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Dry Eyes, Meibomian Gland Dysfunction and MiBo Thermoflo

Dry eye & Meibomian gland dysfunction (MGD)

Dry eye syndrome (DES), or keratoconjunctivitis sicca, is a prevalent condition characterized by insufficient tear production or excessive tear evaporation. Globally, its prevalence varies widely, affecting between 5% and 50% of the population, depending on the diagnostic criteria and the studied population1. In the United States, approximately 16 million adults are diagnosed with DES, with millions more likely undiagnosed2. Common symptoms include dryness, irritation, burning sensation, redness, a gritty feeling, and blurred vision, which can significantly impact daily activities and quality of life3.

 

Meibomian Gland Dysfunction and Dry Eye Syndrome

Meibomian gland dysfunction (MGD) is a leading cause of dry eye syndrome. The meibomian glands, situated along the eyelid margins, secrete oils (meibum) that form the tear film's outer layer, reducing tear evaporation. In MGD, these glands become blocked or their secretions change, leading to an unstable tear film and increased evaporation, causing dry eye symptoms. Thickened and obstructed meibomian glands can result in inflammation and gland dropout, further exacerbating dry eye issues4.

Physiology and Process of Meibum Thickening

Several factors contribute to the thickening of meibum over time. Genetic predispositions can affect gland function and meibum quality. Dietary factors, such as low intake of omega-3 fatty acids, can influence meibum composition, making it more prone to thickening5. Environmental aspects, including extensive use of digital devices, significantly impact meibum. Prolonged screen time reduces blink rates from the normal 15-20 blinks per minute to 3-4 blinks per minute, causing meibum stagnation and thickening6. Additionally, air conditioning, heating, and pollution can dry out the eyes and worsen MGD7. Meibomian gland dropout and atrophy, resulting from prolonged dysfunction and inflammation, are often considered irreversible, though early intervention can help manage symptoms and preserve gland function8.

In-Office Devices for Managing MGD

Various in-office devices utilize heat to manage MGD by melting the thickened meibum and facilitating its secretion. MiBo Thermoflo is one such device that employs thermoelectric heat applied to the eyelids to warm the meibomian glands. This heat therapy helps melt thickened meibum, improving tear film quality and reducing dry eye symptoms. Treatments typically involve several sessions, with heat applied to the eyelids for a few minutes per session9. Other devices like LipiFlow and TearScience also use thermal pulsation to clear gland obstructions and restore normal meibomian gland function10. These non-invasive treatments can provide substantial relief by addressing the underlying cause of dry eye syndrome in patients with MGD.

Footnotes

  1. Stapleton, F., Alves, M., Bunya, V. Y., Jalbert, I., Lekhanont, K., Malet, F., ... & Vehof, J. (2017). TFOS DEWS II Epidemiology Report. The Ocular Surface, 15(3), 334-365. ↩

  2. Farrand, K. F., Fridman, M., Stillman, I. O., & Schaumberg, D. A. (2017). Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. American Journal of Ophthalmology, 182, 90-98. ↩

  3. Craig, J. P., Nichols, K. K., Akpek, E. K., Caffery, B., Dua, H. S., Joo, C. K., ... & Stapleton, F. (2017). TFOS DEWS II Definition and Classification Report. The Ocular Surface, 15(3), 276-283. ↩

  4. Nelson, J. D., Shimazaki, J., Benitez-del-Castillo, J. M., Craig, J. P., McCulley, J. P., Den, S. T., & Foulks, G. N. (2011). The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Investigative Ophthalmology & Visual Science, 52(4), 1930-1937. ↩

  5. Jones, L., Downie, L. E., Korb, D., Benitez-Del-Castillo, J., Dana, R., Deng, S. X., ... & Nichols, K. K. (2017). TFOS DEWS II Management and Therapy Report. The Ocular Surface, 15(3), 575-628. ↩

  6. Patel, S., & Henderson, R. (2013). Factors related to blink rate and contact lens wear. Optometry and Vision Science, 90(2), 103-109. ↩

  7. Uchino, M., & Schaumberg, D. A. (2013). Dry eye disease: impact on quality of life and vision. Current Ophthalmology Reports, 1(2), 51-57. ↩

  8. Lemp, M. A., & Crews, L. A. (2012). Update on the epidemiology, diagnosis, and treatment of dry eye disease. Clinical Ophthalmology, 6, 251-261. ↩

  9. Lane, S. S., DuBiner, H. B., Epstein, R. J., Ernest, P. H., Greiner, J. V., Hardten, D. R., ... & McDonald, J. E. (2012). A new system, the LipiFlow, for the treatment of meibomian gland dysfunction. Cornea, 31(4), 396-404. ↩

  10. Finis, D., Hayajneh, J., König, C., & Schrader, S. (2014). Evaluation of an automated thermodynamic treatment (LipiFlow) system for meibomian gland dysfunction: A prospective, randomized, observer-masked trial. Ophthalmology, 121(6), 1143-1150. ↩

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