Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction
Christophe Baudouin,Elisabeth M. Messmer,Pasquale Aragona,Gerd Geerling,Yonca A. Akova,José Benítez-del-Castillo,Kostas G. Boboridis,Jesus Merayo-Lloves,Maurizio Rolando,Marc Labetoulle +9 more
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TLDR
A new pathophysiological scheme is proposed for MGD in order to better identify the pathological mechanisms involved and to allow more efficient targeting of therapeutics, and to gain true disease status rather than being viewed as a mere dysfunction.Abstract:
Meibomian gland dysfunction (MGD) is the most frequent cause of dry eye disease (DED). Eyelid inflammation, microbial growth, associated skin disorders as well as potentially severe corneal complications culminate to make MGD a complex multifactorial disorder. It is probable that MGD is a heterogeneous condition arising from any combination of the following five separate pathophysiological mechanisms: eyelid inflammation, conjunctival inflammation, corneal damage, microbiological changes and DED resulting from tear film instability. The pathogenesis of both MGD and DED can be described in terms of a 'vicious circle': the underlying pathophysiological mechanisms of DED and MGD interact, resulting in a double vicious circle. The MGD vicious circle is self-stimulated by microbiological changes, which results in increased melting temperature of meibum and subsequent meibomian gland blockage, reinforcing the vicious circle of MGD. Meibomian gland blockage, dropout and inflammation directly link the two vicious circles. MGD-associated tear film instability provides an entry point into the vicious circle of DED and leads to hyperosmolarity and inflammation, which are both a cause and consequence of DED. Here we propose a new pathophysiological scheme for MGD in order to better identify the pathological mechanisms involved and to allow more efficient targeting of therapeutics. Through better understanding of this scheme, MGD may gain true disease status rather than being viewed as a mere dysfunction.read more
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TFOS DEWS II Definition and Classification Report
Jennifer P. Craig,Kelly K. Nichols,Esen K. Akpek,Barbara Caffery,Harminder S Dua,Choun Ki Joo,Zuguo Liu,J. Daniel Nelson,J. Daniel Nelson,Jason J. Nichols,Kazuo Tsubota,Fiona Stapleton +11 more
TL;DR: The new definition recognizes the multifactorial nature of dry eye as a disease where loss of homeostasis of the tear film is the central pathophysiological concept and central to the scheme is a positive diagnosis of DED with signs and symptoms, and this is directed towards management to restore homeostosis.
Journal ArticleDOI
TFOS DEWS II pathophysiology report
Anthony J. Bron,Anthony J. Bron,Cintia S. de Paiva,Sunil K. Chauhan,Stefano Bonini,Eric E. Gabison,Sandeep Jain,Erich Knop,Maria Markoulli,Yoko Ogawa,Victor L. Perez,Yuichi Uchino,Norihiko Yokoi,Driss Zoukhri,David A. Sullivan +14 more
TL;DR: The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease, finding the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation to be important.
Journal ArticleDOI
Emerging strategies for the diagnosis and treatment of meibomian gland dysfunction: Proceedings of the OCEAN group meeting
Gerd Geerling,Christophe Baudouin,Pasquale Aragona,Maurizio Rolando,Kostas G. Boboridis,José Benítez-del-Castillo,Yonca A. Akova,Jesus Merayo-Lloves,Marc Labetoulle,Martin Steinhoff,Elisabeth M. Messmer +10 more
TL;DR: Ocular imaging has advanced in recent years, providing ophthalmologists with a better understanding of ocular diseases, and the emerging technologies of interferometry, non-contact meibography, keratography and in vivo confocal laser microscopy are outlined, which offer exciting possibilities for the future.
Journal ArticleDOI
Role of corneal nerves in ocular surface homeostasis and disease.
Marc Labetoulle,Christophe Baudouin,Margarita Calonge,Jesus Merayo-Lloves,Kostas G. Boboridis,Yonca A. Akova,Pasquale Aragona,Gerd Geerling,Elisabeth M. Messmer,Jose M. Benitez-del-Castillo +9 more
TL;DR: The physiology ofCorneal nerves, the pathology of corneal nerve diseases and how these relate to neuropathic pain, NK and DED are explored and what novel treatments may be useful against diseases involving corneals.
Journal ArticleDOI
Prospective evaluation of intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction.
TL;DR: The results support the efficacy of IPL + MGX in relieving both signs and symptoms of dry eye disease secondary to meibomian gland dysfunction (MGD).
References
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Journal ArticleDOI
The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Anatomy, Physiology, and Pathophysiology of the Meibomian Gland
TL;DR: It is accepted that MGD is important, conceivably underestimated, and possibly the most frequent cause of dry eye disease due to increased evaporation of the aqueous tears, and a comprehensive review of physiological and pathophysiological aspects of the meibomian glands is sought.
Journal ArticleDOI
The international workshop on meibomian gland dysfunction: Executive summary
Kelly K. Nichols,Gary N. Foulks,Anthony J. Bron,Ben J. Glasgow,Murat Dogru,Kazuo Tsubota,Michael A. Lemp,David A. Sullivan +7 more
TL;DR: This paper presents a poster presented at the first International Workshop on Meibomian Gland Dysfunction at the annual meeting of the Tear Film and Ocular Surface Society in Toronto, Canada.
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Prevalence of Dry Eye Among the Elderly
TL;DR: Symptoms and signs of dry eye are common among the elderly but were not associated with age, race, or sex in this population-based sample of elderly Americans.
Journal ArticleDOI
The International Workshop on Meibomian Gland Dysfunction: Report of the Definition and Classification Subcommittee
J. Daniel Nelson,Jun Shimazaki,Jose M. Benitez-del-Castillo,Jennifer P. Craig,James P. McCulley,Seika Den,Gary N. Foulks +6 more
TL;DR: Anatomic changes of the lid margin, expressibility of meibomian lipids, gland dropout by meibography, evaporimetry, and meibometry are most commonly used.
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The epidemiology of dry eye in Melbourne, Australia
Catherine A. McCarty,Aashish K Bansal,Patricia M. Livingston,Y. L. Stanislavsky,Hugh R. Taylor +4 more
TL;DR: The epidemiology of dry eye in the adult population of Melbourne, Australia is described to describe the first reported population-based data ofdry eye in Australia, where the prevalence of dryEye varies by sign and symptom.