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Clinicians should encourage proper eyelid hygiene, test early for MGD
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SAN ANTONIO – Practitioners should be screening for meibomian gland dysfunction and checking meibum quality more often, according to Andrew Pucker OD, PhD, FAAO, in his presentation here at the American Academy of Optometry annual meeting.
Pucker and his team aimed to determine the differences between contact lens wearers who drop out and those who do not.
A five-site study recruited adults up to 45 years old who had discontinued contact lens wear within the past 6 to 12 months due to discomfort. Contact lens dropout subjects were compared to age- and sex-matched successful contact lens wearing controls. There were 56 matched-pairs across all sites.
Each subject was administered a study-specific contact lens questionnaire and a Standardized Patient Evaluation of Eye Dryness (SPEED)questionnaire. Clinical testing included noninvasive tear break-up time (NITBUT), tear meniscus height (TMH), meibomian gland function (expression and plugging) and meibography (Oculus Keratograph 5M).
Meibomian gland atrophy was graded subjectively on a 0 to 3 scale by eyelid for each eye; atrophy was categorized as significant if the upper or lower eyelid grade was at least 2.0 or the total grade for both upper and lower eyelids was at least 4.0.
Subjects with a SPEED score greater than 5.0 and a positive NITBUT were considered to have dry eye.
Diagnosed dry eye was associated with contact lens dropout, according to Pucker.
NIBUT, TMH and significant upper, lower and total meibomian gland atrophy was not different between groups.
“Atrophy plays a part but is not a precipitating factor for contact lens dropout,” Pucker said during his presentation.
Upper and lower meibomian gland plugging and upper but not lower meibum quality were associated with contact lens dropout.
Patients should be practicing eyelid hygiene, Pucker said.
The researchers concluded that practitioners should screen for and educate contact lens patients about the importance of eyelid hygiene to maintain comfortable contact lens wear.
“If you have upper eyelid meibomian plugging, you are five times more likely to have contact lens dropout. Overall, we need to be looking for early MGD in clinic and make sure the glands are expressing properly,” Pucker said. – by Abigail Sutton
Reference:
Pucker A. The association between meibomian gland health and soft contact lens dropout. Presented at: American Academy of Optometry annual meeting; San Antonio; November 7 – 10, 2018.
Disclosure: Pucker reported no relevant financial disclosures.