Emerging treatment options for meibomian gland dysfunction

Qiao, Jing; Yan, Xiaoming

doi:10.2147/opth.s33182

Cited by 79 publications

(64 citation statements)

References 47 publications

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“…While the avascular cornea serves as both a protective barrier and the main refractive element of the visual system, the lacrimal gland (LG) is the major organ secreting key proteins and electrolytes into the tear film that bathes the cornea and, through nutrient and antimicrobial proteins, sustains its function [1, 2]. Dry eye disease (DED) is a multifactorial disease of the ocular surface causing visual disturbance and tear film instability [3] and can be due to either aqueous tear insufficiency originating with defects in aqueous tear production by the LG [4] or evaporative dry eye associated with meibomian gland insufficiency [5, 6]. Accordingly to reports, severe DED affects approximately 5 million Americans above age 50 and its global prevalence ranges from 5 % to 35 % of the population [3].…”

Section: Introductionmentioning

confidence: 99%

A thermo-responsive protein treatment for dry eyes

Wang

Jashnani

Aluri

et al. 2015

Journal of Controlled Release

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Millions of Americans suffer from dry eye disease, and there are few effective therapies capable of treating these patients. A decade ago, an abundant protein component of human tears was discovered and named lacritin(Lacrt). Lacrt has prosecretory activity in the lacrimal gland and mitogenic activity at the corneal epithelium. Similar to other proteins placed on the ocular surface, the durability of its effect is limited by rapid tear turnover. Motivated by the rationale that a thermo-responsive coacervate containing Lacrt would have better retention upon administration, we have constructed and tested the activity of a thermo-responsive Lacrt fused to an Elastin-like polypeptide (ELP). Inspired from the human tropoelastin protein, ELP protein polymers reversibly phase separate into viscous coacervates above a tunable transition temperature. This fusion construct exhibited the prosecretory function of native Lacrt as illustrated by its ability to stimulate β-hexosaminidase secretion from primary rabbit lacrimal gland acinar cells. It also increased tear secretion from non-obese diabetic (NOD) mice, a model of autoimmune dacryoadenitis, when administered via intra-lacrimal injection. Lacrt ELP fusion proteins undergo temperature-mediated assembly to form a depot inside the lacrimal gland. We propose that these Lacrt ELP fusion proteins represent a potential therapy for dry eye disease and the strategy of ELP-mediated phase separation may have applicability to other diseases of the ocular surface.

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Section: Introductionmentioning

confidence: 99%

A thermo-responsive protein treatment for dry eyes

Wang

Jashnani

Aluri

et al. 2015

Journal of Controlled Release

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“…In refractory cases, procedures including intraductal MG probing, thermal pulsation devices, and intense pulse light therapy may be of benefit. 95–96,97 In addition, treatment of blepharitis, including recognition and treatment of demodex blepharitis may remove inciting stimuli. Moreover, addressing other co-morbidities, such as ocular allergies, conjunctivochalasis, exposure keratopathy, and essential blepharospasm are important steps in mitigating patient symptoms.…”

Section: Management Of Patients With Neuropathic Corneal Painmentioning

confidence: 99%

Neuropathic Corneal Pain

2017

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Neuropathic pain is caused by a primary lesion or dysfunction of the nervous system and can occur in the cornea. However, neuropathic corneal pain (NCP) is currently an ill-defined disease. Patients with NCP are extremely challenging to manage and evidence-based clinical recommendations for the management of patients with NCP are scarce. The objectives of this review are to provide guidelines for diagnosis and treatment of patients with NCP and to summarize current evidence-based literature in this area. We performed a systematic literature search of all relevant publications between 1966 and 2017. Treatment recommendations are, in part, based on methodologically sound randomized controlled trials (RCTs), demonstrating superiority to placebo or relevant control treatments, and on the consistency of evidence, degree of efficacy, and safety. In addition, the recommendations include our own extensive experience in the management of these patients over the past decade. A comprehensive algorithm, based on clinical evaluation and complementary tests, is presented for diagnosis and subcategorization of patients with NCP. Recommended first-line topical treatments include neuro-regenerative and anti-inflammatory agents, whilst first-line systemic pharmacotherapy includes tricyclic antidepressants and the anticonvulsant. Second line oral treatments recommended include the opioid-antagonist and opiate analgesics. Complementary and alternative treatments, such as cardio-exercise, acupuncture, omega-3 fatty acid, and gluten-free diet, may have additional benefits, as do potential non-invasive and invasive procedures in recalcitrant cases. Medication selection should be tailored on an individual basis, considering side effects, comorbidities, and levels of peripheral and centralized pain. Nevertheless, there is an urgent need for long-term studies and RCTs assessing the efficacy of treatments for NCP.

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“…The LipiFlow® System uses heat and gentle pressure pulsations to unblock obstructed meibomian glands [75]. In a prospective, open-label study (with no control group) involving 21 patients with MGD (meibomian gland secretion score of ≤12 for 15 glands in the lower eyelid), a single LipiFlow treatment led to improved symptoms (based on OSDI scores) and signs (meibomian gland secretion scores, corneal fluorescein staining and TBUT) both one and nine months after treatment [75, 76]. Another emerging treatment for MGD is application of intense pulsed light (IPL) to the eyelid margins.…”

Section: Therapeutic Interventionsmentioning

confidence: 99%

Therapeutic Strategies to Treat Dry Eye in an Aging Population

Ezuddin

Alawa

2015

Drugs Aging

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Dry eye (DE) is a prevalent ocular disease that primarily affects the elderly. Affecting up to 30% of adults aged 50 years and older, dry eye affects both visual function and quality of life. Symptoms of dry eye which include ocular pain (aching, burning), visual disturbances, and tearing can be addressed with therapeutic agents that target dysfunction of the meibomian glands, lacrimal glands, goblet cells, ocular surface and/or neural network. This review provides an overview of the efficacy, use, and limitations of current therapeutic interventions being used to treat DE.

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Emerging treatment options for meibomian gland dysfunction

Cited by 79 publications

References 47 publications

A thermo-responsive protein treatment for dry eyes

A thermo-responsive protein treatment for dry eyes

Neuropathic Corneal Pain

Therapeutic Strategies to Treat Dry Eye in an Aging Population

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