Thursday, July 28, 2011

New Treatments for Blepharitis and Dry Eyes- Meibomian Gland Deficiency

New Treatments for Blepharitis- “Meibomian Gland Deficiency- Optometric Management,
April, 2011.

Majority (75%) of patients with Blepharitis also has chronic dry eye syndrome.  The symptoms often feel similar.  Blepharitis tends to recur, where as chronic dry eye symptoms can be treated with TheraLife Eye.  Customers with Blepharitis often has rosacea on the face, nose, flaky skin, dandruff, or certain bacterial or bugs growing on the eye lashes.  It is recommended that you wear no make up on the eyes. 

There are newer options to offer our patients who continue to suffer the effects of meibomian gland dysfunction (MGD), despite our best efforts with traditional therapies.  MGD is reported to afflict 67.2% of people over the age of 60 in the United States. Common treatments include:

1. Hot compresses 2-3 times per day.  Each time gently massage your eye lids after wards

2. Essential fatty acids – such as Omega 3 Fish Oil or Flaxseed Oil for their strong anti- inflammatory properties

3. topical and oral antibiotics

4. topical cyclosporine.

Two newly described therapies for MGD include

            o  Gland Probing

            o  Intense Pulsed Light (IPL).

Gland Probing
Meibomian gland probing was proposed by Steven Maskin, MD using a 76 micron, stainless steel probe of 2- or 4 mm length to unblock glands.  He presented a case series of 25 patients diagnosed with MGD, based on lid margin or tarsal hyperemia, telangiectasia, thickening or irregularity or meibomian gland metaplasia, plus lid tenderness upon palpation; or subjective complaints such as stickiness, irritation or discomfort. Gland patency was assessed via transillumination to determine the best candidates for probing; intact or atrophied glands were avoided. After anesthesia with either tetravisc or 4% lidocaine, the 2 mm probe was passed through the gland perpendicular to the lid margin.  During the probing, there was mild resistance at the level of the orifice; more moderate resistance associated with a gritty sensation; and more severe resistance suggestive of fibrovascular tissue that was able to be penetrated with mild additional pressure.  Twenty-four of 25 patients (96%) had immediate post-probing relief, while all patients reported relief of symptoms by four months post-procedure.  Twenty patients (80%) did not need re-treatment by average follow-up of 11.2 months, while the remaining five patients (20%) required re-treatment at an average of four to six months. 
Intense Pulse Light (IPL)
Another experimental treatment is Intense Pulsed Light (IPL), introduced by Rolando Toyos, MD. The treatment uses heat from a special flash lamp to melt the obstructions in the meibomian gland orifices.12  When originally used in dermatology for acne and rosacea patients,  IPL patients would subsequently report that their eyes felt better post treatment.  In 2003, Toyos conducted a study in which 100 patients with treatment resistant MGD were treated with IPL on the lower lid on only one side.  He reported that following treatment, the MGD was improved, both subjectively and clinically.  Dr. Toyos claims that when the light is absorbed by the blood vessels, the heat that is generated melts the secretions and opens the glands, decreasing the inflammatory cytokines, and allows for easier expression and improvement of tear film stability.  There’s also some evidence that IPL decreases parasites on the eyelash margin that can cause meibomian gland problems.  It usually takes three to four treatments over the course of four months, with maintenance treatments required every six to twelve months.
As the number of dry eye patients in our practices continues to grow, newer and more innovative methods of diagnosis and management will enable us to treat more of these patients more efficaciously.

Why TheraLife Eye?

Blepharitis tends to recur, where as chronic dry eye symptoms can be treated with TheraLife Eye.  Typical signs of Blepharitis is inflamed eye lids, red eyes, tired, irritated.  TheraLife Eye stimulates both the Lacrimal gland for tear secretion, and meibomian gland to secrete balanced tears that lasts all day long. 
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