The Tear Film and Ocular Surface Society’s Meibomian Gland Workshop was tasked to sort through the literature to determine proper terminology of conditions affecting the lid margin. Review the terminology, gland anatomy, gland expression classifications, and treatment strategies.
Blepharitis is an inflammatory condition of the eyelids leading to red, irritated, itchy, and dandruff-like scales that form on the eyelashes.
Ron Melton, OD, FAAO, and Randall Thomas, OD, MPH, FAAO, discussed common practices for treating dry eye, meibomian gland dysfunction (MGD), and blepharitis at the American Optometric Association (AOA) annual meeting. Here are a few medical management pearls from their discussion.
Certainly, one would assume that nothing could be safer than a product designed for use with children. Television commercials with smiling, happy babies covered in frothy bubbles imply the product is harmless. Ubiquitous marketing alone creates a subconscious sense of safety for both doctor and patient.
Dry eye represents a major opportunity with more than 25 million people suffering from the condition in the U.S.,1 and meibomian gland dysfunction (MGD) is thought to be the most common cause of dry eye.2 During a session at SECO, Walt Whitley, OD, MBA, FAAO, shared his tips for making the most of this opportunity in your practice.
While many eyecare practitioners (ECPs) are just now learning about Demodex infestation of the eyelids and adnexa, the fact is that this condition has been around for as long as mankind. The entomologists Johannsen and Riley from Cornell University first described the species in detail anatomically as early as 1915, but it wasn’t until the 1960s that clinical reports of demodex-related blepharitis began to emerge in the literature.
A common barrier to many practitioners is the concern that their practice does not have the patient foundation to make investment in the services economically profitable. I assure you that OSD management will profit the patient in many ways that includes clearer, more comfortable vision, enhancing their productivity and overall wellbeing.
While there are a myriad of associated concerns due to ocular surface inflammation, a few eyelash-related complications of note are trichiasis, acquired distachiasis, local madarosis, and poliosis. Each of these is in some way connected to dry eye.
The lipid layer prevents evaporation of aqueous tears and prevents drying. Lipid deficiency due to meibomian gland dysfunction (MGD) is the most common cause of symptoms associated with dry eye disease.
Focusing on dry eye management is a great practice builder, but is not without challenges. These challenges lie in making the proper diagnosis, implementing new technology, properly training staff, developing an effective treatment plan and the time it takes to properly educate patients.
I can assure you that as consumers, we are all looking for the first-class treatment. When it comes to recommendations for your patients, do you offer them best-in-class treatments, or do you hold back?
Our understanding of dry eye and ocular surface disease is expanding at exponential rates. This is allowing us to more accurately diagnose specific forms of dry eye and determine their root causes.
At the recent SECO meeting, optometrists and ophthalmic technicians sat side by side learning to perform microblepharoexfoliation (MBE), a new therapy for the treatment of blepharitis and ocular surface disease. The program aimed to train both doctor and tech about blepharitis and how to use the BlephEx device.
The mainstay of our therapy today consists of artificial tear preparations, surfactant lid cleansers, warm compresses for the eyelids, and the occasional antibiotic solution or ointment-this is the exact same therapy that was in vogue for treating OSD 25 years ago!
ZYLET :RELIEF TO THE RESCUEfor blepharitis
BlephEx recently released the first medical device that allows doctors to perform a painless, in-office procedure to treat blepharitis.
Everything from our high-tech lifestyles outdoor environmental factors, and the general aging of the population can lead to blepharitis, dry eye disease (DED) and meibomian gland dysfunction (MGD). Sustained tasks, such as reading, can reduce the blink rate to as low as five blinks per minute. This slow blink rate can cause additional stress on an ocular surface that is already compromised due to one of the aforementioned disorders.
Formication, a sensation that resembles that of insects crawling on or under the skin, is a specific form of the general set of abnormal skin sensations known as paresthesias (prickling, tingling sensation of "pins and needles") and tactile hallucinations; it is a well-documented symptom that has numerous possible causes.
In the fifth video of our series on Demodex, Dr. Milton Hom provides additional insight about his experiences with diagnosing, treating and managing this clinical presentation.
In the fourth of our video series on Demodex, Dr. Mario Gutierrez offers practice management suggestions in treating patients with the mite. Plus, he gets into a mite-killing mood.
In the second of our video series on Demodex, Dr. Scott Hauswirth explains how to diagnose this tiny critter.
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