Increase in Tear Film Lipid Layer Thickness Following Treatment of Meibomian Gland Dysfunction

Korb, Donald R.; Greiner, Jack V.

doi:10.1007/978-1-4615-2417-5_50

Cited by 98 publications

(71 citation statements)

References 4 publications

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“…The longevity of such thickening of the lipid layer in response to a regular programme of meibomian therapy is well recognised. 4 This study has shown that this device increases LLT and improves ocular comfort in normal subjects. Further studies are indicated to assess the efficacy of this device in patients with tear film and meibomian gland dysfunction.…”

Section: Discussionmentioning

confidence: 77%

“…2 Different methods for increasing lipid layer thickness (LLT) have been shown to be effective including manual expression, massage, and the application of heat. [3][4][5] Current therapy for patients with obstructive meibomian gland dysfunction and evaporative dry eye includes meibomian therapy with heat, often delivered with a hot flannel placed over the eyelids. However, many patients find this inconvenientFand poor patient compliance is an obstacle to effective therapy.…”

Section: Introductionmentioning

confidence: 99%

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Tear film lipid layer thickness and ocular comfort after meibomian therapy via latent heat with a novel device in normal subjects

Mitra¹,

Menon²,

Casini³

et al. 2004

Eye

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Aim This study measures changes in tear film lipid layer thickness (LLT) and ocular comfort in normal subjects after 10 min use of a novel device, which delivers meibomian therapy with latent heat. The device is designed to promote the release of meibomian sebum into the tear film by delivering latent heat to the eyelids, thus thickening the lipid layer. Normal lid movements are maintained, facilitating resurfacing of the tear film. Method A prospective, controlled, observer masked, single intervention trial in which 24 normal subjects were randomised into three groups. Group I underwent 10 min treatment with the activated device, Group II used the inactivated device for the same duration of time, and Group III had no intervention. The LLT of each subject was measured with a Keeler Tearscope s prior and subsequent to the 10-min period. Subjective alteration in ocular comfort was also assessed. Results Seven of eight subjects (87.5%) in Group I exhibited an increase in LLT. The mean LLT in this group showed a statistically significant increase (left eyes 1.0 levels, Po0.001, right eyes 0.9 levels, Po0.003) compared to Groups II and III. Six of eight subjects (75%) using the activated device experienced subjective improvement in ocular comfort. Conclusion Meibomian therapy with this device increases LLT in normal individuals. This implies a more stable tear film, reflected in subjective improvement in ocular comfort.

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Tear film lipid layer thickness and ocular comfort after meibomian therapy via latent heat with a novel device in normal subjects

Mitra¹,

Menon²,

Casini³

et al. 2004

Eye

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“…23,24 Thin lipid layers (r60 nm) have been correlated with tear film instability, 23,24 increased evaporation rate, 23 high osmolality, 34 symptoms, 24,25 and dry eye disorders. 25 The correlation coefficients in this study for LLT with STA and LLT with FBUT were higher than for STA with FBUT. These data support the premise that measurement of LLT is as valid as either FBUT or STA for the diagnosis of dry eye disorders in those instances of patients presenting with symptoms suggestive of dry eye conditions.…”

Section: Discussionmentioning

confidence: 99%

“…22 Measurements of LLT by interference patterns have been correlated with tear film evaporation, 23 tear film break-up time, 23,24 and dry eye symptoms. 24,25 The purpose of this study was to establish the correlation between LLT and two frequently used standard dry eye tests, 26 fluorescein breakup time (FBUT) and Schirmer's test with anaesthesia (STA).…”

Section: Introductionmentioning

confidence: 99%

Correlation of lipid layer thickness measurements with fluorescein tear film break-up time and Schirmer's test

Isreb

Greiner

Korb

et al. 2003

Eye

120

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Purpose This study correlates measurement of lipid layer thickness (LLT) with two frequently used dry eye tests, fluorescein break-up time (FBUT) and Schirmer's test with anaesthesia (STA). Methods Subjects (n ¼ 44 eyes) with symptoms of dry eye and positive results for dry eye with either FBUT or STA or both were selected. Quantification of LLT was performed by the observation of colour interference patterns in zones of specular reflection using a custom-designed instrument. Results All correlations among pairs of tests were strong and exhibited a significance of Po0.000: STA with FBUT, Pearson's correlation 0.653; STA with LLT, 0.764; FBUT with LLT, 0.751. When LLT was high, ie Z120 nm, which occurred in 14 eyes, STA was also elevated in those eyes and FBUT was high in 13 of the 14 eyes. When LLT was low, ie r60, which occurred in 22 eyes, STA was below normal in 14 of the 22 eyes, and FBUT was below normal in 15 of the 22 eyes. These clinical observations paralleled the statistical findings computed from the entire data set. Conclusions The correlations demonstrated in this study support the premise (1) that measurement of LLT is a reliable test for the diagnosis of dry eye, and (2) that aqueous deficiency and lipid deficiency, as they apply to dry eye disorders, are not mutually exclusive.

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“…The lipid layer of the tear film is derived from secretions of the meibomian glands [1,2], The lipid layer overlies the aqueous layer of the tear film and is responsible for control ling evaporation from the ocular surface [1]. From a conceptual point of view, a surfactant would be required to form an interface be tween the aqueous layer and the hydrophobic long-chain alkane hydrocarbons, sterol esters, wax esters, and triglycerides that comprise the bulk of the lipid component of the tear film [3,4].…”

Section: Introductionmentioning

confidence: 99%

Phospholipids in Meibomian Gland Secretion

et al. 1996

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The bulk of the lipid layer overlying the aqueous portion of the precorneal tear film is composed of polar and nonpolar components. The nonpolar lipids have been the subject of numerous studies; however, the polar lipids have remained relatively uncharacterized. The polar lipids are thought to contain surfactant phospholipids that are critical to the spreading of a lipid film over the aqueous layer, by providing an interface between this layer and the nonpolar lipids. The purpose of the present study is to identify and quantitate the phospholipid complement of meibomian gland secretion which provides the tear film with phospholipids. Meibomian gland secretion was collected from rabbits and phospholipids identified and quan-titated by ³¹P nuclear magnetic resonance spectroscopy. Ten phospholipids were detected from meibomian gland secretion: diphosphatidylglycerol, dihydrosphingomyelin, ethanolamine plasmalogen, phosphatidylethanolamine (PE), phosphatidyl serine, sphingomyelin, lysophosphatidylcholine, phosphate dylinositol, alkylacylphosphatidylcholine, and phosphatidyl-choline (PC). The two major phospholipids were PC and PE, together comprising nearly 60% of the total phospholipid profile. The nature and relative concentrations of the meibomian gland secretion phospholipids are congruous with a surfactant role at the aqueous-lipid interface and, considering the physical chemistry of the tear film, suggest that the phospholipids should be organized in a very flat or planar configuration.

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Increase in Tear Film Lipid Layer Thickness Following Treatment of Meibomian Gland Dysfunction

Cited by 98 publications

References 4 publications

Tear film lipid layer thickness and ocular comfort after meibomian therapy via latent heat with a novel device in normal subjects

Tear film lipid layer thickness and ocular comfort after meibomian therapy via latent heat with a novel device in normal subjects

Correlation of lipid layer thickness measurements with fluorescein tear film break-up time and Schirmer's test

Phospholipids in Meibomian Gland Secretion

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