Is MGD being underdiagnosed? And thoughts on treatment.
Richard L. Lindstrom, MD is the founder and attending surgeon of Minnesota Eye Consultants and Adjunct Professor Emeritus at the University of Minnesota Department of Ophthalmology. He is a board certified ophthalmologist and internationally recognized leader in corneal, cataract, refractive and laser surgery. He has been at the forefront of opthalmology’s changes throughout his career, as a recognized researcher, teacher, inventor, writer, lecturer, highly acclaimed physician and surgeon, and member of Bruder Healthcare’s Medical Advisory Board.
In 2017, Dr. Lindstrom facilitated a discussion with leading ophthalmic professionals about the prevalence of MGD, ways to diagnose the stages of the disease, and frequently recommended treatment paths. This discussion was reproduced in the September issue of Opthalmology Magazine. Here are some of the highlights of that discussion.
According to Dr. Lindstrom as many as 86% of patients with dry eye disease have an evaporative form associated with meibomian gland dysfunction (MGD). Arthur B. Epstein, OD, agrees saying, “Most of my patients come to me on referral. Other than emergencies, almost 90% are being seen for dry eye and related ocular surface disease, and MGD is ubiquitous in this population.”
Luckily, technological advances allow professionals to more effectively pinpoint a diagnosis and target their therapies to address patients’ unique underlying causes. To diagnose the severity of MGD one must look at the tear film breakup time. Dr. Sheppard says, “There are many signs of MGD, and they vary… When patients have an accelerated tear film breakup time, that phenomenon dictates their symptoms, their blink rate, and the clinical pathology.”
Suggested Treatments for MGD
Dr. Lindstrom: “I use a Bruder Moist Heat Eye Compress”.
Dr. Sheppard: “The Bruder mask is excellent. We must caution patients not to use washclothes or put water in their eyes. I have cured many people by getting water out of their personal regimen.”
Dr. Donnenfeld: "I would like to add one important caution regarding eyelid hygiene. Many patients who have blepharitis or MGD use baby shampoo on the lid margins. We know that this is probably the worst advice you can give these patients. They already have soap in their eyes, and when they follow this advice, they are adding more speak to the lid margin, which further destabilizes the tear film. Warm compresses are absolutely key, but they must avoid baby shampoo."
Dr. Lindstrom also suggests increasing lid hygiene to increase the efficacy of treatment. Bruder’s new Hygienic Lid Sheets used with the Bruder Moist Eye Eye Compress are a good way to satisfy this suggestion. “It’s much more fun to care for these patients in my practice now, because I know I really can make a difference in their daily lives,” Dr. Lindstrom said.