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Current and Emerging Therapeutic Strategies for the Treatment of Meibomian Gland Dysfunction (MGD)

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Abstract

Meibomian gland (MG) dysfunction (MGD) is a multifactorial, chronic condition of the eyelids, leading to eye irritation, inflammation and ocular surface disease. Initial conservative therapy often includes a combination of warm compresses in addition to baby shampoo or eyelid wipes. The practice of lid hygiene dates back to the 1950s, when selenium sulfide-based shampoo was first used to treat seborrhoeic dermatitis of the eyelids. Today, tear-free baby shampoo has replaced dandruff shampoo for MGD treatment and offers symptom relief in selected patients. However, many will not achieve significant improvement on this therapy alone; some may even develop an allergy to the added dyes and fragrances in these products. Other manual and mechanical techniques to treat MGD include MG expression and massage, MG probing and LipiFlow®. While potentially effective in patients with moderate MGD, these procedures are more invasive and may be cost prohibitive. Pharmacological treatments are another course of action. Supplements rich in omega-3 fatty acids have been shown to improve both MGD and dry eye symptoms. Tea tree oil, specifically the terpenin-4-ol component, is especially effective in treating MGD associated with Demodex mites. Topical antibiotics, such as azithromycin, or systemic antibiotics, such as doxycycline or azithromycin, can improve MGD symptoms both by altering the ocular flora and through anti-inflammatory mechanisms. Addressing and treating concurrent ocular allergy is integral to symptom management. Topical N-acetylcysteine and topical cyclosporine can both be effective therapeutic adjuncts in patients with concurrent dry eye. A short course of topical steroid may be used in some severe cases, with monitoring for steroid-induced glaucoma and cataracts. While the standard method to treat MGD is simply warm compresses and baby shampoo, a more tailored approach to address the multiple aetiologies of the disease is suggested.

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References

  1. Nelson JD, Shimazaki J, Benitez-del-Castillo JM, Craig JP, McCulley JP, Den S, et al. The International Workshop on Meibomian Gland Dysfunction: report of the Definition and Classification Subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930–7.

    Article  PubMed Central  PubMed  Google Scholar 

  2. McCulley JP, Dougherty JM, Deneau DG. Classification of chronic blepharitis. Ophthalmology. 1982;89(10):1173–80.

    Article  CAS  PubMed  Google Scholar 

  3. Sullivan BD, Evans JE, Cermak JM, Krenzer KL, Dana MR, Sullivan DA. Complete androgen insensitivity syndrome: effect on human meibomian gland secretions. Arch Ophthalmol. 2002;120(12):1689–99.

    Article  CAS  PubMed  Google Scholar 

  4. Cohen LB. Use of Selsun in blepharitis marginalis. Am J Ophthalmol. 1954;38(4):560–2.

    Article  CAS  PubMed  Google Scholar 

  5. Wong AS, Fasanella RM, Haley LD, Marshall CL, Krehl WA. Selenium (Selsun) in the treatment of marginal blepharitis. AMA Arch Ophthalmol. 1956;55(2):246–53.

    Article  CAS  PubMed  Google Scholar 

  6. Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O’Brien T, et al. The International Workshop on Meibomian Gland Dysfunction: report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction. Invest Ophthalmol Vis Sci. 2001;52(4):2050–64.

    Article  Google Scholar 

  7. Thomas K. The ‘no more tears’ shampoo, now with no formaldehyde. New York Times, Business Day. 17 Jan 2014.

  8. Johnson & Johnson Consumer Companies, Inc. Johnson’s baby shampoo ingredients. 22 Jul 2014. http://www.johnsonsbaby.com/haircare/johnsons-baby-shampoo#ingredients. Accessed 9 Jun 2015.

  9. Welling JD, Mauger TF, Schoenfield LR, Hendershot AJ. Chronic eyelid dermatitis secondary to cocamidopropyl betaine allergy in a patient using baby shampoo eyelid scrubs. JAMA Ophthalmol. 2014;132(3):357–9.

    Article  PubMed  Google Scholar 

  10. Zirwas M, Moennich J. Shampoos. Dermatitis. 2009;20(2):106–10.

    CAS  PubMed  Google Scholar 

  11. Scheman A, Jacob S, Zirwas M, Warshaw E, Nedorost S, Katta R, et al. Contact allergy: alternatives for the 2007 North America Contact Dermatitis Group (NACDG) standard screening tray. Dis Mon. 2008;54(1–2):7–156.

    Article  PubMed  Google Scholar 

  12. Gerbach GF, Robinson MK, Felter SP, White IR, Basketter DA. Understanding fragrance allergy using an exposure-based risk assessment approach. Contact Dermat. 2001;45(6):333–40.

    Article  Google Scholar 

  13. Korb DR, Greiner JV. Increase in tear film lipid layer thickness following treatment of meibomian glad dysfunction. Adv Exp Med Biol. 1994;350:293–8.

    Article  CAS  PubMed  Google Scholar 

  14. Olson MC, Korb DR, Greiner JV. Increase in tear film lipid layer thickness following treatment with warm compresses in patients with meibomian gland dysfunction. Eye Contact Lens. 2003;29(2):96–9.

    Article  PubMed  Google Scholar 

  15. Arita R, Morishige N, Shirakawa R, Sato Y, Amano S. Effects of eyelid warming devices on tear film parameters in normal subjects and patients with meibomian gland dysfunction. Ocul Surf. 2015. doi:10.1016/j.jtos.2015.04.005.

    Google Scholar 

  16. Maskin SL. Intraductal meibomian gland probing relieves symptoms of obstructive meibomian gland dysfunction. Cornea. 2010;29(10):1145–52.

    Article  PubMed  Google Scholar 

  17. TearScience®. LipiFlow® video gallery. 2015. http://www.lipiflow.com/video-gallery. Accessed 9 Jun 2015.

  18. Lane SS, DuBiner HB, Epstein RJ, Ernest PH, Greiner JV, Hardten DR, et al. A new system, the LipiFlow, for the treatment of meibomian gland dysfunction. Cornea. 2010;31:396–404.

    Article  Google Scholar 

  19. Greiner JV. Long-term (12-month) improvement in meibomian gland function and reduced dry eye symptoms with a single thermal pulsation treatment. Clin Exp Ophthalmol. 2013;41(6):524–30.

    Article  Google Scholar 

  20. TearScience®. MiBo® clinical research website. 2015. http://mibomedicalgroup.com/clinical-research. Accessed 9 Jun 2015.

  21. McCulley JP, Shine WE. The lipid layer of tears: dependent on meibomian gland function. Exp Eye Res. 2004;78(3):361–5.

    Article  CAS  PubMed  Google Scholar 

  22. Qiao J, Yan X. Emerging treatment options for meibomian gland dysfunction. Clin Ophthalmol. 2013;7:1797–803.

    CAS  PubMed Central  PubMed  Google Scholar 

  23. Aghai ZH, Kode A, Saslow JG, Nakhla T, Farhath S, Stahl GE, et al. Azithromycin suppresses activation of nuclear factor-kappa B and synthesis of pro-inflammatory cytokines in tracheal aspirate cells from premature infants. Pediatr Res. 2007;62(4):483–8.

    Article  CAS  PubMed  Google Scholar 

  24. Liu Y, Kam WR, Ding J, Sullivan DA. One man’s poison is another man’s meat: using azithromycin-induced phospholipidosis to promote ocular surface health. Toxicology. 2014;320:1–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Luchs J. Efficacy of topical azithromycin ophthalmic solution 1 % in the treatment of posterior blepharitis. Adv Ther. 2008;25(9):858–70.

    Article  CAS  PubMed  Google Scholar 

  26. Ta CN, Shine WE, McCulley JP, Pandya A, Trattler W, Norbury JW. Effects of minocycline on the ocular flora of patients with rosacea or seborrheic blepharitis. Cornea. 2003;22:545–8.

    Article  PubMed  Google Scholar 

  27. Aronowicz JD, Shine WE, Oral D, Vargas JM, McCulley JP. Short term oral minocycline treatment of meibomianitis. Br J Ophthalmol. 2006;90(7):856–60.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Hoeprich PD, Warshauer DM. Entry of four tetracyclines into saliva and tears. Antimicrob Agents Chemother. 1974;5(3):330–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Kashkouli MB, Fazel AJ, Kiavash V, Nojomi M, Ghiasian L. Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomized double-masked open-label clinical trial. Br J Ophthalmol. 2015;99(2):199–204.

    Article  PubMed  Google Scholar 

  30. Perry HD, Donnenfeld ED. New frontiers in dry eye treatment: for the first time, an eyedrop increases tear production by reducing inflammation. Ophthalmology Management. 2003. http://www.ophthalmologymanagement.com/articleviewer.aspx?articleID=85723. Accessed 3 Jun 2015.

  31. Perry HD, Doshi-Carnevale S, Donnenfeld ED, Solomon R, Biser SA, Bloom AH. Efficacy of commercially available topical cyclosporine A 0.05 % in the treatment of meibomian gland dysfunction. Cornea. 2006;25(2):171–5.

    Article  PubMed  Google Scholar 

  32. Rubin M, Rao SN. Efficacy of topical cyclosporine 0.05 % in the treatment of posterior blepharitis. J Ocul Pharmacol Ther. 2006;22(1):47–53.

    Article  CAS  PubMed  Google Scholar 

  33. Akyol-Salman I, Azizi S, Mumcu U, Baykal O. Efficacy of topical N-acetylcysteine in the treatment of meibomian gland dysfunction. J Ocul Pharmacol Ther. 2010;26(4):329–33.

    Article  CAS  PubMed  Google Scholar 

  34. Akyol-Salman I, Azizi S, Mumcu UY, Ates O, Baykal O. Comparison of the efficacy of topical N-acetyl-cysteine and a topical antibiotic combination therapy in the treatment of meibomian gland dysfunction. J Ocul Pharmacol Ther. 2012;28(1):49–52.

    Article  CAS  PubMed  Google Scholar 

  35. Liu A, Ji J. Omega-3 essential fatty acids therapy for dry eye syndrome: a meta-analysis of randomized controlled studies. Med Sci Monit. 2014;20:1583–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Macsai MS. The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (an AOS thesis). Trans Am Ophthalmol Soc. 2008;106:336–56.

    PubMed Central  PubMed  Google Scholar 

  37. Endres S, Ghorbani R, Kelley VE, et al. The effect of dietary supplementation with n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells. N Engl J Med. 1989;320(5):265–71.

    Article  CAS  PubMed  Google Scholar 

  38. Calder PC. Polyunsaturated fatty acids, inflammation, and immunity. Lipids. 2001;36(9):1007–24.

    Article  CAS  PubMed  Google Scholar 

  39. Oleñik A, Mahillo-Fernández I, Alejandre-Alba N, Fernández-Sanz G, Pérez MA, Luxan S, et al. Benefits of omega-3 fatty acid dietary supplementation on health-related quality of life in patients with meibomian gland dysfunction. Clin Ophthalmol. 2014;8:831–6.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Patterson LE. New thinking on dry eye and MGD. Ophthalmology Management. 2014;18:2. http://www.ophthalmologymanagement.com/articleviewer.aspx?articleID=112052. Accessed 22 Jun 2015.

  41. Lee H, Chung B, Kim KS, Seo KY, Choi BJ, Kim TI. Effects of topical loteprednol etabonate on tear cytokines and clinical outcomes in moderate and severe meibomian gland dysfunction: randomized clinical trial. Am J Ophthalmol. 2014;158(6):1172–83.

    Article  CAS  PubMed  Google Scholar 

  42. Torkildsen GL, Cockrum P, Meier E, Hammonds WM, Silverstein B, Silverstein S. Evaluation of clinical efficacy and safety of tobramycin/dexamethasone ophthalmic suspension 0.3 %/0.05 % compared to azithromycin ophthalmic solution 1 % in the treatment of moderate to severe acute blepharitis/blepharoconjunctivitis. Curr Med Res Opin. 2001;27(1):171–8.

    Article  Google Scholar 

  43. Tighe S, Gao YY, Tseng S. Terpinen-3-ol is the most active ingredient of tea tree oil to kill Demodex mites. Transl Vis Sci Technol. 2013;2(7):1–8.

    Article  Google Scholar 

  44. Bhandari V, Reddy JK. Blepharitis: always remember demodex. Middle East Afr J Ophthalmol. 2014;21(4):317–20.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Rubel DM, Freeman S, Southwell IA. Tea tree oil allergy: what is the offending agent? Report of three cases of tea tree oil allergy and review of the literature. Australas J Dermatol. 1998;39(4):244–7.

    Article  CAS  PubMed  Google Scholar 

  46. Crawford GH, Sciacca JR, James WD. Tea tree oil: cutaneous effects of the extracted oil of Melaleuca alternifolia. Dermatitis. 2004;15(2):59–66.

    Article  PubMed  Google Scholar 

  47. Arita R, Itoh K, Maeda S, Maeda K, Furuta A, Tomidokoro A, et al. Meibomian gland duct distortion in patients with perennial allergic conjunctivitis. Cornea. 2010;29(8):858–60.

    Article  PubMed  Google Scholar 

  48. Toda I, Shimazaki J, Tsubota K. Dry eye with only decreased tear break-up time is sometimes associated with allergic conjunctivitis. Ophthalmology. 1995;102:302–9.

    Article  CAS  PubMed  Google Scholar 

  49. Suzuki S, Goto E, Dogru M, Asano-Kato N, Matsumoto Y, Hara Y, et al. Tear film lipid layer alterations in allergic conjunctivitis. Cornea. 2006;25(3):277–80.

    Article  PubMed  Google Scholar 

  50. Arita R, Itoh K, Maeda S, Maeda K, Tomidokoro A, Amano S. Association of contact lens–related allergic conjunctivitis with changes in the morphology of meibomian glands. Jpn J Ophthalmol. 2012;56:14–9.

    Article  PubMed  Google Scholar 

  51. Mathers WD, Billborough M. Meibomian gland function and giant papillary conjunctivitis. Am J Ophthalmol. 1992;114(2):188–92.

    Article  CAS  PubMed  Google Scholar 

  52. Esmaeli B, Harvey JF, Hewlett B. Immunohistochemical evidence for estrogen receptors in meibomian glands. Ophthalmology. 2000;107(1):180–4.

    Article  CAS  PubMed  Google Scholar 

  53. Sullivan DA, Sullivan BD, Ullman MD, Rocha EM, Krenzer KL, Cermak JM, et al. Androgen influence on the meibomian gland. Invest Ophthalmol Vis Sci. 2000;41(2):3732–42.

    CAS  PubMed  Google Scholar 

  54. ClinicalTrials.gov. Safety and efficacy of KPI-121 in subjects with inflammatory meibomian gland disease [ClinicalTrials.gov identifier: NCT02218489]. 2015. https://clinicaltrials.gov/ct2/show/NCT02218489. Accessed 22 Jun 2015.

  55. ClinicalTrials.gov. A study of AGN-195263 for the treatment of meibomian gland dysfunction [ClinicalTrial.gov identifier: NCT01633788]. 2015. https://clinicaltrials.gov/ct2/show/NCT01633788. Accessed 22 Jun 2015.

  56. Colligris B, Crooke A, Huete-Toral F, Pintor J. An update on dry eye disease molecular treatment: advances in drug pipelines. Expert Opin Pharmacother. 2014;15(10):1371–90.

    Article  CAS  PubMed  Google Scholar 

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  1. New York Eye and Ear Infirmary of Mount Sinai, 150 East 32nd Street #102, New York, NY, USA

    Adam R. Thode & Robert A. Latkany

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Thode, A.R., Latkany, R.A. Current and Emerging Therapeutic Strategies for the Treatment of Meibomian Gland Dysfunction (MGD). Drugs 75, 1177–1185 (2015). https://doi.org/10.1007/s40265-015-0432-8

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