Dry eye treatment

Greater understanding of the ocular surface and in particular the lipid layer has helped to spark a wave of innovative treatments for meibomian gland dysfunction (MGD), the leading cause of evaporative dry eye disease, according to Béatrice Cochener MD, PhD. “Innovations in MGD treatments have been brought on by progress in ocular surface research in recent years and we now have a much better understanding of the role of the lipid layer. The traditional treatments of MGD consist of the ‘warm and moist’ approach using warm compresses, lid massage and improved eyelid hygiene, as well as antibiotics and anti-inflammatory agents aiming at improving the quality of the meibum,” she told delegates attending the European Society of Ophthalmology (SOE) Congress in Barcelona. Dr Cochener explained that the goal of all the treatments of MGD is to improve the flow of meibomian gland secretions, thus leading to normal tear film stability. While the ‘warm and moist’ approach has proven its efficacy over time, such treatments may be frustrating to patients and ophthalmologists and adherence is frequently an issue over the longer term. The use of topical antibiotics and corticosteroids to suppress the bacterial colonisation and inflammation of the eyelid margin associated with MGD has been shown to be effective in the relief of symptoms and the signs of MGD, said Dr Cochener, with the inflammatory and infectious components underlying MGD still not fully understood. Two different Demodex mite species, Demodex folliculorum and Demodex brevis, have also been found to cause blepharitis, and are often overlooked in the differential diagnosis of corneal and external disease, she said. Progress has also been made in the production of artificial tears and ointments to combat dry eye, said Dr Cochener, with charged microemulsions such as the cationic Cationorm (Santen Pharmaceutical) showing improvements in symptoms and corneal staining compared with traditional aqueous eye drops. Eyelid-warming devices such as goggles and masks have also undergone systematic improvements to help relieve symptoms of MGD. The Blephasteam goggles (Thea Laboratories), for instance, are worn for 10 minutes twice daily followed by an eyelid massage and cleansing with sterile wipes, she said. More controversial, however, is the use of intense pulsed light therapy. “These are popular in vascular skin diseases but the mechanism of action in MGD is unknown and further studies are needed to confirm their safety and efficacy, 
said Dr Cochener. Automated thermodynamic treatments are also proving increasingly popular. The LipiView Interferometer is a diagnostic device for measuring the quality of the tear film and ocular surface and quantify the residual functional MG, and is used in conjunction with the LipiFlow thermal pulsation device. “Results show it is with one single treatment at least as efficient at three months versus daily hygiene care and lid massages, but we need more controlled studies to validate its performance over the longer-term,” she concluded. Béatrice Cochener: beatrice.cochener@ophtalmologie-chu29.fr