Study: Why they need to get the diagnosis right in the first place
I appreciated this abstract as an excellent narrative of what goes wrong sometimes in MGD patients: The MGD ends up causing the clinical signs that dry eye causes, and it should come as no surprise when treating the results of the MGD is not as successful as treating the MGD itself.
This is one of the reasons patients justly complain “We’re treating the symptoms, not the cause.” At one level, of course, we have to treat symptoms if we want to get through our day. But we ALL need differential diagnosis. Period.
Timely, accurate differential diagnosis is one of the biggest gaps in good dry eye care today. It’s improving, but it has a long, long way to go.
Inflamed Obstructive Meibomian Gland Dysfunction Causes Ocular Surface Inflammation. Suzuki T, Invest Ophthalmol Vis Sci. 2018 Nov 1.
Meibomian gland dysfunction (MGD) is one of the primary causes of evaporative dry eye. Stagnation of meibum induces an unstable tear film, thus resulting in shortened tear film breakup time and superficial punctate keratopathy (SPK) in the lower cornea and punctate staining of lower bulbar conjunctiva. MGD is sometimes accompanied with inflammation (termed "meibomitis") via the proliferation of bacteria in the meibomian gland and eyelash area. Meibomitis is strongly related to ocular surface inflammation such as corneal cellular infiltrates and neovascularization, SPK, and conjunctivitis. It is difficult to differentiate SPK caused by dry eye from that caused by meibomitis. When clinicians are unaware of the existence of meibomitis, and only aware of SPK on the cornea, they often try to treat SPK as it is caused by dry eye using dry eye-specific eyedrops or even using punctual plugs when conservative therapy is ineffective. However, even when intensive dry eye therapy is applied, it may be unsuccessful until SPK caused by meibomitis is recognized and treated with systemic antimicrobial agents. Hence, the tear secreting glands, including the meibomian glands, and the ocular surface should be clinically considered as one unit (i.e., the meibomian gland and ocular surface [MOS]) when considering the pathophysiology and treatment of ocular surface inflammatory diseases (i.e., corneal epithelial damage). Following this clinical pathway, a treatment focusing on meibomian gland inflammation may be a more reasonable approach for meibomitis-related or associated keratoconjunctivitis to more effectively treat this ocular surface disease.