Effect of Lid Debridement-Scaling in Sjögren Syndrome Dry Eye

Ngo, William; Caffery, Barbara; Srinivasan, Sruthi; Jones, Lyndon

doi:10.1097/opx.0000000000000668

Cited by 14 publications

(26 citation statements)

References 21 publications

(25 reference statements)

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“…As an example, there are a growing number of reports indicating that patients with refractory dry eye, including those with Sjogren’s syndrome, show significant improvement when they receive effective therapy for MGD. 3 , 11 , 12 These findings are in alignment with a statement that Wolff made in 1946 when he concluded that the meibomian glands “are essentially the glands proper to the cornea, which in the interests of vision have been moved out of the way.” 13 The clinical science to substantiate that the health of the ocular surface is indeed dependent upon healthy meibomian gland function has taken several decades to emerge. 9 , 14 – 16 The result is a growing awareness that ocular surface health cannot be sustained, optimized, or rehabilitated in the absence of a healthy meibomian gland function.…”

Section: Introductionsupporting

confidence: 76%

“… 17 Supplementary therapy, which includes front surface lid heating in various forms, lid margin scrubs, lid margin debridement-scaling, and additional disease comanagement, can then help maintain the improvement of gland function achieved by evacuating the gland contents. 4 , 5 , 11 , 17 , 36 The conventional method of evacuating stagnated contents is to manually express the glands. Although the procedure is effective, it is painful and needs to be repeated several times a year.…”

Section: Discussionmentioning

confidence: 99%

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The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye

Blackie

Coleman

Holland

2016

OPTH

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PurposeTo evaluate the sustained effect (up to 1 year) of a single, 12-minute vectored thermal pulsation (VTP) treatment in improving meibomian gland function and dry eye symptoms in patients with meibomian gland dysfunction and evaporative dry eye.MethodsThe prospective, multicenter, open-label clinical trial included 200 subjects (400 eyes) who were randomized to a single VTP treatment (treatment group) or twice-daily, 3-month, conventional warm compress and eyelid hygiene therapy (control group). Control group subjects received crossover VTP treatment at 3 months (crossover group). Effectiveness measures of meibomian gland secretion (MGS) and dry eye symptoms were evaluated at baseline and 1, 3, 6, 9, and 12 months. Subjects with inadequate symptom relief could receive additional meibomian gland dysfunction therapy after 3 (treatment group) and 6 months (crossover group).ResultsAt 3 months, the treatment group had greater mean improvement in MGS (P<0.0001) and dry eye symptoms (P=0.0068), compared to controls. At 12 months, 86% of the treatment group had received only one VTP treatment, and sustained a mean improvement in MGS from 6.4±3.7 (baseline) to 17.3±9.1 (P<0.0001) and dry eye symptoms from 44.1±20.4 to 21.6±21.3 (P<0.0001); 89% of the crossover group had received only one VTP treatment with sustained mean improvement in MGS from 6.3±3.6 to 18.4±11.1 (P<0.0001) and dry eye symptoms from 49.1±21.0 to 24.0±23.2 (P<0.0001). Greater mean improvement in MGS was associated with less severe baseline MGS (P=0.0017) and shorter duration of time between diagnosis and treatment (P=0.0378).ConclusionA single VTP treatment can deliver a sustained mean improvement in meibomian gland function and mean reduction in dry eye symptoms, over 12 months. A single VTP treatment provides significantly greater mean improvement in meibomian gland function and dry eye symptoms as compared to a conventional, twice-daily, 3-month regimen. Early VTP intervention for meibomian gland dysfunction is associated with improved treatment outcomes.

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Section: Introductionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye

Blackie

Coleman

Holland

2016

OPTH

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“…This result may be because both groups received eyelid exfoliation treatment. Score differences between the aforementioned studies may be because Korb and Blackie26 and Ngo et al27 performed LDS, whereas Epstein et al30 performed MBE. Meibum quality was assessed with MGYLS.…”

Section: Discussionmentioning

confidence: 99%

“…10,[28][29][30][31] Concerning clinical applications of eyelid exfoliation treatment, 2 stu dies used this treatment for DED, 26,27 4 studies for blepharitis, 10,28,30,31 and 2 studies for CL discomfort. 10,29 Regarding study group intervention, 2 studies performed eyelid exfoliation treatment alone, 27,29 whereas 5 studies performed eyelid exfoliation treatment combined with antimicrobial lid scrubs composed of terpinen-4-ol 30,31 and 1,2-octanediol 28 or warm compresses. 26 Different interventions were used in the control group, such as warm compresses, 26 terpinen-4-ol, 28 1,2-octanediol, 28 LidHygenix (Optimed Ltd.), 10,29 eyelid exfoliation treatment combined with sham lid scrubs, 30 sham eyelid exfoliation treatment combined with terpinen-4-ol, 31 and no intervention.…”

Section: Study Characteristicsmentioning

confidence: 99%

Eyelid Exfoliation Treatment Efficacy and Safety in Dry Eye Disease, Blepharitis, and Contact Lens Discomfort Patients: A Systematic Review

Ballesteros-Sánchez

Gargallo-Martínez

Gutiérrez-Ortega

et al. 2023

Asia-Pacific Journal of Ophthalmology

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Purpose: To determine the efficacy and safety of eyelid exfoliation treatment in dry eye disease (DED), blepharitis, and contact lens (CL) discomfort patients. Methods: A systematic review that included only full-length randomized controlled studies, reporting the effects of eyelid exfoliation treatment in 2 databases, PubMed and Web of Science, was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The search period was between October 29, 2022 and December 6, 2022. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. Results: A total of 7 studies were included in this systematic review. Eyelid exfoliation treatment influence on DED, blepharitis, and CL discomfort were analyzed in 6, 4, and 2 studies, respectively. Eyelid exfoliation treatment achieved a better improvement than control group interventions in all reported variables. The mean differences between both groups were as follows: Ocular Surface Disease Index score of –5.0 ± 0.9 points, tear breakup time of 0.43 ± 0.2 seconds, ocular surface staining of –1.4 ± 1.5 points, meibomian glands secretions of 1.2 ± 1.1 points, meibomian glands yielding liquid secretion of 0.6 ± 0.3 points, microorganism load of –3.2 ± 4.7 points, and Contact Lens Dry Eye Questionnaire-8 of –2.15 ± 0.1 points. Minimal discomfort (n = 13) and eyelid irritation (n = 2) were the main complications after an eyelid exfoliation treatment. Conclusions: Eyelid exfoliation is a safe and effective treatment that should be indicated for DED, blepharitis, and CL discomfort.

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“…Hyperkeratinisation is a key feature of MGD and contributes to obstruction at the orifice of the meibomian gland . It follows that removing excess keratinised material from the eyelid margin, through debridement (Figure ), improves meibomian gland function, decreases ocular surface staining and reduces ocular discomfort symptoms . Using topical anaesthetic and lissamine green prior to the debridement treatment will assist with loosening and identifying the keratinised tissue, respectively.…”

Section: Optimising Tear Film and Ocular Surface Health For Contact Lmentioning

confidence: 99%

Tear film evaluation and management in soft contact lens wear: a systematic approach

Downie

Craig

2017

Clinical and Experimental Optometry

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The human tear film is a highly ordered structure consisting of a thin layer of lipid on the surface and a thicker aqueous-mucin phase, which increases in mucin concentration toward the corneal epithelial cell layer. The health of the tear film and ocular surface influences the likelihood of being able to achieve successful contact lens wear. Contact lens discomfort and dryness are the most frequent reasons why contact lens wearers experience reduced wearing times, which can eventually lead to contact lens discontinuation. Comprehensive clinical assessment of tear film integrity and ocular surface health is therefore essential prior to commencing contact lens wear, to enable the ocular surface environment to be optimised to support lens wear. These parameters should also be evaluated over the course of contact lens wear, in order to identify any aspects requiring clinical management and ensure maintenance of optimal lens-wearing conditions. This review summarises current knowledge relating to the effects of soft contact lens wear on the tear film and ocular surface. It also provides a systematic approach to evaluating tear film and ocular surface integrity, in order to guide the clinical management of tear film anomalies with respect to contact lens wear.Key words: conjunctiva, contact lenses, cornea, dry eye, tearsThe tear film is a complex, precisely ordered fluid structure comprising a thin outer layer of lipid and a thicker underlying aqueous-mucin phase, with increasing mucin concentration toward the corneal epithelial cell layer. A thin layer of membrane-bound mucin, glycocalyx, imparts hydrophilicity to the hydrophobic corneal surface.1 In excess of 1,000 proteins or fractions of proteins have been identified within the human tear film.2,3 The tear fluid also contains a variety of regulated inflammatory mediators, including by-products of arachidonic acid metabolism, the complement cascade, cytokines and components derived from the ocular microbiome. 3,4The integrity of the tear film can strongly influence the likelihood of achieving successful contact lens wear. Contact lens discomfort and dryness are the most frequent reasons why contact lens wearers experience reduced wearing times, which can eventually lead to contact lens discontinuation. 5 Comprehensive clinical assessment of tear film quality and quantity, and ocular surface health are therefore essential both prior to commencing contact lens wear, to enable the ocular surface environment to be optimised to support lens wear, and over the course of lens wear, to identify any aspects requiring clinical attention to maintain optimal lens-wearing conditions. This review summarises current knowledge relating to the effects of soft contact lens wear on tear film composition, and outlines an approach to evaluating tear film and ocular surface integrity, to guide the clinical management of tear film anomalies with respect to contact lens wear. ASSESSING THE TEAR FILM AND OCULAR SURFACE IN CONTACT LENS WEAR: A SYSTEMATIC APPROACHUsing techniques such as in...

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Effect of Lid Debridement-Scaling in Sjögren Syndrome Dry Eye

Abstract: This pilot study showed that LDS improved symptoms, ocular staining, and meibomian gland function for the group that received LDS. This indicates that LDS can aid in the management of SS dry eye.

Cited by 14 publications

References 21 publications

The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye

The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye

Eyelid Exfoliation Treatment Efficacy and Safety in Dry Eye Disease, Blepharitis, and Contact Lens Discomfort Patients: A Systematic Review

Tear film evaluation and management in soft contact lens wear: a systematic approach

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