“If you do only one of the two, you’re going to halfway treat this disease,” says Dr. Gaddie.
MGD and its associated conditions
To understand how to manage MGD, practitioners must understand MGD’s role in ocular health and the associated conditions that it can create.
MGD is a chronic abnormality of the glandular function characterized by terminal duct obstruction. This obstruction changes the quality of the tear film and creates symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease (OSD).
There are various subtypes of MGD. Dr. Gaddie says several classifications of MGD are common in his practice:
• Acne rosacea
• Sebhorriec dermatitis
• Atopic disease
• Psoriatic disease
Dr. Gaddie says certain medications contributed to the severity of these diseases, both in high-delivery MGD and low-delivery MGD. Medications can play a role in low-delivery MGD by reducing the output of the ocular ducts, he says.
“One of the classic things we think of as causing a subacute reduction in the delivery of meibum is Accutane (isotretinoin, Roche),” he says.
Certain drugs may dry the meibum, reducing the delivery of secretions and creating symptoms of dry eye.
While much research has been performed to identify optimal treatments for MGD, Dr. Gaddie says that some treatments may not be effective.
“What do I use to treat? I use heat,” he says.
Warm compresses that help open the meibomian glands can increase secretion flow and clear out obstructions.
Dr. Gaddie says other treatment strategies, including topical drugs such as Zithromax (azithromycin, Pfizer), are an option, but says effectiveness may be limited.
“It works well, but as soon as you stop [usage], the effect goes away,” he says.
Other steroidal/antibiotic drug combinations such as Tobradex ST (tobramycin/ dexamethazone, Alcon) may be useful, though Dr. Gaddie says these medications may have prohibitive side effects.
“Dexamethazone is probably the greatest chance of having an intraocular pressure (IOP) rise,” he says.
But aside from the treatment used to manage symptoms of MGD, Dr. Gaddie says practitioners need to assess all underlying causes, especially blink rates and how incomplete blinks can lead to meibomian gland atrophy.
ODs should expect standards of care to change with more priority given to meibomian gland assessment and treatment.
“We will see technologies coming out that allow you to look at the structure of meibomian glands,” says Dr. Gaddie.
While the interconnected nature of MGD symptoms and conditions can make the disease hard to understand, Dr. Gaddie says to take a comprehensive approach to treatment that addresses each dry eye component in turn.
He says his patients who have been on Restasis and LipiFlow (TearScience) treatment have shown the best results.
“The combination of the anti-inflammatory and the gland evacuation seems to be the most productive for patients,” he says.