Dry eye and MGD

Question 1

What is MGD also known as?

Answer 1

Posterior blepharitis

Question 2

What is the aetiology of MGD?

Answer 2

Duct obstruction due to:
Hyperkeratinisation of duct epithelium
Keratinised cell debris
Increased meibum viscosity

Question 3

What are signs of MGD?

Answer 3

Gland plugging/capping
Cloudy/pasty yellow secretion on expression
Tear foaming
Telangiectasic vessels
Lid notching
Irregular posterior margin
Glands malpositioned towards globe

Question 4

Why do gland plugging/capping and pasty/cloudy secretions occur?

Answer 4

Increase in melting point of meibum (from ~32 to 35 degrees)
Melting temp increases due to bacterial changes causing changes in lipases and esterases

Question 5

What is dry eye also known as?

Answer 5

Drt eye syndrome
Keratoconjunctivitis (KCS)

Question 6

How much of the UK population have dry eye?

Answer 6

~1/3 of adult population

Question 7

What are the consistent risk factors for dry eye?

Answer 7

CL wear
VDU use
Age
Sex
Race
HRT
Connective tissue disease
Sjogren syndrome
Stem cell transplant
Certain meds (antihistamines, isotretinoin)

Question 8

What are the probable risk factors for dry eye?

Answer 8

Diabetes
Rosacea
Viral infection
Thyroid disease
Refractive surgery
Low fatty acid intake

Question 9

What are the inconclusive risk factors for dry eye?

Answer 9

Menopause
Acne
Sarcoidosis
Smoking
Alcohol
Pregnancy
Demodex infestation
Oral contraceptives

Question 10

How much does the chance of dry eye increase by every 10 years?

Answer 10

~2%

Question 11

What is Aqueous Deficient Dry Eye (ADE)?

Answer 11

Not enough aqueous is being produced

Question 12

What is Evaporative Dry Eye (EDE)?

Answer 12

Lipid layer is evaporating too much

Question 13

What are the signs of dry eye?

Answer 13

TBUT <10 secs
MGD
Smile stain
Reduced tear meniscus
Redness
Dry conjunctiva
Lid wiper epitheliopathy
LIPCOF

Question 14

What are the symptoms of dry eye?

Answer 14

Discomfort
Dryness
Redness
Irritation
FB sensation
Grittiness
Burning
Wind sensitivity
Fluctuating vision/reduced vision quality
Sxs made worse by wind, heat, smoke and/or prolonged near activities

Question 15

What are the grades for Meibomian gland assessment of Meibum quality?

Answer 15

0 - clear
1 - cloudy
2 - cloudy with debris
3 - toothpaste

Question 16

What are the grades for Meibomian gland assessment of Meibum expressibility?

Answer 16

0 - all glands express
1 - 3-4 glands express
2 - 1-2 glands express
3 - no glands express

Question 17

What does a 0.2mm tear meniscus mean?

Answer 17

mild dry eye (aqueous deficient)

Question 18

How should dry eye be managed?

Answer 18

1:Educate px (lifestyle, local environment modifications, address modifiable RFs, diet, ocular lubricants, lid hygiene, compress and massage)
2: Give ocular lubricants and conserve tears (protective glasses, punctal occlusion, moisture chamber glasses)
3: Specialist dry eye/IP for punctal plugs, IPL, scleral/bandage CLs, pharmacological management
4: Refer to secondary care (surgical punctal occlusion, amniotic membrane, serum drops, pharmacological management or surgical procedures)

Question 19

When should you refer to secondary care?

Answer 19

If underlying conditions suspected
Secondary complications present
Abnormal lid anatomy or function
Persistent or severe sxs which don’t respond to management after 2-4 weeks
Paediatric pxs