Ms. Karen Walsh, a practicing optometrist, and a contact lens expert, begins by stating that optometrists can achieve a lot more with Meibomian gland dysfunction (MGD) and Dry Eye Disease (DED) patients. We learn about the following points in regards to both those conditions:

1. Meibomian gland dysfunction 
   1. Definition 
   2. Signs and Symptoms 
   3. Prevalence 
   4. Process 
   5. MGD and DED interaction 
2. Dry Eye Disease 
   1. Definition 
   2. Prevalence 
3. Contact Lens (CL) Wearers 
   1. CL and tear film
   2. CL and Meibomian gland 
   3. CL Discomfort 
   4. CL Discomfort and DED differential diagnosis 

Next, Ms. Walsh talks about the clinical diagnosis of these conditions

1. Diagnosis 
2. Clinical Assessment 
   1. Non-Invasive Tear Break-Up time 
   2. Ocular surface staining 
   3. Lid margin appearance 
   4. Diagnostic gland expression 

Next, we move on to learn about the treatment options available for these conditions

1. Meibomian Gland Dysfunction 
   1. In-office procedures 
   2. At-home procedures 
   3. Lipiflow, iLux, TearCare, MiboFlo, and Blephasteam 
   4. IPL for MGD 
2. Contact Lens Wearers 
   1. CL comfort with warm compress 
   2. CL comfort with BlepEx 
   3. Use of Artificial tears

Ms. Walsh summarizes all the points in a take-home slide. The session ends with a question and answer segment with the live audience.

References

Papers

Meibomian Gland Dysfunction

Nelson JD, Shimazaki J, Benitez-del-Castillo JM, Craig JP, McCulley JP, Den S, Foulks GN. The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2011 Mar 30;52(4):1930-7.

https://pubmed.ncbi.nlm.nih.gov/21450914/

Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, Lemp MA, Sullivan DA. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011 Mar 30;52(4):1922-9.

https://pubmed.ncbi.nlm.nih.gov/21450913/

Cochener B, Cassan A, Omiel L. Prevalence of meibomian gland dysfunction at the time of cataract surgery. J Cataract Refract Surg. 2018 Feb;44(2):144-148.

https://pubmed.ncbi.nlm.nih.gov/29587971/

Geerling G, Baudouin C, Aragona P, Rolando M, Boboridis KG, Benítez-Del-Castillo JM, Akova YA, Merayo-Lloves J, Labetoulle M, Steinhoff M, Messmer EM. Emerging strategies for the diagnosis and treatment of meibomian gland dysfunction: Proceedings of the OCEAN group meeting. Ocul Surf. 2017 Apr;15(2):179-192.

https://pubmed.ncbi.nlm.nih.gov/28132878/

Ngo W, Situ P, Keir N, Korb D, Blackie C, Simpson T. Psychometric properties and validation of the Standard Patient Evaluation of Eye Dryness questionnaire. Cornea. 2013 Sep;32(9):1204-10.

https://pubmed.ncbi.nlm.nih.gov/23846405/

Finis D, Pischel N, König C, Hayajneh J, Borrelli M, Schrader S, Geerling G. Vergleich des OSDI- und SPEED-Fragbogens zur Evaluation des Sicca-Syndroms in der klinischen Praxis [Comparison of the OSDI and SPEED questionnaires for the evaluation of dry eye disease in clinical routine]. Ophthalmologe. 2014 Nov;111(11):1050-6. German.

https://pubmed.ncbi.nlm.nih.gov/25030896/

Lam PY, Shih KC, Fong PY, Chan TCY, Ng AL, Jhanji V, Tong L. A Review on Evidence-Based Treatments for Meibomian Gland Dysfunction. Eye Contact Lens. 2020 Jan;46(1):3-16.

https://pubmed.ncbi.nlm.nih.gov/31834043/

Finis D, König C, Hayajneh J, Borrelli M, Schrader S, Geerling G. Six-month effects of a thermodynamic treatment for MGD and implications of meibomian gland atrophy. Cornea. 2014 Dec;33(12):1265-70.

https://pubmed.ncbi.nlm.nih.gov/25321941/

Greiner JV. A single LipiFlow® Thermal Pulsation System treatment improves meibomian gland function and reduces dry eye symptoms for 9 months. Curr Eye Res. 2012 Apr;37(4):272-8.

https://pubmed.ncbi.nlm.nih.gov/22324772/

Greiner JV. Long-term (12-month) improvement in meibomian gland function and reduced dry eye symptoms with a single thermal pulsation treatment. Clin Exp Ophthalmol. 2013 Aug;41(6):524-30.

https://pubmed.ncbi.nlm.nih.gov/23145471/

Blackie CA, Coleman CA, Holland EJ. The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye. Clin Ophthalmol. 2016 Jul 26;10:1385-96.

https://pubmed.ncbi.nlm.nih.gov/27555745/

Craig JP, Chen YH, Turnbull PR. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2015 Feb 12;56(3):1965-70.

https://pubmed.ncbi.nlm.nih.gov/25678687/

Arita R, Mizoguchi T, Fukuoka S, Morishige N. Multicenter Study of Intense Pulsed Light Therapy for Patients With Refractory Meibomian Gland Dysfunction. Cornea. 2018 Dec;37(12):1566-1571.

https://pubmed.ncbi.nlm.nih.gov/30004962/

Albietz JM, Schmid KL. Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction. Clin Exp Optom. 2018 Jan;101(1):23-33.

https://pubmed.ncbi.nlm.nih.gov/28585267/

Guilloto Caballero S, García Madrona JL, Colmenero Reina E. Effect of pulsed laser light in patients with dry eye syndrome. Arch Soc Esp Oftalmol. 2017 Nov;92(11):509-515. English, Spanish.

https://pubmed.ncbi.nlm.nih.gov/28256362/

Fishman HA, Periman LM, Shah AA. Real-Time Video Microscopy of In Vitro Demodex Death by Intense Pulsed Light. Photobiomodul Photomed Laser Surg. 2020 Aug;38(8):472-476.

https://pubmed.ncbi.nlm.nih.gov/31985328/

Dry Eye Disease

Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012 May;31(5):472-8.

https://pubmed.ncbi.nlm.nih.gov/22378109/

Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017 Jul;15(3):276-283.

https://pubmed.ncbi.nlm.nih.gov/28736335/

Contact Lens and Tear Film

Wang J, Fonn D, Simpson TL, Jones L. Precorneal and pre- and postlens tear film thickness measured indirectly with optical coherence tomography. Invest Ophthalmol Vis Sci. 2003 Jun;44(6):2524-8.

https://pubmed.ncbi.nlm.nih.gov/12766052/

King-Smith PE, Fink BA, Hill RM, Koelling KW, Tiffany JM. The thickness of the tear film. Curr Eye Res. 2004 Oct-Nov;29(4-5):357-68.

https://pubmed.ncbi.nlm.nih.gov/15590483/

Guillon M, Styles E, Guillon JP, Maïssa C. Preocular tear film characteristics of nonwearers and soft contact lens wearers. Optom Vis Sci. 1997 May;74(5):273-9.

https://pubmed.ncbi.nlm.nih.gov/9219285/

Lemp MA. Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J. 1995 Oct;21(4):221-32. PMID: 8565190.

https://pubmed.ncbi.nlm.nih.gov/8565190/

Young G, Efron N. Characteristics of the pre-lens tear film during hydrogel contact lens wear. Ophthalmic Physiol Opt. 1991 Jan;11(1):53-8. PMID: 2034456.

https://pubmed.ncbi.nlm.nih.gov/2034456/

Guillon M, Guillon JP. Hydrogel lens wettability during overnight wear. Ophthalmic Physiol Opt. 1989 Oct;9(4):355-9. PMID: 2631000.

https://pubmed.ncbi.nlm.nih.gov/2631000/

Keir N, Jones L. Wettability and silicone hydrogel lenses: a review. Eye Contact Lens. 2013 Jan;39(1):100-8.

https://pubmed.ncbi.nlm.nih.gov/23274760/

Morris CA, Holden BA, Papas E, Griesser HJ, Bolis S, Anderton P, Carney F. The ocular surface, the tear film, and the wettability of contact lenses. Adv Exp Med Biol. 1998;438:717-22.

https://pubmed.ncbi.nlm.nih.gov/9634959/

Contact lens and Meibomian Gland

Arita R, Itoh K, Inoue K, Kuchiba A, Yamaguchi T, Amano S. Contact lens wear is associated with decrease of meibomian glands. Ophthalmology. 2009 Mar;116(3):379-84.

https://pubmed.ncbi.nlm.nih.gov/19167077/

Uçakhan Ö, Arslanturk-Eren M. The Role of Soft Contact Lens Wear on Meibomian Gland Morphology and Function. Eye Contact Lens. 2019 Sep;45(5):292-300.

https://pubmed.ncbi.nlm.nih.gov/30608243/

Alghamdi WM, Markoulli M, Holden BA, Papas EB. Impact of duration of contact lens wear on the structure and function of the meibomian glands. Ophthalmic Physiol Opt. 2016 Mar;36(2):120-31.

https://pubmed.ncbi.nlm.nih.gov/26890701/

Pucker AD, Jones-Jordan LA, Marx S, Powell DR, Kwan JT, Srinivasan S, Sickenberger W, Jones L; Contact Lens Assessment of Symptomatic Subjects (CLASS) Study Group. Clinical factors associated with contact lens dropout. Cont Lens Anterior Eye. 2019 Jun;42(3):318-324.

https://pubmed.ncbi.nlm.nih.gov/30538060/

Pucker AD, Jones-Jordan LA, Li W, Kwan JT, Lin MC, Sickenberger W, Marx S, Srinivasan S, Jones LW. Associations with Meibomian Gland Atrophy in Daily Contact Lens Wearers. Optom Vis Sci. 2015 Sep;92(9):e206-13.

https://pubmed.ncbi.nlm.nih.gov/26154690/

Machalińska A, Zakrzewska A, Adamek B, Safranow K, Wiszniewska B, Parafiniuk M, Machaliński B. Comparison of Morphological and Functional Meibomian Gland Characteristics Between Daily Contact Lens Wearers and Nonwearers. Cornea. 2015 Sep;34(9):1098-104.

https://pubmed.ncbi.nlm.nih.gov/26114822/

Tichenor AA, Cox SM, Ziemanski JF, Ngo W, Karpecki PM, Nichols KK, Nichols JJ. Effect of the Bruder moist heat eye compress on contact lens discomfort in contact lens wearers: An open-label randomized clinical trial. Cont Lens Anterior Eye. 2019 Dec;42(6):625-632.

https://pubmed.ncbi.nlm.nih.gov/31587960/

Siddireddy JS, Tan J, Vijay AK, Willcox MDP. The Effect of Microblepharon Exfoliation on Clinical Correlates of Contact Lens Discomfort. Optom Vis Sci. 2019 Mar;96(3):187-199.

https://pubmed.ncbi.nlm.nih.gov/30801507/

Siddireddy JS, Vijay AK, Tan J, Willcox M. Effect of Eyelid Treatments on Bacterial Load and Lipase Activity in Relation to Contact Lens Discomfort. Eye Contact Lens. 2020 Jul;46(4):245-253.

https://pubmed.ncbi.nlm.nih.gov/31794542/

Contact Lens Discomfort

Craig JP, Nelson JD, Azar DT, Belmonte C, Bron AJ, Chauhan SK, de Paiva CS, Gomes JAP, Hammitt KM, Jones L, Nichols JJ, Nichols KK, Novack GD, Stapleton FJ, Willcox MDP, Wolffsohn JS, Sullivan DA. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017 Oct;15(4):802-812.

https://pubmed.ncbi.nlm.nih.gov/30985488/

Molina K, Graham AD, Yeh T, Lerma M, Li W, Tse V, Lin MC. Not All Dry Eye in Contact Lens Wear Is Contact Lens-Induced. Eye Contact Lens. 2020 Jul;46(4):214-222.

https://pubmed.ncbi.nlm.nih.gov/31517736/

Pucker AD, McGwin G Jr, Franklin QX, Nattis A, Lievens C. Evaluation of Systane Complete for the Treatment of Contact Lens Discomfort. Cont Lens Anterior Eye. 2020 Oct;43(5):441-447.

https://pubmed.ncbi.nlm.nih.gov/31727514/

Blackie CA, Carlson AN, Korb DR. Treatment for meibomian gland dysfunction and dry eye symptoms with a single-dose vectored thermal pulsation: a review. Curr Opin Ophthalmol. 2015 Jul;26(4):306-13.

https://pubmed.ncbi.nlm.nih.gov/26058030/