Tear film lipid layer thickness measurement from Ocular Surface Analyzer as a marker to monitor treatment of meibomian gland dysfunction in a study comparing physiological detergent-free eyelid wipes with conventional therapy: A randomized trial

Abstract

Purpose: To compare the efficacy of physiological, non-detergent eyelid wipes with conventional lid hygiene in patients with meibomian gland dysfunction (MGD).

Methods: Fifty participants with MGD were recruited and randomized into two groups. Participants in group I used Evolve Pure™ Eyewipes twice a day to clean the eyelid debris along with standard therapy (antibiotic and lubricants) and participants in group II followed lid hygiene with warm compresses along with standard therapy. Symptoms, ocular surface assessment (lipid layer thickness, tear meniscus height, non-invasive tear film breakup time, and meibography), slit-lamp biomicroscopy (eyelash contamination, meibomian gland blockage, meibomian gland secretion, and meibomian gland telangiectasia) and tear film osmolarity were noted at baseline and 90 days after therapy.

Results: Significant improvement in symptoms and signs of MGD was observed in both groups after treatment (P < 0.001); however, the clinical improvement was better with the use of eyelid wipes. Lipid layer thickness increased significantly in group I (P = 0.0006) and group II (P = 0.0002), which was maintained even after adjusting for sociodemographic variables such as age, sex, and severity score of symptoms and signs.

Conclusion: Lipid layer thickness of the tear film is a sensitive marker in monitoring response to treatment in patients with MGD. The use of physiological detergent-free eyelid wipes is non-inferior to lid hygiene and warm compresses, which remains the mainstay for treatment of MGD; the clinical improvement with eyelid wipes was noted to be better.

Keywords: Eyelid wipes; lid hygiene; lipid layer thickness; meibomian gland blockage; meibomian gland dysfunction; ocular surface analyzer.

Figure 1

Flowchart showing enrollment and outcomes. The number of participants in the study whose outcomes were analyzed at the 90-day follow-up visit is shown in the flowchart

Figure 2

Representative images of a patient with MGD captured using the ocular surface analyzer at the baseline visit and 90 days after treatment with eyelid wipes and standard therapy. Baseline ocular surface parameters (a) such as non-invasive break-up time (NIBUT), lipid layer thickness (LLT) and type, tear meniscus height (TMH), and meibomian gland loss (MGL) along with post-treatment ocular surface parameters (b) are clearly elucidated. Meibography images of the upper eyelid at baseline in the right (c) and left eye (e) demonstrate 32%and 25% meibomian gland loss (MGL), respectively. Following treatment for MGD, MGL in the right eye (d) and left eye (f) do not show any significant change with treatment