of IPL treatment required for CLDE has not been assessed before [48,49], therefore future study will explore the optimal dose and duration of IPL treatment required.…”

Intraductal meibomian gland probing and its efficacy in the treatment of meibomian gland dysfunction

“…24 MGP is also mentioned in recent reviews looking at the treatment of MGD, with one published as recently as January, 2020. 19,32,33,37 Five retrospective studies were included in this review. 22,23,25,26,36 Four of these five were conducted by the same first author using his past patients' charts.…”