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MGD paper (Introduction (Current management methods (Goal of tx (Increased…

- - - - Increased stability of tear
        
        dry eye = instability of tears = osmolarity
    - - Labour intensive/time consuming
        
        Microwaveable methods should have better compliance?
- - - - Dry eye symptoms were assessed for each eye using the validated Ocular Surface Disease Index (Schiffman et al, 2000). It consists of 12 questions graded on a scale of 0-4. The OSDI score is calculated by multiplying the total score by 25 and dividing by the total number of questions answered yielding a result between 0 and 100
    - - grade MGD ( morphologic features, expressibility and meibum quality) based upon meibum quality and expressibility (Tomlinson et al, 2011) using a slit lamp. The quality and expressibility of meibum secreted from the central 8 meibomian glands on the lower and upper eyelid was graded on a four-point scale (quality: 0=clear fluid, 1=cloudy fluid, 2=cloudy particulate fluid, 3=inspissated like toothpaste; expressibility: 0=all glands expressible, 1=3-4 glands expressible, 2=1-2 glands expressible, 3=no glands expressible) following firm digital pressure to the eyelid margins. The scores from the upper and lower eyelids were added to give a composite value for quality and expressibility.
    - - Modified Coston Method and counting on eyelash manipulation
    - - Corneal, nasal and temporal bulbar conjunctival staining was graded individually using the Oxford Grading Scale on a 6 point scale (0-5 for each location) to provide a composite score (0-15) for each eye (Bron et al, 2003).
    - - Osmolarity of the tear film in each eye was measured via electrical impedance using the OcuSense TearLab (San Diego, USA). One measurement was taken from each eye. > 8mOsm/L = instability. >308mOsm/L = ocular surface inflammation (ref)
  - - - 18 years of age
      - Must have >/= G1 MGD according to recommendations of the diagnostic subcommittee of the International Workshop on Meibomian Gland Dysfunction (Tomlinson et al. 2011)
    - - Contact lens wear, systemic disease or use of topical / systemic medication known to affect the eyes, presence of ocular disease except for MGD and blepharitis, current use of MGD/blepharitis treatment or use of treatment within the last 6 months, ocular surgery in the last 6 months.