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Andrew T McPherson, Jack V Greiner, Paula J Oliver; Vital Staining of the Cornea and Conjunctiva Following Treatment of Meibomian Gland Dysfunction in Dry Eye Patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4400.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the degree of vital staining of the cornea and conjunctiva in dry eye (DE) patients following meibomian gland therapy.
In this observational single-center study, symptomatic DE patients with meibomian gland dysfunction (MGD) underwent modified conventional therapy (2 manual lid expressions per eye during a 3 mo period supplemented with daily moist warm compress therapy; n=16, 32 eyes). Meibomian gland analysis (MGA) scores were determined by assessing 15 lower eyelid glands using the Meibomian Gland Evaluator (TearScience®,Morrisville,NC); secretions were graded as 0=no secretion, 1=inspissated-filamentary, 2=cloudy/turbid liquid, 3=clear liquid. DE patients required MGA scores ≤ 20 for inclusion. Sodium fluorescein (SF) corneal staining and lissamine green (LG) conjunctival staining were graded as 0=none, 1=mild, 2=moderate, 3=severe for 5 corneal and 6 bulbar conjunctival regions. MGA, SPEED, OSDI, osmolarity, lid wiper epitheliopathy (LWE) and TFBUT were determined at baseline (BL) and 3 mo. Average staining of individual corneal and conjunctival tissues was determined in each eye. Tissues were grouped based on staining severity [grade 0=(0-0.49), grade 1=(0.5-1.0), grade 2=(1.01-2), and grade 3=(2.01-3)], where lower grades indicate less severe staining. The percentage of eyes in each severity group was determined.
There were no statistically significant changes in SPEED, OSDI, osmolarity, LWE or TFBUT. MGA scores were significantly increased at 3 mo vs BL (22.81±1.61 vs 13.28±0.97; p=0.0005). SF staining decreased in severity from BL (grade 0: 9.38%, grade 1: 46.88%, grade 2: 31.25%, grade 3: 12.5%) to 3 mo (grade 0: 37.5%, grade 1: 28.13%, grade 2: 25 %, grade 3: 9.38%). LG staining decreased in severity from BL (grade 0: 31.25%, grade 1: 46.88%, grade 2: 18.75%, grade 3: 3.13%) to 3 mo (grade 0: 43.75%, grade 1: 43.75%, grade 2: 12.5%, grade 3: 0%). This represents a nearly 30% increase in the number of patients attaining a grade 0 staining score in the cornea and more than 12% increase in the number of patients attaining a grade 0 score in the conjunctiva at the 3 mo time point.
A 3-mo combined therapy regimen of two manual lid expressions and daily warm compresses improved meibomian gland secretion and decreased corneal and conjunctival staining in dry eye patients with meibomian gland dysfunction.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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