title: Evaluation of an automated thermodynamic treatment (LipiFlow®) system for meibomian gland dysfunction: a prospective, randomized, observer-masked trial. A randomized, double-masked study to evaluate the effect of omega-3 fatty acids supplementation in meibomian gland dysfunction Topical interleukin 1 receptor antagonist for treatment of dry eye disease: a randomized clinical trial. Comparison of the efficacy of topical N-acetyl-cysteine and a topical steroid-antibiotic combination therapy in the treatment of meibomian gland dysfunction. A New System, the LipiFlow, for the Treatment of Meibomian Gland Dysfunction A Randomized Double-Masked Study of 0.05% Cyclosporine Ophthalmic Emulsion in the Treatment of Meibomian Gland Dysfunction Randomised masked clinical trial of the MGDRx eyebag for the treatment of meibomian gland dysfunction-related evaporative dry eye A Randomized, Controlled Treatment Trial of Eyelid-Warming Therapies in Meibomian Gland Dysfunction Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. A Novel Thermodynamic Treatment for Meibomian Gland Dysfunction Efficacy of topical cyclosporin 0.05% in the treatment of posterior blepharitis. Prevalence of dry eye among adult Chinese in the Beijing Eye Study Effects of topical loteprednol etabonate on tear cytokines and clinical outcomes in moderate and severe meibomian gland dysfunction: randomized clinical trial. Minocycline controls clinical outcomes and inflammatory cytokines in moderate and severe meibomian gland dysfunction. Low-concentration homogenized castor oil eye drops for noninflamed obstructive meibomian gland dysfunction. The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (an AOS thesis). Efficacy of Commercially Available Topical Cyclosporine A 0.05% in the Treatment of Meibomian Gland Dysfunction The effect of low-dose doxycycline therapy in chronic meibomian gland dysfunction. Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomised double-masked open-label clinical trial Efficacy of topical azithromycin ophthalmic solution 1% in the treatment of posterior blepharitis Comparison of Self-applied Heat Therapy for Meibomian Gland Dysfunction Efficacy of topical N-acetylcysteine in the treatment of meibomian gland dysfunction.
abstract: PURPOSE To compare the effectiveness of a single LipiFlow ( ® ) treatment with combined lid warming and massage in patients with meibomian gl and dysfunction ( MGD ) . METHODS In this prospect i ve , r and omized , crossover , observer-masked clinical trial , subjects were r and omized to receive either a single 12-min LipiFlow-LipiFlow Thermal Pulsation ( LTP ) system treatment or to perform combined twice-daily lid warming and massage for 3 months . All subjects were examined before , and 1 and 3 months after initiation of treatments . Investigated parameters included subjective symptoms , lipid layer thickness , meibomian gl and assessment , tear break-up time , tear osmolarity , corneal and conjunctival staining , Schirmer test values , and tear meniscus height . RESULTS A total of 31 subjects completed the 3-month follow-up . At 1 and 3 months , patients in the LipiFlow treatment group had a significant reduction in Ocular Surface Disease Index ( OSDI ) scores compared with those in the lid-margin hygiene group . Both treatments produced a significant improvement in expressible meibomian gl and s compared to the baseline parameters , but no significant difference was noted between the two groups . The other investigated objective parameters did not show a significant difference . CONCLUSION Results of our study show that a single LipiFlow treatment is as least as effective as a 3-month , twice-daily lid margin hygiene regimen for MGD . However , the present study was observer-masked only , and therefore a placebo effect may have confounded any improvements in subjective symptoms and other parameters in both groups Background Dysfunction of the meibomian gl and ( MG ) is among the most frequent causes of ophthalmological symptoms . The inflammation seen in meibomian gl and dysfunction ( MGD ) is part of its pathogenesis , and evidence of the antioxidant-inflammatory properties of omega-3 fatty acids suggests this to be an appropriate treatment for MGD . Objective We aim ed to assess the effectiveness of omega-3 fatty acids versus placebo , in improving the symptoms and signs of MGD . Methods We conducted a r and omized and double-mask trial of 3 months duration . We enrolled 61 patients who presented with symptomatic MGD and no tear instability ( defined as tear breakup time [ TBUT ] < 10 seconds ) . Participants were r and omly assigned to two homogeneous subgroups . For patients in group A , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus a placebo oral agent . For patients in group B , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus oral supplementation with omega-3 fatty acids . We performed the following tests : ( 1 ) TBUT ; ( 2 ) Schirmer I test ; ( 3 ) Ocular Surface Disease Index © ( OSDI © ; Allergan , Inc. , Irvine , CA , USA ) ; ( 4 ) MG expression ; ( 5 ) evaluation of lid margin inflammation ; and ( 6 ) interpalpebral and corneal dye staining . Results After 3 months of evaluation , the mean OSDI , TBUT , lid margin inflammation , and MG expression presented improvement from the baseline values , in group B ( P < 0.01 , P < 0.001 , P < 0.0001 , P < 0.0001 , respectively ) . The Schirmer test results were also improved and statistically significant ( P < 0.01 ) . Conclusion Oral omega-3 fatty acids , 1.5 grams per day , may be beneficial in the treatment of MGD , mainly by improving tear stability IMPORTANCE The immunopathogenic mechanisms of dry eye disease ( DED ) , one of the most common ophthalmic conditions , is incompletely understood . Data from this prospect i ve , double-masked , r and omized trial demonstrate that targeting interleukin 1 ( IL-1 ) by topical application of an IL-1 antagonist is efficacious in significantly reducing DED-related patient symptoms and corneal epitheliopathy . OBJECTIVE To evaluate the safety and efficacy of treatment with the topical IL-1 receptor antagonist anakinra ( Kineret ; Amgen Inc ) in patients having DED associated with meibomian gl and dysfunction . DESIGN AND SETTING Prospect i ve phase 1/2 , r and omized , double-masked , vehicle-controlled clinical trial . PARTICIPANTS Seventy-five patients with refractory DED . INTERVENTIONS Participants were r and omized to receive treatment with topical anakinra , 2.5 % ( n = 30 ) , anakinra , 5 % ( n = 15 ) , or vehicle ( 1 % carboxymethylcellulose ) ( n = 30 ) 3 times daily for 12 weeks . MAIN OUTCOMES AND MEASURES Primary outcomes were corneal fluorescein staining ( CFS ) , complete bilateral CFS clearance , dry eye-related symptoms as measured by the Ocular Surface Disease Index , tear film breakup time , and meibomian gl and secretion quality . RESULTS Topical anakinra was well tolerated compared with vehicle , with no reports of serious adverse reactions attributable to the therapy . After 12 weeks of therapy , participants treated with anakinra , 2.5 % , achieved a 46 % reduction in their mean CFS score ( P = .12 compared with vehicle and P < .001 compared with baseline ) ; participants treated with anakinra , 5 % , achieved a 17 % reduction in their mean CFS score ( P = .88 compared with vehicle and P = .33 compared with baseline ) ; and patients treated with vehicle achieved a 19 % reduction in their mean CFS score ( P = .11 ) . Complete bilateral CFS clearance was noted in 8 of 28 patients ( 29 % ) treated with anakinra , 2.5 % , vs in 2 of 29 patients ( 7 % ) treated with vehicle ( P = .03 ) . By week 12 , treatment with anakinra , 2.5 % , and treatment with anakinra , 5 % , led to significant reductions in symptoms of 30 % and 35 % , respectively ( P = .02 and P = .01 , respectively , compared with vehicle ) ; treatment with vehicle led to a 5 % reduction in symptoms . CONCLUSIONS AND RELEVANCE Treatment with topical anakinra , 2.5 % , for 12 weeks was safe and significantly reduced symptoms and corneal epitheliopathy in patients with DED . These data suggest that the use of an IL-1 antagonist may have a role as a novel therapeutic option for patients with DED . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00681109 PURPOSE This study aim ed to compare the efficacy of topical N-acetyl-cysteine ( NAC ) with a topical steroid-antibiotic combination , betamethasone-sulfacetamide sodium therapy in patients with meibomian gl and dysfunction ( MGD ) . METHODS Twenty patients with MGD were prospect ively r and omized and assigned into 2 groups . The patients were instructed to use either NAC 5 % or a topical steroid-antibiotic combination , betamethasone 0.1%-sulfacetamide sodium 10 % , topically 4 times a day for a month . All patients were instructed to apply lid hygiene once daily . RESULTS One month of topical therapy provided statistically significant improvements in fluorescein break-up time and Schirmer scores as compared with the initial study visit in both groups ( P≤0.001 ) . Significant improvements for the symptoms of ocular burning , itching , and intermittent filmy or blurred vision were noted in both groups at 1 month as compared with 1 day ( P<0.05 ) . Considering these rates , there was no significant difference between the groups ( P>0.05 ) . None of the patients developed an allergic reaction to the medications , and intraocular pressure measurements were within the normal limits in both groups . CONCLUSION When used in conjunction with eyelid hygiene , topical administration of NAC appears to be as effective as a topical steroid-antibiotic combination , betamethasone-sulfacetamide sodium therapy in patients with MGD Purpose To evaluate the safety and effectiveness of the LipiFlow System compared to the iHeat Warm Compress ( WC ) for adults with meibomian gl and dysfunction ( MGD ) . Methods This was a non-significant risk , prospect i ve , open-label , r and omized , crossover multicenter clinical trial . One hundred thirty-nine subjects were r and omized between LipiFlow ( n=69 ) and WC control ( n=70 ) . Subjects in the LipiFlow group received a 12-minute LipiFlow treatment and were reexamined at 1 day , 2 weeks and 4 weeks . Control subjects received a 5-minute iHeat treatment with instructions to perform the same treatment daily for 2 weeks . At 2 weeks , they crossed over ( LipiFlow Crossover ) and received the LipiFlow  treatment . Effectiveness parameters : meibomian gl and ( MG ) assessment , tear break-up time ( TBUT ) and dry eye symptoms . Safety parameters : adverse events , ocular health exam , ocular surface staining , intraocular pressure , visual acuity and discomfort . Results LipiFlow result ed in significant improvement ( P < 0.05 ) in MG secretion at 2 and 4 weeks ( mean ± st and ard deviation at baseline = 6.3 ± 3.5 ; 2 weeks = 14.3 ± 8.7 ; 4 weeks = 16.7 ± 8.7 ) ; and TBUT at 2 and 4 weeks : ( at baseline = 5.5 ± 2.9 ; 2 weeks = 6.9 ± 5.0 ; 4 weeks = 7.4 ± 5.5 ) . There was no significant change in MG secretion or TBUT in the control group . LipiFlow result ed in a greater significant reduction in dry eye symptoms than the iHeat WC . The crossover group demonstrated similar significant improvement 2 weeks post-treatment with the LipiFlow . There was no significant difference between groups in the incidence of non-serious , device-related adverse events . Conclusion The LipiFlow System was significantly more effective than iHeat WC . These results support its safety and effectiveness in the treatment of MGD and dry eye symptoms Purpose : To compare the efficacy of topical cyclosporine [ 0.05 % cyclosporine A ( CsA ) ] and preservative-free artificial tears in the treatment of meibomian gl and dysfunction ( MGD ) . Methods : A 3-month prospect i ve , r and omized , double-masked , parallel-group controlled trial enrolled 70 patients with symptomatic MGD and unstable tear film [ tear breakup time ( TBUT ) < 8 seconds ] . Patients were r and omized to topical CsA ( 0.05 % ; group A ) and 0.5 % carboxymethylcellulose ( control ; group B ) instilled twice daily for 3 months . Ocular Surface Disease Index ( OSDI ) , lid margin inflammation , meibomian gl and expression , conjunctival injection , corneal and interpalpebral dye staining , noninvasive tear breakup time ( NIBUT ) using the Tearscope Plus and invasive fluorescein tear breakup time ( FBUT ) , and Schirmer I test were performed . Results : At the 3-month evaluation , mean OSDI , NIBUT and FBUT , lid margin inflammation , meibomian gl and expressibility , and tarsal injection showed significant improvement from baseline in group A ( P < 0.01 , P < 0.01 , P < 0.001 , P < 0.05 , and P < 0.001 , respectively ) . In group B , only the OSDI improved significantly from baseline at 3 months ( P = 0.003 ) . TBUTs ( NIBUT and FBUT ) were significantly longer in group A at all visits , and the mean change of TBUTs from baseline was also significantly greater in group A at 3 months ( P < 0.001 ) . Conclusions : Topical CsA 0.05 % twice daily may be helpful in the treatment of MGD mainly by improving tear film stability Background / aims To investigate the efficacy and safety of the MGDRx EyeBag ( The Eyebag Company , Halifax , UK ) eyelid warming device . Methods Twenty-five patients with confirmed meibomian gl and dysfunction (MGD)-related evaporative dry eye were enrolled into a r and omised , single masked , contralateral clinical trial . Test eyes received a heated device ; control eyes a non-heated device for 5 min twice a day for 2 weeks . Efficacy ( ocular symptomology , non-invasive break-up time , lipid layer thickness , osmolarity , meibomian gl and dropout and function ) and safety ( visual acuity , corneal topography , conjunctival hyperaemia and staining ) measurements were taken at baseline and follow-up . Subsequent patient device usage and ocular comfort was ascertained at 6 months . Results Differences between test and control eyes at baseline were not statistically significant for all measurements ( p>0.05 ) . After 2 weeks , statistically significant improvements occurred in all efficacy measurements in test eyes ( p<0.05 ) . Visual acuity and corneal topography were unaffected ( p>0.05 ) . All patients maintained higher ocular comfort after 6 months ( p<0.05 ) , although the benefit was greater in those who continued usage 1–8 times a month ( p<0.001 ) . Conclusions The MGDRx EyeBag is a safe and effective device for the treatment of MGD-related evaporative dry eye . Subjective benefit lasts at least 6 months , aided by occasional retreatment . Trial registration number NCT01870180 Abstract Aim The main treatment for meibomian gl and dysfunction ( MGD ) , a major cause of dry eye , is eyelid warming . Lack of compliance is the main reason for treatment failure . This has led to the development of eyelid-warming devices that are safe , effective and convenient . To obtain robust evidence demonstrating their efficacy , the authors conducted a 3-arm r and omized clinical study . Methods The authors conducted a 3-month assessor-blinded , r and omized , controlled trial of patients from the Singapore National Eye Centre experiencing at least one of eight dry eye symptoms ‘ often ’ or ‘ all the time ’ . Patients who wore contact lenses , had an active infection or known diagnosis of thyroid dysfunction and rheumatoid arthritis were excluded from the study . MGD participants were r and omly assigned to warm towel ( n = 25 ) , EyeGiene ® ( Eyedetec Medical Inc. , Danville , CA , USA ) ( n = 25 ) and Blephasteam ® ( Spectrum Thea Pharmaceuticals LTD , Macclesfield , UK ) ( n = 25 ) treatments . The primary efficacy and safety outcomes included the proportions of participants with improved symptoms and changes in best corrected visual acuity ( BCVA ) , respectively . Other outcomes included tear break up time ( TBUT ) , Schirmer test , corneal fluorescein dye staining and number of visibly occluded meibomian gl and ( MG ) orifices . Results The study population was 53.5 ± 11.1 years old and predominantly Chinese . For severity of symptom after 3 months of treatment , 78.3 % Blephasteam ® participants reported improvement compared to 45.5 % warm towel participants ( p = 0.023 ) . The corresponding proportions for improvement in the frequency of symptoms were 82.6 % and 50.0 % , respectively ( p = 0.020 ) . The proportions of improvement of symptoms in EyeGiene ® patients were not significantly different from warm towel intervention . At 1 month of treatment , the crude odds ratio of improvement of severity of irritation for Blephasteam ® compared to control was 3.0 ( 95 % CI 0.88–10.18 ) . However , the odds ratio adjusted by age was 5.67 ( 1.30–24.66 ) . The lid-warming treatments did not significantly change the TBUT , Schirmer test results or number of visibly occluded MGs in the study period . All treatment modalities did not worsen BCVA after 3 months . Conclusion Blephasteam ® is more effective than warm towel for MGD treatment , with warm towel and EyeGiene ® being comparable effective . Older age might predict for treatment efficacy . All studied therapies were safe for visual acuity ( VA ) for 3 months of treatment PURPOSE To evaluate the effect of intense pulsed light ( IPL ) applied to the periocular area for meibomian gl and dysfunction ( MGD ) in a prospect i ve , double-masked , placebo-controlled , paired-eye study . METHODS Twenty-eight participants underwent IPL treatment  , with homogeneously sequenced light pulses delivered to one eye and placebo treatment to the partner control eye at 1 , 15 , and 45 days following baseline ( BL ) evaluation . Lipid layer grade ( LLG ) , noninvasive tear break-up time ( NIBUT ) , tear evaporation rate ( TER ) , tear meniscus height ( TMH ) , and subjective symptom score using visual analogue scales ( VAS ) were compared with BL and control values at each visit . RESULTS Lipid layer grade improved significantly from BL to Day ( D ) 45 in the treated eye ( P < 0.001 ) , but not the control eye ( P = 0.714 ) , with 82 % of treated eyes improving by at least one LLG . Noninvasive tear break-up time also improved significantly from BL to D45 in the treated ( P < 0.001 ) but not in the control eye ( P = 0.056 ) and was significantly longer than in the treated eye at D45 ( 14.1 ± 9.8 seconds versus 8.6 ± 8.2 seconds , P < 0.001 ) . The tear evaporation rate was not different in the treated eye compared with the control eye at any visit . Tear meniscus height did not change from BL in either eye ( P > 0.05 ) . Visual analog scale symptom scores improved from BL in the treated ( P = 0.015 ) , but not the control eye ( P = 0.245 ) , with 86 % of participants noting reduced symptoms in the treated eye by D45 . CONCLUSIONS Intense pulsed light with multiple sculpted pulses shows therapeutic potential for MGD , improving tear film quality and reducing symptoms of dry eye . ( https://www.anzctr.org.au number , ACTRN12614000162617 . ) Purpose : To evaluate a novel thermodynamic treatment for obstructive meibomian gl and dysfunction ( MGD ) . Material s and Methods : Fourteen adult subjects ( 10 females , 4 males , mean age = 54.2 ± 9.6 yr ) were recruited in a multi-center , feasibility clinical trial in Durham and Cary , North Carolina and Boston , Massachusetts . Inclusion criteria included : previous diagnosis of moderate to severe dry eye ; dry eye symptoms for at least three months prior ; daily topical lubricant use ; and evidence of meibomian gl and ( MG ) obstruction in the central five gl and s of both eyes lower eyelids . Exclusion criteria included : history of recent acute or chronic ocular inflammation or infection and lid surface abnormalities affecting lid function . The treatment : the device heats the palpebral surface of upper and lower eyelids while simultaneously applying grade d pulsatile pressure to the outer eyelid for 12 min , thereby expressing the MGs during heating . One eye was r and omly selected to undergo additional manual heated expression with another treatment device . Results : The mean MG secretion score , tear break-up time , corneal staining score , number of MGs yielding liquid secretion and symptom scores all improved significantly from baseline to 1 week . This was maintained through the 3-month follow-up . There was no statistically significant difference in any outcome between the automated device treatment only and the additional heated manual expression . Conclusion : The combination of heat applied to the palpebral surface , while simultaneously expressing MGs during a single 12-minute treatment , was effective , in this feasibility study , in treating obstructive MG dysfunction and dry eye signs and symptoms for the 3-month study period We assessed the efficacy of topical cyclosporin 0.05 % ophthalmic emulsion versus tobramycin 0.3%/dexamethasone 0.1 % in patients with posterior blepharitis .  Posterior blepharitis improved significantly from the initial study visit with both cyclosporin treatment and tobramycin/dexamethasone . Cyclosporin provided greater improvements in Schirmer 's scores ( P < 0.001 ) and tear break-up time ( P = 0.018 ) than tobramycin/dexamethasone after 12 weeks of treatment . Eyelid health also improved in both groups , but the mean improvement in meibomian gl and secretion quality was significantly greater with cyclosporin than with tobramycin/dexamethasone ( P = 0.015 ) . Moreover , a higher percentage of patients in the cyclosporin treatment group had improvements in symptoms of blurred vision , burning , and itching and more cyclosporin-treated patients experienced resolution of lid telangiectasia . The findings in this prospect i ve study suggest that posterior blepharitis can be more effectively treated with cyclosporin than with tobramycin/dexamethasone . These findings should be further evaluated in large-scale , controlled , clinical trials Purpose To study the prevalence and associations of dry eye symptoms in adult Chinese . Methods The Beijing Eye Study is a population -based study in northern China , which included 4439 of 5324 subjects invited to participate with an age of 40 + years ( response rate : 83.4 % ) . For the present study , a r and om sample was taken consisting of 1957(44.1 % ) subjects ( 1112 women ; 56.9 % ) .  Dry eye symptoms were evaluated with ( 1 ) an  interviewer-assisted question naire ; ( 2 )  measurement of the tear-film break-up time ; ( 3 ) assessment of the fluorescein staining of the cornea ; ( 4 ) slit-lamp-based examination of a meibomian gl and dysfunction ;  and ( 5 ) Schirmer 's test .  Results Symptoms of a dry eye felt ‘ often ’ or ‘ at all times ’ were present in 411 subjects ( 21.0 % ) . In a multivariate analysis , dry eye symptoms were significantly associated with age ( P<0.001 ) , female gender ( P<0.001 ; odds ratio ( OR ) : 1.56 ; 95 % confidence intervals ( CI ) : 1.23 , 1.98 ) , urban region ( P<0.001;OR : 1.89 ; 95 % CI : 1.46 , 2.48 ) , low degree of nuclear cataract ( P=0.02 ) , and undercorrection of refractive error ( P=0.005 ; OR : 1.42 ; 95 % CI : 1.11 , 1.82 ) . All tests for dry eye did not vary significantly between the dry eye group and the normal group . Conclusions The dry eye symptoms as evaluated subjectively in a question naire occurred in about 21 % of the adult population in China , with associations to age , female gender , urban region , and undercorrection of a refractive error . Measurement of the tear-film break-up time , assessment of the corneal fluorescein staining , slit-lamp-based examination of a meibomian gl and dysfunction , and Schirmer 's test were not significantly associated with dry eye symptoms PURPOSE To assess tear cytokine levels and clinical outcomes in moderate and severe meibomian gl and dysfunction ( MGD ) after 2 months of treatment with topical loteprednol etabonate and eyelid scrubs with warm compresses vs eyelid scrubs with warm compresses alone . DESIGN R and omized controlled trial . METHODS Patients with moderate and severe MGD were r and omized into 2 groups : topical loteprednol etabonate and eyelid scrubs with warm compresses ( Group I , 34 eyes ) or eyelid scrubs with warm compresses ( Group II , 36 eyes ) . We evaluated cytokine levels , tear film break-up time ( TBUT ) , corneal and conjunctival fluorescein staining , biomicroscopic examination of lid margins and meibomian gl and s , and the Ocular Surface Disease Index before initiating treatment and 1 month and 2 months after treatment . RESULTS There were significant decreases in the levels of interleukin (IL)-6 , IL-8 , and IL-1β in Group I , and IL-6 and IL-8 in Group II . Moreover , the observed decreases of these cytokines in Group I were attributed to a remarkable decrease between treatment and 1 month after treatment . In Group I , there were improvements in all of the clinical outcomes , with prominent improvement in TBUT , corneal and conjunctival fluorescein staining , and meibum quality after 1 month of treatment , compared with Group II . An improvement in meibomian gl and expressibility and MGD stage reduction were more remarkable in Group I. CONCLUSIONS Topical loteprednol etabonate and eyelid scrubs with warm compresses were tolerated and efficacious for the treatment of moderate and severe MGD . We suggest that such beneficial effects could manifest after 1 month PURPOSE To assess clinical outcomes and tear cytokine levels in patients with moderate and severe meibomian gl and dysfunction ( MGD ) after treatment with oral minocycline and artificial tears versus artificial tears only . DESIGN Prospect i ve , r and omized clinical trial . METHODS Sixty eyes of 60 patients with stage 3 or 4 meibomian gl and dysfunction were enrolled . We evaluated the tear film break-up time , Schirmer test results , corneal and conjunctival fluorescein staining results , biomicroscopic examination results of lid margins and meibomian gl and s , and tear cytokine levels before and after 1 month and 2 months of oral minocycline and artificial tears ( group 1 ) or artificial tears only ( group 2 ) . Tear sample s were collected and analyzed using a BD Cytometric Bead Array ( BD Bioscience , San Jose , California , USA ) for detection of interleukin (IL)-1β , IL-6 , IL-7 , IL-8 , IL-12p70 , IL-17α , interferon-γ , tumor necrosis factor-α , and monocyte chemotactic protein-1 . The Wilcoxon signed-rank test , Mann-Whitney U test , generalized linear model , and linear mixed model were performed . RESULTS Patients in group 1 showed statistically significant improvement in all clinical signs and symptoms after 1 month and 2 months of treatment . Patients of group 1 showed more significant improvement compared with those in group 2 . Patients in group 1 also showed statistically significant reductions in IL-6 , IL-1β , IL-17α , tumor necrosis factor-α , and IL-12p70 after 2 months of treatment . CONCLUSIONS Oral minocycline can provide clinical benefits in treating moderate and severe meibomian gl and dysfunction by reducing inflammatory cytokine levels OBJECTIVE We developed low-concentration homogenized castor oil eye drops for the treatment of patients with noninflamed obstructive meibomian gl and dysfunction ( MGD ) , a major cause of lipid-deficiency dry eye , and assessed the safety , stability , and efficacy of the eye drops . DESIGN R and omized , double-masked , placebo-controlled crossover clinical trial . PARTICIPANTS Forty eyes of 20 patients with noninflamed MGD . METHODS After a preliminary study of eye drops containing castor oil , 2 % castor oil and 5 % polyoxyethylene castor oil ( emulsifier ) were mixed to formulate homogenized oil eye drops . The patients were assigned r and omly to receive oil eye drops or placebo six times daily for 2 periods of 2 weeks each . MAIN OUTCOME MEASURES At the end of each treatment period , we assessed symptoms , tear interference grade , tear evaporation , fluorescein and rose bengal scores , tear break-up time ( BUT ) , and meibomian gl and orifice obstruction . Safety and stability tests were also performed . RESULTS Symptom scores , tear interference grade , tear evaporation test results , rose bengal scores , tear BUT , and orifice obstruction scores after the oil eye drop period showed significant improvement compared with the results after the placebo period . No complications attributable to the eye drops were observed . The oil eye drops were stable when stored at 4 degrees C. CONCLUSIONS The results indicate that castor oil eye drops are effective and safe in the treatment of MGD . The possible mechanisms of this treatment are improvement of tear stability as a result of lipid spreading , ease of meibum expression , prevention of tear evaporation , and the lubricating effect of the oil eye drops PURPOSE Blepharitis and meibomian gl and dysfunction ( MGD ) are common sources of complaints from patients . To evaluate the effect on ocular symptoms , ocular findings , and serum and meibomian gl and contents , patients with blepharitis and MGD were prospect ively evaluated to determine the effects of dietary supplementation with omega-3 fatty acids . METHODS In a prospect i ve r and omized placebo-controlled masked trial , patients with simple obstructive MGD and blepharitis , who had discontinued all topical medications and tetracyclines  , received oral omega-3 dietary supplementation consisting of two 1000-mg capsules 3 times a day . Patients were examined every 3 months for 1 year with the Ocular Surface Disease Index ( OSDI ) objective clinical measures , including tear production and stability , ocular surface and meibomian gl and health , and biochemical plasma , red blood cell ( RBC ) , and meibum evaluation . Primary outcome measures were change in tear breakup time ( TBUT ) , meibum score , and overall OSDI score at 1 year . RESULTS At 1 year , the omega-3 group had a 36 % and 31 % reduction in their omega-6 to omega-3 fatty acid ratios in RBCs and plasma , respectively ( P = .3 ) , whereas the placebo group demonstrated no change . At 12 months , the omega-3 group had an improvement in TBUT , OSDI score , and meibum score . Changes in meibum content were observed in the omega-3 group ( P = .21 ) ; the level of meibum saturated fatty acids decreased . CONCLUSIONS This trial demonstrated a decrease in the RBC and plasma ratios of omega-6 to omega-3 in patients taking omega-3 dietary supplementation  , as compared to controls , and improvements in their overall OSDI score , TBUT , and meibum score . This is the first demonstration of an induced change in the fatty acid saturation content in meibum as a result of dietary supplementation with omega-3 fatty acids Objective : To investigate the efficacy of topical cyclosporine A 0.05 % ( tCsA ) ( Restasis ® , Allergan Pharmaceuticals ) in the treatment of meibomian gl and dysfunction ( posterior blepharitis ) . Methods : Thirty-three patients with symptomatic meibomian gl and dysfunction were r and omized in a prospect i ve study to either tCsA or placebo ( Refresh Plus ® preservative-free artificial tears ) , 2 times daily for 3 months . They were evaluated at baseline and at 1 , 2 , and 3 months for subjective symptoms and objective signs including meibomian gl and inclusion s , lid margin vascular injection , tarsal telangiectasis , fluorescein staining , tear breakup time , and Schirmer scores . Results : Twenty-six patients completed the study . All patients were tested for ocular symptoms , lid margin vascularity , tarsal telangiectasis , meibomian gl and inclusion s , tear breakup time , and fluorescein staining . At the 3-month visit , the tCsA group showed a greater improvement in ocular symptoms than the placebo group , but this difference was not statistically significant . At the 3-month visit , several objective examination findings were statistically significantly ( P < 0.05 ) improved in the tCsA group compared with the placebo group . These differences included lid margin vascular injection , tarsal telangiectasis , and fluorescein staining . The most significant finding ( P = 0.001 ) was the greater decrease in the number of meibomian gl and inclusion s in the tCsA group compared with the placebo group . Conclusions : Topical CsA may be helpful in the treatment of meibomian gl and dysfunction ( posterior blepharitis ) . Topical CsA did not induce an improvement in the symptoms , but it did decrease the number of meibomian gl and inclusion s in patients with meibomian gl and dysfunction PURPOSE The aim was to investigate the effect of low dose doxycycline ( 20 mg ) therapy in patients with chronic meibomian gl and dysfunction that were refractory to conventional therapy . METHODS The r and omized prospect i ve study enrolled 150 patients ( 300 eyes ) who have chronic meibomian gl and dysfunction and who did n't respond to lid hygiene and topical therapy for more than 2 months . All topical therapy was stopped for at least 2 weeks prior to beginning the study . After conducting the tear break up time test ( TBUT ) and Schirmer test , the authors r and omly divided the patients into three groups a high dose group ( doxycycline , 200 mg , twice a day ) , a low dose group ( doxycycline , 20 mg , twice a day ) and a control group ( placebo ) . After one month , the author repeated the TBUT and Schirmer tests , and analyzed the degree of symptomatic improvement . RESULTS Compared to the control group , both the high and low dose group showed statistically significant differences after treatment in TBUT , Schirmer test , the number of symptoms reported and the degree of improvement of subjective symptoms . However , there was no statistically significant difference between the high and low dose group after treatment in TBUT ( 9.42 + /- 2.87 sec , 9.54 + /- 1.58 sec , p=0.726 ) , Schirmer test ( 19.98 + /- 4.05 mm , 19.65 + /- 5.02 mm , p=0.624 ) , the number of symptoms reported ( 1.45 + /- 0.62 , 1.53 + /- 0.52 , p=0.304 ) , as well as the degree of improvement of subjective symptoms ( p=0.288 ) . The high dose group ( 18 patients , 39.13 % ) reported side effects more frequently than did the low dose group ( 8 patients , 17.39 % ) ( P=0.002 ) . CONCLUSIONS Low dose doxycycline ( 20 mg twice a day ) therapy was effective in patients with chronic meibomian gl and dysfunction that were refractory to conventional therapy Background / aims To assess the efficacy and safety of oral azithromycin compared with oral doxycycline in patients with meibomian gl and dysfunction ( MGD ) who had failed to respond to prior conservative management . Methods 110 patients ( > 12 years old ) with MGD were r and omly assigned to receive either oral 5-day azithromycin ( 500 mg on day 1 and then 250 mg/day ) or 1-month doxycycline ( 200 mg/day ) . They also continued eyelid warming/cleaning and artificial tears . A score comprising five symptoms and seven signs ( primary outcome ) was recorded prior to treatment and at 1 week , and 1 and 2 months after treatment . Total score was the sum of both scores at each follow-up . Side effects were recorded and overall clinical improvement was categorised as excellent , good , fair or poor based on the percentage of change in the total score . Results Symptoms and signs improved significantly in both groups ( p=0.001 ) . While improvement of symptoms was not different between the groups , bulbar conjunctival redness ( p=0.004 ) and ocular surface staining ( p=0.01 ) were significantly better in the azithromycin group . The azithromycin group showed a significantly better overall clinical response ( p=0.01 ) . Mild gastrointestinal side effects were not significantly different between the groups except for the second visit , when the doxycycline group had significantly more side effects ( p=0.002 ) . Conclusions Although both oral azithromycin and doxycycline improved the symptoms of MGD , 5-day oral azithromycin is recommended for its better effect on improving the signs , better overall clinical response and shorter duration of treatment . Trial registration number NCT01783860 Introduction Azithromycin , a broad-spectrum antibiotic with potent anti-inflammatory activities , has the potential to effectively treat blepharitis , an inflammatory disease of the eyelid with abnormal eyelid flora as an etiologic determinant . The present study compared the efficacy of topical azithromycin ophthalmic solution 1 % ( AzaSite ® ; Inspire Pharmaceuticals , Inc , NC , USA ) combined with warm compresses ( azithromycin group ) to warm compresses alone ( compress group ) in patients with posterior blepharitis . Methods Twenty-one patients diagnosed with posterior blepharitis were r and omized in an open-label study to receive either azithromycin plus warm compresses ( 10 patients ) , or compresses alone ( 11 patients ) . All patients were instructed to apply compresses to each eye for 5–10 minutes twice daily for 14 days . Each eye in the azithromycin group also received azithromycin solution ( 1 drop ) twice daily for the first 2 days followed by once daily for the next 12 days . Patients were evaluated at study initiation ( visit 1 ) and at end of treatment ( visit 2 ) for the severity of five clinical signs : eyelid debris , eyelid redness , eyelid swelling , meibomian gl and ( MG ) plugging , and the quality of MG secretion . At visit 2 , patients also rated their degree of overall symptomatic relief . Results Twenty patients completed the study . At visit 2 , patients in the azithromycin group demonstrated significant improvements in MG plugging , MG secretions , and eyelid redness as compared with the compress group . In the azithromycin group , MG plugging resolved completely in three patients and MG secretion returned to normal in two patients ; no such results were seen in the compress group . Furthermore , a higher percentage of patients in the azithromycin group rated overall symptomatic relief as excellent or good . Visual acuity measurements and biomicroscopic evaluation revealed no ocular safety issues . Conclusion Azithromycin ophthalmic solution in combination with warm compresses provided a significantly greater clinical benefit than warm compresses alone in treating the signs and symptoms of posterior blepharitis Purpose To compare the effects on ocular temperature , lipid layer grade , tear film stability , and tear meniscus height after a single application of two commercially available warm compresses in mild-to-moderate dry eye and to report participant treatment preference . Methods Forty-one subjects with mild-to-moderate dry eye symptoms were enrolled in a r and omized , paired-eye , investigator-masked trial . Heat was applied simultaneously to one eye ( r and omized ) with a portable eye mask ( EyeGiene ) and to the contralateral eye with a microwave-heated flaxseed eye bag ( MGDRx Eye Bag ) .  Outer and inner eyelid temperatures , tear film lipid layer grade ( LLG ) , and noninvasive tear film breakup time ( NIBUT ) were measured at baseline and immediately after 10 minutes of device application . Results Outer and inner eyelid temperatures , LLG , and NIBUT did not differ before treatment between eyes assigned to eye mask and eye bag therapy . All measurements were significantly increased from baseline , after warming with both devices ( all p < 0.05 ) . Outer and inner eyelid temperature changes were significantly greater with the eye bag than with the eye mask ( outer eyelid , + 3.5 ± 1.0 ° C vs. + 2.4 ± 0.8 ° C ; inner eyelid , + 3.5 ± 1.0 ° C vs. + 2.5 ± 0.9 ° C ; all p < 0.001 ) , although there was no significant difference in LLG and NIBUT improvement between treatments ( all p > 0.05 ) . A majority of subjects ( 78 % ) preferred the application of heat with the eye bag over the eye mask . Conclusions Both the EyeGiene mask and the MGDRx Eye Bag are convenient eyelid warming devices that result in clinical ly and statistically significant increases in NIBUT and LLG in patients with mild-to-moderate dry eye symptoms . The MGDRx Eye Bag is more effective in raising ocular temperature and is the preferred treatment method among subjects PURPOSE To evaluate the efficacy of topical N-acetyl-cysteine ( NAC ) therapy in patients with meibomian gl and dysfunction ( MGD ) . METHODS Twenty patients with MGD were prospect ively r and omized and assigned into 2 groups . The patients were instructed to use either NAC 5 % or preservative-free artificial tear topically 4 times a day for a month . All patients were instructed to apply lid hygiene once daily . Preservative-free artificial tears treated group served as control . Paired sample Student 's t-tests were used to detect differences between the baseline and 1 month after treatment initiation in mean ocular symptoms , fluorescein break-up time ( FBUT ) values , and Schirmer scores in each group . Difference in mean ocular symptoms , Schirmer 's test scores , and FBUT values between the baseline and 1 month after treatment initiation were compared between the groups using Mann-Whitney U test . RESULTS One month of topical NAC therapy provided statistically significant improvements in FBUT and Schirmer scores as compared with the initial study visit . The average Schirmer increase rate was significantly better in the NAC group than in the control group . Significant improvements for the symptoms of ocular burning , foreign body sensation , and intermittent filmy or blurred vision were noted in both groups ; and only NAC-treated group showed improvement for the symptom of itching , at 1 month as compared with 1 day . NAC provided significantly better improvement in itching symptom when compared with controls . CONCLUSIONS Topical administration of NAC is thought to be effective and well tolerated in patients with MGD
target: No quantitative synthesis was attempted for either mebiomian plugging or meibomian secretion scores and no significant changes were observed with any other outcome parameter .
  Conclusion : Only the systemic antimicrobials were found to improve the clinical features of meibomian gl and dysfunction .
  Varying effects of different therapeutic agents ( heat therapies , omega-3-fatty acids and castor oil ) were identified for MGD but the risk of bias pertaining to r and omization and allocation concealment was found to be associated with most of the current RCTs .
background: Introduction : Meibomian Gl and Dysfunction ( MGD ) is a common , often overlooked , chronic condition affecting eyes for which various therapies are being evaluated .
  Considering the absence of a systematic review and meta- analysis , the present review was carried out .