Treating MGD early

There was an interesting 'panel' discussion on PCON recently about whether to treat lid margin disease (MGD) in patients who do not yet have symptoms (don't hurt). I'm posting some highlights here because I think this is a very timely topic. While I'm not sure I'm crazy about the idea of them prescribing all these drugs to people with a very mild case, on the other hand the fact that they are identifying the signs and educating their patients about it absolutely thrills me. That's surely a sign of significant progress. This is not, obviously, knowledge diffused evenly through optometric circles, else we would not still be hearing so frequently from people with raging lid margin disease who were not properly diagnosed, let alone treated, by their first four doctors. But progress leads to more progress.

Panel: Treating asymptomatic lid disease improves comfort, long-term results

We now understand the profound influence of adequate meibomian gland secretions on ocular comfort and quality of vision.
(Dr. William Townsend)

Define "we", please? :-)

Perhaps this could be rephrased as "We all ought to, and a growing number of us actually do now understand..."

We treat all patients with active meibomian gland dysfunction to prevent ongoing inflammation and tissue damage. Therapeutic modalities such as warm compresses, lid expression, systemic tetracyclines, oral omega-3 essential fatty acids and cyclosporine A have been shown to positively affect meibomian gland disease. While the immediate benefits of therapy such as increased gland output and visual enhancement are desirable, the real benefits of long-term therapy (preserving meibomian gland function and preventing atrophy) are the real effects that the patient will appreciate years later.

The management of lid disease is particularly challenging because although the provider may recommend appropriate treatment, the task of carrying out the administration of the various therapies falls on the patient. Early detection and treatment may save him or her from the discomfort and annoyance of advanced meibomian gland disease years later.
(Dr. William Townsend)

Currently, AzaSite, as well as Restasis, is an off-label treatment option for blepharitis and meibomianitis. However, with evidence growing that drugs such as these are proving beneficial and offering our patients an actual treatment vs. palliative care, I have begun prescribing treatment to previously asymptomatic patients. My “go to” treatment plan includes the standard warm compresses and lid hygiene (preferably with some type of commercial lid scrub) and AzaSite twice daily for 2 days and then once daily for the next few weeks. It is the treatment plan I put myself on.
(Dr. Blair Lonsberry)

When I treat asymptomatic patients with signs of blepharitis, I take the basic philosophical approach that no patient ever starts with severe lid margin disease. Most patients start with a mild case that, left untreated, progresses to more severe forms. That being said, I explain to patients with lid margin disease that an infection or inflammation of the lid margin left untreated can progress to significant symptoms that include itching, burning, chronic redness and uncomfortable contact lens wear and that it can also make other conditions such as dry eye worse. After a thorough explanation most patients decide to pursue treatment.
(Dr. Scot Morris)

Patients are not always as asymptomatic as they seem at first glance. Asymptomatic and completely satisfied are two different things. I ask patients about dryness, contact lens wearing time and red eyes. I always discuss my findings, as well as the risks of doing nothing and benefits of treatment.

Foaming eyelid cleansers, such as OcuSoft Lid Scrub Foaming Eyelid Cleanser (OcuSoft, Rosenberg, Texas) make it easy for patients to treat mild blepharitis in the shower. It is surprising how many asymptomatic patients return much happier, simply with a minimal routine change.
(Dr. Christine Sindt)