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2 Meibomian Gland Dysfunction and Dry Eye Definition Symptoms Meibomian gland Dysfunction (MGD) is a chronic diffuse abnormality of the meibomian gland commonly characterized by terminal duct obstruction which may result in alteration of the tear film. Prevalence is found to be greater than 60% in population studies from Asia. - - - Pathogenesis of MGD - - - Meibomian gland located in the tarsal plates of the eye lids opens at the posterior lid margin. It is the chief source of lipids for the human tear film and functions in stabilizing the tear film. It forms a protective barrier against microbes, dust and pollen. MGD is an obstruction of terminal ducts. Factors such as age,sex,hormonal disturbances and topical medication influence the obstructive process. MGD results in increased evaporation and instability of the tear film. It increases bacterial growth on the lid margin,evaporative dry eye and ocular surface inflammation. Clinical Irritation in eye Clinically apparent inflammation Ocular surface disease Signs of MGD - Meibomianitis –plugging of the meibomian duct opening Frothy discharge Toothpaste sign Blocked duct Diagnosis of MGD MGD in symptomatic patients: - Orifice plugging or lid margin signs of MGD - Applying moderate digital pressure over the central third of the lower and upper lids to determine the extent and severity. MGD in asymptomatic patients: - Non- obvious MGD may be diagnosed by gland expression digital pressure over the eye lid Prevalence - presence; Alteration - changes; Microbes - microorganism like bacteria; Frothy - covered with a mass of small bubbles; Toothpaste sign - when squeezed hard enough, a secretion that has the appearance of toothpaste squeezed from a tube. A R A V I N D E Y E C A R E S Y S T E M 3 Test for dry eye - - - - - - Administration of a symptom questionnaire Measurement of the blink rate and calculation of the blink interval Measurement of lower tear meniscus height Measurement of tear osmolarity (if available) Instilling of fluorescein and measurement of the tear film break up time (if but) and ocular protection index Grading of corneal and conjunctival fluorescein staining - Schirmer’s test or alternate test [phenol red thread test] Treatment for MGD related dry eye MGD related dry eye requires - Supplementation and stabilization of lipid deficient tear film. - Rehydration and lubrication of the ocular surface with topical lubricants are the main stage of treatments. - Warm compresses 2-3 times day - Lid scrubs and eye lid massage - Anti -inflammatory antibiotics such as tetracycline and omega-3 fatty acids. - Sr.Thenmozhi OP, Aravind - Coimbatore Digital glasses for lazy eyes Lazy eye or amblyopia occurs in one eye, which did not develop normal vision and become lazy . Traditionally drops and eye patches are used to cure this lazy eye. Recently programmable electronic glasses are invented to improve vision in the children. Amblyopia has to be treated before the age of eight for better results. It can be treated till seventeen. Researchers at the Glick Eye Institute tested the effectiveness of this digital glasses. The researchers recruited 33 subjects with lazy eye, aged 3-8. In the study the lens over the lazy eye switched from clear to opaque, every 30 seconds. After three months there was a good improvement in the lazy eye. The US Food and Drug administration (FDA) had approved the amblyopia occlusion glasses as a medical device. They are available for 450 dollars there. -www.medicalnews. 16 Nov 2015 Compassion Oct - Dec, 2015