Meibom-Drüsen-Dysfunktion

Infrared thermography: different options of thermal eyelid warming

PURPOSE

Current therapies of Meibomian gland dysfunction (MGD) include thermal eyelid warming. It was the aim of the study to investigate the temperature run after eyelid warming using 3 different techniques (hot compresses, Blephasteam® (Thea Pharma GmbH, France), and having a sauna) in patients with MGD compared with normal subjects by infrared thermography.

METHODS

A prospective case-control study was done. Temperature profiles of the eyelids were investigated in 93 subjects (49 normals, 44 MGD patients) after warming of the eyelids by 3 methods: hot compresses, Blephasteam®, and having a sauna. Temperature runs of the eyelids were measured with an infrared thermal imaging camera (VarioCAM® HD research 675/30 mm, InfraTec GmbH) at baseline and after eyelid warming for 10 min. Statistical analysis were done by Wilcoxon test or t tests for unpaired samples.

RESULTS

The initial eyelid temperature was significantly increased after the use of Blephasteam® compared with hot compresses in MGD and normal patients (p < 0.001). Having a sauna showed a similar warming effect of the eyelids than Blephasteam^® in normals and MGD patients (p > 0.05). Additionally, the warming effect of the eyelids after having a sauna was significantly longer than after the use of Blephasteam® in MGD (p = 0.016) and normal patients (p = 0.01).

CONCLUSION

Eyelid temperature after having a sauna was similar to commonly used warming devices; yet, the duration of the eyelid warming effect was longer. Thus, having a sauna might be an alternative option for warming of the eyelids.

Meibomian Gland Dysfunction in Primary and Secondary Sjögren Syndrome

PURPOSE

We hypothesized that women with primary (pSS) and secondary Sjögren syndrome (sSS; with systemic lupus erythematosus [SLE] or rheumatoid arthritis [RA]) have meibomian gland dysfunction (MGD). We sought to test our hypothesis.

METHODS

Subjects with pSS, sSS + SLE, sSS + RA, and non-SS-related MGD were recruited from the Sjögren's Syndrome Foundation or outpatient clinics at Tufts University School of Dental Medicine or Brigham and Women's Hospital. The control population was recruited from the Greater Boston area. After providing written informed consent, the subjects underwent an eye examination and/or completed two questionnaires that assess symptoms of dry eye disease (DED).

RESULTS

Our results demonstrate that pSS and sSS patients have MGD. These subjects had meibomian gland orifice metaplasia, an increased number of occluded meibomian gland orifices, and a reduced quality of meibomian gland secretions. Further, patients with pSS, sSS + SLE, sSS + RA, and MGD had significant alterations in their tear film, lid margin, cornea, and conjunctiva. Symptoms of DED were increased ∼10-fold in all pSS, sSS, and MGD groups relative to controls.

CONCLUSIONS

Our findings support our hypothesis and show that individuals with pSS, sSS + SLE, and sSS + RA have MGD. In addition, our study indicates that patients with pSS and sSS have both aqueous-deficient and evaporative DED.

Activities of autonomic neurotransmitters in Meibomian gland tissues are associated with menopausal dry eye

The secretory activities of meibomian glands are regulated by the autonomic nervous system. The change in density and activity of autonomic nerves in meibomian glands during menopause play an important role in the pathogenesis of dry eye. In view of this, we established a dry eye rat model by removing the bilateral ovaries. We used neuropeptide Y and vasoactive intestinal polypeptide as markers of autonomic neurotransmitters. Our results showed that the concentration of estradiol in serum significantly decreased, the density of neuropeptide Y immunoreactivity in nerve fibers significantly increased, the density of vasoactive intestinal polypeptide immunoreactivity in nerve fibers significantly decreased, and the ratio of vasoactive intestinal polypeptide/neuropeptide Y positive staining significantly decreased. These results suggest that a decrease in ovary activity may lead to autonomic nervous system dysfunction, thereby affecting the secretory activity of the meibomian gland, which participates in sexual hormone imbalance-induced dry eye.