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Evaporative dry eye (EDE) due to meibomian gland dysfunction (MGD) is one of the common clinical problems encountered in ophthalmology. It is a major cause of dry eye disease (DED) and of ocular morbidity. In EDE, inadequate quantity or quality of lipids produced by the meibomian glands leads to faster evaporation of the preocular tear film and symptoms and signs of DED. Although the diagnosis is made using a combination of clinical features and special diagnostic test results, the management of the disease might be challenging as it is often difficult to distinguish EDE from other subtypes of DED. This is critical because the approach to the treatment of DED is guided by identifying the underlying subtype and cause. The traditional treatment of MGD consists of warm compresses, lid massage, and improving lid hygiene, all measures aimed at relieving glandular obstruction and facilitating meibum outflow. In recent years, newer diagnostic imaging modalities and therapies for EDE like vectored thermal pulsation and intense pulsed light therapy have emerged. However, the multitude of management options may confuse the treating ophthalmologist, and a customized rather than a generalized approach is necessary for these patients. This review aims to provide a simplified approach to diagnose EDE due to MGD and to individualize treatment for each patient. The review also emphasizes the role of lifestyle modifications and appropriate counseling so that patients can have realistic expectations and enjoy a better quality of life.
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Purpose: Dry eye disease (DED) is because of a decrease in the tear film’s volume or a change in the composition of tears. Evaporative dry eye is the most common type, which is due to meibomian gland dysfunction (MGD). In this study, the morphology of meibomian glands was evaluated in all kinds of dry eyes to look for any loss of meibomian glands, assess the function of remaining glands, and investigate the relationship between anatomy, function, and severity of DED. Methods: A total of 300 patients were included in the study, with 150 eyes in the study group and 150 in the control group. Meibomian gland morphology was assessed by examining the tarsal plate after everting the eyelids. Tear film function was evaluated using tear film break?up time (TBUT) and Schirmer’s test (SCH I and II). Meibomian gland morphology was examined with a slit?lamp under magnification, a transilluminator using a small light emitting diode (LED) bulb, and non?contact meibography using an auto refracto?keratometer (ARK). Results: Females had a higher prevalence of dry eyes in our study. In all, 103 eyes (68.6%) in the study group had evaporative dry eye, making it the most prevalent type. Among the 150 controls, 104 controls with 69.3% had no dry eye symptoms, and in those with symptoms, the evaporative type was the most common, with a 28% prevalence. Conclusion: TBUT should be performed in all patients with detectable MG abnormality. Meibography has high specificity and sensitivity to diagnose MGD and in turn dry eyes and should be considered a routine screening modality.
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@#Considering the increased use of electronic devices, the incidence of dry eye disease(DED)has been rising. The condition has seriously affected people's work and lives. DED, the most common ocular surface disease, can be caused by many factors. The meibomian gland dysfunction(MGD)is one of the main factors. Either abnormal secretions from the meibomian gland or an obstruction of the gland ducts can lead to evaporative dry eye. By summarising the relevant literature, this review addresses the aetiology, pathology, diagnosis and treatment of DED associated with MGD.
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Objective To investigate the value of therapeutic bandage type contact lens in the treatment of severe dry tear with dry eye. Methods 54 cases of severe tear evaporative dry eye patients from January 2016 to April 2017 were randomly divided into observation group (27 cases) and control group (27 cases). The observation group received the treatment of artificial tears combined with bandage contact lens treatment, the control group only received the treatment of artificial tears. Continuous treatment trials compared two groups of symptoms score, tear secretion after 1 months (SⅠt, SⅡt), tear break-up time (break up, time, BUT) and tear ferning test (tear ferning, test, TFT). Results After treatment, the scores of the two groups were decreased, and the observation group was lower than the control group. The difference was statistically significant (P＜0. 05); the levels of SⅠt, SⅡt and BUT were improved in both groups, and the improvement effect was better in the observation group (P＜0. 05); The detection level of TFT in the observation group was better than that in the control group, the difference was statistically significant (P＜0. 05). Conclusion The treatment of bandage contact lens in severe tear evaporation effect in treatment of patients with dry eye in strong type is effective and able to significantly improve their symptoms score and SⅠt, BUT and TFT index.
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·AIM: To study the mechanism and effect of Qingxuan decoction on evaporative dry eye in rabbit model. ·METHODS: Totally 25 healthy male Japanese white rabbits were randomly divided into 5 groups: control group, model group, western medicine group, high dose of Qingxuan decoction group, low dose of Qingxuan decoction group. The blank control group did not do any treatment. The improved dry eye model of rabbit was prepared by the improved method of glandular burning of the eyelid plate. The high and low dose group were given daily 27. 2mg/kg, 6. 8mg/kg Qingxuan decoction by gavage. The model group was intragastric with the same amount of normal saline every day. The western medicine group with tobramycin and dexamethasone ophthalmic ointment 1 drops, once a day. The treatment were administered continuously for 28d. At 14d before the experiment, 7d before the experiment, 7d after the model, and 14d after the model, all the rabbits were tested by Schirmer Ⅰ test ( SⅠt) and break-up time (BUT). On the 15d after modeling, the animals were sacrificed by excessive anaesthesia. Rabbit ocular surface tissue sections were prepared. Hematoxylin - eosin staining method was used to observe the corneal morphological changes in each group. The concentrations of TNF-α, IL-1 and IL-6 in the ocular surface of rabbits were detected by ELISA. ·RESULTS: (1) BUT, SⅠt: 7d after the model had been prepared, BUT and SⅠt of the model group and the western medicine group, high dose and low dose of Qingxuan decoction group was improved ( P< 0. 05 );Those of western medicine group, high dose and low dose of Qingxuan Decoction group compared with the model group, were significantly different (P<0. 05). (2) TNF-α, IL-1, IL-6: The ELISA assay showed that TNF-α and IL-1, IL-6 concentration in the model group rabbits was significantly higher than those of the control group, TNF-α and IL-1, IL-6 concentration in western medicine group and high dose group of rabbits was significantly lower than those in the model group, the differences were statistically significant (P<0. 05), and in high dose group the effect was better than that of Western medicine group. ( 3 ) Histopathological examination: on the 14d after the model, the corneal epithelium in the blank control group was stratified well. The cells in the base were columnar, near the surface, the cornea epithelium showed a squamous change. Conjunctiva showed complete epithelial layer and subconjunctival tissue layer, and goblet cells arranged closely. The number of corneal epithelial cells in model group was reduced or even stripped, and the matrix layer was disorder; Irregular loss of conjunctival epithelial cell layer and a large decrease in goblet cells. The corneal morphology of the rabbits in the western medicine group and the high dose group was close to the normal group, and the number of conjunctival goblet cells was not significantly different from that in the blank control group. ·CONCLUSION: The expression of Qingxuan decoction can inhibit the inflammatory reaction through down -regulation of TNF-α and IL-1, IL-6 and in evaporative dry eye rabbit cornea and conjunctiva, so as to improve the ocular symptoms, increase tear secretion, prolong the time of BUT.
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AIM: To observe the clinical effect of the tonifying kidney pills with mingmuwuzi treating evaporative dry eyes.METHODS: This study adopted the positive drug control,prospective study,random number remainder grouping method to 65 cases of outpatient patients diagnosed with evaporative dry eyes which were divided into the treatment group 32 cases (64 eyes) and the control group 33 cases (66 eyes).The treatment group took the decoction of kidney pills with mingmuwuzi,combined with sodium hyaluronate eye drops.The control group simply use sodium hyaluronate eye drops,both group were set to 4wk for a course of treatment.To observe the symptoms and signs of two groups before and after the treatment,the change of the evaluation index and curative effect were evaluated.RESULTS: The effectiveness of the treatment group was 87.5%,the control group was 78.8%,the difference was statistically significant (z=-3.149,P<0.05).CONCLUSION: The treatment of the kidney pills with mingmuwuzi combined with sodium hyaluronate eye drops to evaporative dry eyes is more effective than the simple use of sodium hyaluronate eye drops.
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Objective To investigate the impact factors for temperature of cornea(TOC) and analyse the relationship between TOC and evaporative dry eye. Methods Two hundred and fifty-seven patients(405 eyes) with normal lacrimal secretion received dry eye tests.Patients were divided into positive group and negative group according to the results,and were randomly subdivided into 4 groups with different environment temperature(T) and relative humidity(RH).For all eyes,TOC,body surface temperature(TBS) of forehead and center corneal thickness(CCT) were measured right after blinking.The impact factors for TOC and the differences in TOC between positive group and negative group were analysed.Results TOC was positively correlated with TBS(r=0.89),T(r=0.75) and RH(r=0.60)(P
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The preocular tear film has recently been described as a bilaminar structure,including lipid layer and aqueous/mucin gel layer.The lipid layer has two phases,a relatively thick outer layer,containing nonpolar lipids such as wax esters,sterol esters,hydrocarbons, and triglycerides;and a thin polar inner layer,predominantly consisting of phospholipids.It s confirmed that there are differences in meibomian fatty acid composition between healthy and evaporative dry eye patients.Thus,therapies targeted at replenishing or stabilizing the lipid layer are key points to the treatment of evaporative dry eye,either as monotherapy or in conjunction with therapies designed to enhance aqueous production.