MGD/ Posterior Blepharities

Question 1

Signs:

Answer 1

Absent
Cloudy meibomian
Lid notching
Foamy tear film
Reduced NITBUT
Associated dry eye with associated signs/hyperaemia

Question 2

Aetiology & Pathophysiology:

Answer 2

Bacterial lipases break down meibomian lipids
Meibomian secretions ===> abnormal
Tear film stability impacted
Blocked meibomian glands due to desquamated epithelial cells /debris (e.g., make-up)
Associated with anterior blepharitis, trauma, microbial contamination
Poor hygiene is a high risk
Significant increase in prevalence with age
Tear film instability due to other causes can produce eyelid inflammatory response ===>lipid changes & a cyclical process.

Question 3

Management:

Answer 3

Warm compress ==5 min minimum @40º
Lid expression +lid hygiene
Cease CL wear OK if tolerated & managed
Dietary advise & Omega 3
Artificial tears
Severe cases to be referred for antibiotic therapy
Surfactant cleaner if DW
DD is indicated

Question 4

CL implications:

Answer 4

Oily CL deposits = more thorough cleaning regime
Evaporative dry eye inherent ===>tear film quality changes for CL wearers
Reduced WT
Reduced CL comfort
Poorer stability / fitting challenges