MEIBOMIAN GLAND DYSFUNCTION

Evaporative dry eye due to deficiency of the tear film lipid layer is primarily treated with lid hygiene, tear supplementation, and anti-inflammatory therapy.


LID HYGIENE

Lid hygiene consists of mechanical lid hygiene, eyelid warming, and mechanical massage of the eyelids, and is performed to improve the quality and quantity of tear film lipids. Eyelid warming is applied to melt pathologically altered meibomian lipids. Heat may be delivered using warm towel compresses, eye warmer masks (MGDRx EyeBag), eyelid warming device (Blephasteam), or thermal pulse therapy (LipiFlow). Lid massage is performed to express obstructed glands. The Norwegian Dry Eye Clinic customizes lid hygiene based on the disease severity and with regard to patient preference.


TEAR SUPPLEMENTATION

Lubricants are used to lubricate the ocular surface, reduce elevated tear film osmolarity, dilute inflammatory or inflammation-inducing agents, and replace missing tear constituents. The exemption card scheme for user fee group 1 covers medication through the “blue prescription” scheme for Norwegian residents.


ANTI-INFLAMMATORY THERAPY

Restasis ® (Allergan) and Ikervis ® (Santen) Cyclosporine are eye drops that may counteract the inflammation and superficial punctate keratitis due to dry eye disease. Oral tetracycline treatment and topical azithromycin have anti-inflammatory properties and may decrease meibomian lipid breakdown products.


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