Treatment Outcomes in Patients with Meibomian Gland Dysfunction: Preliminary Findings of a Retrospective Clinical Study within an Orthoptist-Led Dry Eye Clinic

Zeeshaan Daruwalla BOrth&OphthSc¹, ²

Meri Vukicevic BOrth PhD¹

Konstandina Koklanis BOrth(Hons) PhD¹

Nandor Jaross FRANZCO PhD²

¹ Discipline of Orthoptics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
² Australian Eye Specialists, Werribee, Australia

ABSTRACT

Purpose: This study aimed to observe the treatment outcomes of participants presenting with meibomian gland dysfunction (MGD) with and without aqueous deficiency to an orthoptist-led dry eye clinic.

Methods: This was a single-site retrospective clinical study. Participants diagnosed and managed for meibomian gland dysfunction in a private Melbourne practice were included. Participants underwent either conservative treatment without meibomian gland expression (CT), conservative treatment with meibomian gland expression (CT-MGE) or combination therapy which included CT-MGE in conjunction with intense pulsed light therapy (CT-MGE-IPL). Outcome data included ocular surface disease index (OSDI), tear meniscus height (TMH), rate of tear film flow (RTFF), non-invasive tear film break-up time (NIBUT) and percentage of meibomian gland loss in the upper (MGUL) and lower lids (MGLL).

Results: Data was extracted from the electronic medical records of 284 participants (568 eyes) affected with dry eye disease (DED) which includes MGD with or without aqueous disease; 68% female with mean age of 63.3 years (±16.4). At baseline, 87.3% of participants had dry, irritated, painful eyes, 89.4% used topical lubricants while omega-3 intake and hydration levels were below recommended daily intake. Participants all underwent conservative treatment and were offered a choice for additional treatment including meibomian gland expression and intense pulsed light therapy which were both considered to be effective for the relief of MGD. All three treatment methods improved patient symptoms on OSDI and decreased the amount of meibomian gland loss. However, there was no improvement in TMH or NIBUT. The post treatment outcomes related to RTFF were mixed and findings suggest that the use of meibomian gland expression may yield better outcomes overall.

Conclusion: The findings of this study suggest that all treatments are effective in managing MGD, although outcomes may be better if management includes meibomian gland expression.