Alleviate Lid Disease
Panelists offer a basic solution to a common problem.
Is dry eye ever simple? Many patients' dry eye symptoms are caused by a combination of conditions, such as localized meibomitis or systemic inflammatory disease. We now know that dry eye disease is self-perpetuating: Dry eyes increase tear film osmolarity, resulting in inflammation and additional dryness, leaving eyes vulnerable to bacterial infection.
Here, panel members share their strategies for treating meibomitis, a common contributor to dry eye disease.
When treating meibomitis, the participants agree it's best to start simple.
"I tell my patients to massage their eyelids while they're standing in the warm water from their morning shower," says Marc R. Bloomenstein, O.D., F.A.A.O. "This loosens the material clogging the glands so the meibum flows more freely. I don't prescribe an antibiotic or a steroid until I'm sure the patient has a chronic condition."
Jimmy D. Bartlett, O.D., F.A.A.O., Birmingham, Ala., notes that patients can benefit from applying warm compresses to their eyes. "After 10 or 15 minutes, heat from the compresses will melt the wax blocking the glands. The patient can then dislodge this material with lid massage," he says. The hot compresses are key: Massage alone is less effective at unclogging the meibomian glands.
With consistent use, warm soaks will loosen the waxy caps from the gland openings. Some of the participants remove the caps with forceps, especially if the patient wears contact lenses, but they all agree that this level of intervention isn't always necessary. They also suggest that patients massage their eyelids rather than vigorously scrub them, which can cause additional inflammation.
Patients with meibomitis experience burning, gritty and foreign body sensations secondary to inflammatory mediators on the cornea.
Medicating chronic meibomitis
For many patients, a few weeks of hot compresses and lid massage resolves their meibomitis; however, others go on to develop a chronic condition that requires medical treatment.
Randall K. Thomas, O.D., M.P.H., F.A.A.O., estimates that about half his meibomitis patients respond to traditional treatment, whereas the other half improve only after adding doxycycline to their treatment regimen.
"Interestingly, it's not the antibiotic effects of doxycycline that reduce meibomitis, but its anti-inflammatory effects," Dr. Thomas says. "This agent alters the fatty acid metabolism of the meibomian gland secretion.
"I prescribe 50 mg of oral doxycycline twice a day for 2 weeks, and then once a day for several months. Following lid treatment, such as massage and hot compresses, with several months of doxycycline is very beneficial for patients with meibomitis," Dr. Thomas says.
For longer-term therapy, Paul M. Karpecki, O.D., F.A.A.O., suggests switching to 20 mg of doxycycline b.i.d.
Back to basics
There's no doubt meibomitis can contribute to a
patient's dry eye experience and treatment. According to the panelists, the best
treatment approach is to begin slowly with traditional compresses and massage
before turning to pharmaceutical therapies.
Optometric Management, Issue: February 2005