Abstract
Abstract: :
Purpose: To evaluate clinical impact, aqueous tear parameters, meibomian gland drop–out and meibomian gland lipid composition change in patients with primary meibomianitis, before and after initiating treatment with oral minocycline. Methods:A prospective, clinic–based study. Patients with clinical meibomianitis were evaluated clinically and by fluorophotometry, evaporometry, meibography, microbiology and meibomian gland biochemistry before beginning oral minocycline and at 3 months on minocycline and 3 months after stopping minocycline. Results:Sixteen patients, 11 male and 5 females, mean ages 69 yrs old were enrolled. Improvement was observed in clinical signs at the second and third visit. Microflora showed a decrease. Also tear volume(TV)and flow(TF) were decreased(TV: 1.39 ± 0.62 µl vs. 0.79 ± 0.43 µl vs. 1.05 ± 0.78 µl, P < 0.05; TF: 0.17 ± 0.12 µl/min vs. 0.11 ± 0.09 vs. 0.08 ± 0.07 µl/min, P < 0.05). Tear evaporation rate did not change over time(0.056 ± 0.032 µl/cm2/min 10–2 vs. 0.054 ± 0.031 µl/cm2/min 10–2 vs. 0.053 ± 0.026 µl/cm2/min 10–2, P > 0.05). Meibomian gland drop–out and meibomian secretion turbidity improved over time. Polar and non–polar lipids analyzed by HPLC showed a decrease in triglycerides(TG), monoglycerides (MG) and free fatty acids(FFA) as we have previously reported and an increase in sphingomyelin(SM) and phosphatidylcholine (PC) between the first and second visit. Conclusions:There were clinical improvements in meibomianitis signs and these persisted for at least 3 months after discontinuation of treatment. This occurred despite a decrease in aqueous tear production (manifest by a statistically significant decrease in aqueous tear volume and tear flow) with no change in evaporation and an improvement in measurable meibomian gland drop–out and improved clarity of meibomian secretion. Decreased bacterial flora and meibomian gland lipid changes appeared to be associated with clinical improvement.
Keywords: cornea: clinical science • cornea: tears/tear film/dry eye • antibiotics/antifungals/antiparasitics