New therapies for dry eye disease

New office-based procedures for Meibomian gland dysfunction

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Shahzad Mian MD
A variety of new office-based treatments show significant promise in the treatment of dry eye disease (DED) associated with Meibomian gland dysfunction (MGD), according to Shahzad Mian MD. “We do have an increasing range of options available even though the management of dry eye often leaves patients and practitioners unhappy with the lack of relief of symptoms. Despite the high prevalence and significant impact on quality of life, there is little understanding of the aetiology and success of treatments,” Dr Mian said at the World Ophthalmology Congress 2020 Virtual. Dr Mian illustrated the difficulty of treating DED with reference to a 72-year-old Caucasian female patient who presented with sensations of grit, burning and tearing in her eyes with intermittent blurry vision. She had a history of hypertension, which was being treated. A slit-lamp exam showed moderate inferior punctate keratopathy and significant inspissation of the Meibomian gland. “The diagnosis here was Meibomian gland dysfunction with evaporative dry eye. However, the patient had already undergone many different treatments including hot compresses, artificial tears, topical steroids, anti-inflammatories and punctal plugs without any relief,” he said. Dr Mian said that other treatments to consider for patients with MGD include autologous serum tears, tea tree oil, amniotic membrane grafts, scleral lenses, thermal pulsation systems and Intense Pulsed Light (IPL). Autologous serum tears are a useful adjunct for patients who have been using other forms of treatment including artificial tears or anti-inflammatories. “We know from studies that they do help patients in terms of signs and symptoms of DED. Objective measures such as Schirmer scores and fluorescein staining were shown to improve with treatment,” he said.Tea tree oil, which is indicated in patients with Demodex blepharitis, works by eradicating mites and has antibacterial, antifungal and anti-inflammatory properties. “Patients with demodex treated with tea tree oil for a minimum of six weeks showed dramatic resolution of ocular irritation, conjunctival inflammation and all inflammatory signs,” he said. Amniotic membrane grafts are commonly used to promote wound healing and corneal re-epithelisation in indications such as recurrent corneal erosion, corneal abrasion, neurotrophic keratitis, corneal exposure from incomplete blink and severe dry eye, said Dr Mian. Scleral contact lenses are another option for the management of severe inflammatory DED such as graft versus host disease, ocular cicatricial pemphigoid, neurotrophic keratitis, exposure keratopathy and for mechanical protection, he added.In the end, Dr Mian’s 72-year-old patient was successfully treated with Intense Pulsed Light (IPL). “This causes changes in the superficial blood vessels, eliminates some of the flora and raises skin temperature. The patient told us after IPL treatment that it was like ‘having a vacation from my eyes for the last month’,” he said. Results published in the scientific literature show objective improvement in ocular surface disease index and tear breakup time, he concluded. Shahzad Mian: smian@med.umich.edu
Tags: dry eye disease