Thursday, May 25, 2017

Managing Eyelid Inflammation (Blepharitis) in Doctor's Offices.

Managing EyeLid Inflammation (Blepharitis) in Doctor's Offices.

This is an exert from "Optometric Management- by Dr. David Devries, May 2017

Dr, Devries is a praticing optometrist who wrote this article about how he manages eyelid inflammation in his dry eye practice.  

Meibography combined with diagnostic expression

Meibomian Gland Dysfunction - a major cause of dry eyes must be addressed in people with dry eyes.  Since it contributes significantly to evaporative dry eyes, leading cause of chronic dry eye syndrome.  . Diagnosis is the key and the most effective tool that I have seen, which I utilize within the meibography ( image of meibomian glands) combined with diagnostic expression.

Expressing by lightly pressing on the meibomian glands ( located on the lower eye lids) allows the eye doctor to easily determine if the meibum is clear and “baby oil like.” Turbid, thickened meibum can be explained to a patient but being able to also image the meibomian glands is extremely usefull. Once a patient sees what their meibomian glands look like compared to normal glands, there seems to be a much greater urgency to receive treatment. 

Types of Meibography Equipement

There are multiple units available to perform meibography (LipiView II, LipiScan, Oculus Keratograph 4, Topcon, Meibox). Meibography not only helps patients realize the importance of compliance in their treatment but it also helps drive more advanced procedures.

1. Hot Compress

Hot compress is vital in treating MGD. A hot wash cloth is just not good enough to melt the meibomian clogging.  Having products available in the practice will tremendously help in the compliance aspect of treatment.

2. Debridement

As a result of meibography - which looks at the health of the meibomian glands, we are now doing more advanced lid procedures with patients. A frequent procedure I perform is the cleaning of the biofilm from the lid margins. Microblepharoexfoliation (BlephEx) is an in-office procedure that takes about 5 minutes to perform. Patients are very willing to have this procedure performed and the vast majority recognize improvements within a very short period of time.

3.  IPL and LipiFlow

We are also performing more vectored thermal lid pulsation (LipiFlow) as well as Intense Pulse Light (IPL) treatment on the people with  MGD with ocular rosacea. The basis of improvement in IPL is believed to be the photocoagulation of fragile telangiectasia that leak pro-inflammatory agents. Inflammation leads to a thickening of the meibum and eventual obstruction of the glands. Dermatology patients having cosmetic rosacea treatment with IPL recognize improvement in their dry eye after multiple treatments. This has led to the increasing utilization of IPL within eye care.


Seeing is believing and meibography has provided the necessary visualization for my patients to be willing to have not only baseline treatment but advanced procedures as well.

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