DRY EYE DISEASE

SCREEN FOR LID HYGIENE

EDUCATE MGD PATIENTS THAT EYELID CLEANING IS THE EYES VERSION OF TEETH FLOSSING

Melissa Barnett, O.D., F.A.A.O., F.S.L.S., Sacramento, Calif.

GO TO any dentist’s office, and you’ll see one or more posters that promote the importance of dental hygiene. An example: “You don’t have to brush your teeth, just the ones you want to keep.” Given that meibomian gland dysfunction (MGD) “may well be the leading cause of dry eye disease (DED) throughout the world,” according to the International Workshop on Meibomian Gland Dysfunction, it makes sense for us, as optometrists, to consider placing posters on our office walls that promote the importance of eyelid hygiene. Taking a cue from dentists: “You don’t have to clean your meibomian glands, just the ones you want to keep.” (This is particularly important for patients who have acne rosacea, as up to 50% may have MGD, reveals Current Eye Research.)

1 EDUCATE ON THE VALUE OF THE EYELIDS

Patients know well the value of healthy teeth, but many are not aware of the value of keeping their eyelids healthy, namely the meibomian glands’ role in maintaining ocular surface health. To increase this awareness, briefly educate MGD patients about the function of their meibomian glands during the lid evaluation portion of the comprehensive exam. (Keep in mind that an array of diagnostic devices can assist in providing a “picture” of one’s glands, including the Keratograph 5M [Oculus], LipiScan [TearScience] and LipiView II [TearScience].)

“The meibomian glands are glands in your upper and lower eyelids that produce lipids and proteins. These lipids and proteins help maintain a healthy tear film, reduce tear film evaporation and, thus, preserve a healthy ocular surface. You have meibomian gland dysfunction, or the clogging of these glands, which significantly contributes to the chronic, incurable condition dry eye disease. The symptoms of dry eye disease are ocular dryness, burning, itching, foreign-body sensation and excessive tearing.”

After learning about the meibomian glands’ importance, patients will likely ask, “Is there anything I can do to manage these symptoms?” At this point, briefly discuss eyelid hygiene. An example:

“One way to combat dry eye disease symptoms is to practice eyelid hygiene by using warm compresses on the eyelids and eyelid scrubs to keep the glands open. Some patients who have done this have come back and said their eyes and vision were better afterward. Think of it as flossing for your eyelids.”

2 EXPLAIN LID HYGIENE

Next, explain to MGD patients how, specifically, to perform lid hygiene. This is what I typically say to patients:

“Warm compresses, be it via warm cloths or a variety of commercial products, provide heat, which loosens clogged meibomian glands in the eyelids. Apply warm compresses to closed lids for 10 minutes daily. Commercial product use can range from five to 10 minutes daily. Afterward, gently move a cotton swab across the eyelid margins five to 10 times as a means of scrubbing and, therefore, removing any debris that may be blocking the meibomian glands.” (See “Lid Hygiene Products,” above.)

(As a brief, yet related aside, I prescribe a specific lid hygiene product that kills any microorganisms and bacteria and prevent biofilm formation, in addition to clearing potentially clogged meibomian glands. I have MGD patients use the product each night prior to bed, so they can make its use part of their bedtime routine.)

For my female patients, I recommend the nightly removal of eye makeup via safe, commercially available products:

“Removing your eye makeup expedites clean eyelids and creates a healthy tear film. So whether you opt for cotton pads or pre-moistened pads, I want you to gently rub them back and forth along the lids for between five and 10 minutes.”

START TODAY

Just as a failure to take care of one’s teeth can lead to tooth loss, a failure to practice lid hygiene can exacerbate MGD and, ultimately, lead to meibomian gland drop out, which has a profound negative affect on a patient’s quality of life. Teeth can be replaced; meibomian glands cannot. As a result, educate patients about the role their meibomian glands play in ocular surface health, and how, specifically, to practice lid hygiene. OM

DR. BARNETT is a principal optometrist at the University of California, Davis Eye Center in Sacramento, Calif., where she specializes in anterior segment disease and specialty contact lenses. She is a fellow of the AAO, a diplomate of the American Board of Certification in Medical Optometry and serves on the board of GPLI, SLS, Women of Vision and Ocular Surface Society of Optometry. To comment on this article, visit tinyurl.com/OMComment.