Meibomian Gland Dysfunction in Lens Wearers
KELLY K. NICHOLS, OD, MPH, PHD
Contact lens-related dry eye is classified as
an evaporative dry eye disease according to the 1995 NEI/Industry Report (Lemp,
1995). Disorders of the meibomian glands, such as meibomitis,
are also in the evaporative category. Clinically, many symptomatic contact lens
patients have lid margins that look less than pristine. How should you manage lens-wearing
patients who have lid disease?
Almost any published information regarding management of lid disease
mentions the use of a warm compress for five to 10 minutes, two to three times each
day. Studies have evaluated the impact of warm compresses on tear break-up time,
tear stability and tear evaporation rate (Olson et al, 2003; Mori et al, 2003; Paugh
et al, 1990). The findings in all studies generally showed an improvement in the
measured test following administration of the warm compress.
Interestingly, many reports that recommend warm compresses neglect
to describe how to prepare or use one. In addition, at a recent meeting I heard
a prominent leader in the dry eye/anterior segment disease field report that a patient
who had lid disease and who was using oral antibiotic therapy showed a lack of improvement
mostly because the patient failed to use prescribed warm compresses effectively.
This begs the question...how should we instruct a patient to use
warm compresses? The primary goals are to encourage patients to commit to using
them and to teach patients how to sustain that activity with minimal burden.
Testing Different Methods
To define the best warm compress, I tried several techniques at
home. A warm washcloth in the morning shower scored high for ease, but relatively
low for sustained warmth to the eye area. In contrast, the boiled egg and potato
in the microwave approaches scored low, both in terms of heat control (especially
with more than one use) and burden.
Next, I took one cup of uncooked white rice and poured it into
a clean sock. I chose a sock long enough to create a surface area of at minimum
six inches when I tied a knot in the end. I found that 30 seconds in the microwave
provided excellent warmth without being too hot (microwave times may vary). This
made a good, re-usable, inexpensive spa mask that scored high for both convenience
(once made) and warmth. The slight downside was a nutty smell when warm, but I preferred
it to the other food-based warm compresses.
I also located several warmable spa masks on the Internet (~$20).
Warming these products requires immersing them in very hot water for a period of
time, but once warm they're odor-free.
When Warm Compresses Fail
Many patients prefer a therapy that requires no prescription.
Specifically, if patients can manage meibomian gland disease with aggressive use
of a warm compress, they may opt for that first.
However, failure of warm compress therapy (too time consuming)
may require the addition of an oral antibiotic. Currently, low-dose minocycline
(50mg) and doxycycline (Periostat 20mg) options are available that have a lower
side effect profile and potential for long-term use (in some cases up to nine months),
and many more of my contact lens patients who have lid disease are using oral therapy.
Through personal experience and discussions with colleagues, I find oral therapy
is most effective in combination with appropriate lid hygiene, which includes aggressive
use of warm compresses. CLS
For references, please visit
and click on document #123.
Dr. Nichols is an associate
professor at The Ohio State University College of Optometry in the area of dry eye
Contact Lens Spectrum, Issue: February 2006