Laura Periman, MD
I teach that MGD and blepharitis is best addressed by understanding “The BEIST.” This is my way to organize the OCEAN paper1 and the Baudouin et al Vicious Circles paper.2
B: Bacterial and demodex component. Try Avenova (hypochlorous acid, NovaBay) and intense pulsed light (IPL) therapy.
E: Enzymatic compromise. Optimize the meibum biochemistry.
I: Inflammation. Address the inflammatory burden with omegas, immunomodulators, loteprednol (Lotemax, Bausch + Lomb), and IPL.
S: Stasis. Blink. Debride lid margin. Express. Use thermal pulsation (LipiFlow, TearScience).
T: Temperature. Use warm compresses and thermal pulsation.