Dry Eye Disease Associated with Meibomian Gland Dysfunction: Focus on Tear Film Characteristics and the Therapeutic Landscape

Ophthalmology and Therapy · 2 authors, 3 centres

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TL;DR

The authors describe the pathophysiology and summarize home care, office-based, and pharmacologic treatments, including emerging therapies like NOV03.

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The authors describe the pathophysiology and summarize home care, office-based, and pharmacologic treatments, including emerging therapies like NOV03. The review highlights that while many treatments are available, there is a lack of adequately powered, rigorous clinical trials evaluating efficacy and safety specifically in patients with DED associated with MGD. It concludes that development of targeted therapies will improve individualized treatment options.

STUDY TYPE

narrative_review

SPECIALTY

ophthalmology

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10164226

Dry Eye Disease Associated with Meibomian Gland Dysfunction: Focus on Tear Film Characteristics and the Therapeutic Landscape

Ophthalmology and Therapy

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ABSTRACT

Meibomian gland dysfunction (MGD) is highly prevalent and is the leading cause of evaporative dry eye disease (DED). MGD is characterized by a reduction in meibum secretion and/or a change in meibum composition that results in the disruption of the tear film lipid layer and an increase in the tear film evaporation rate. Excessive evaporation causes tear film instability, desiccation, tear hyperosmolarity, inflammation, and apoptosis of ocular surface cells, resulting in a continuous cycle of DED. The primary treatment goal for DED associated with MGD is to restore the tear film lipid layer and decrease evaporation, thereby reducing ocular signs and symptoms. The management of MGD includes home care options (eyelid hygiene, warming eye masks, ocular lubricants) and office-based treatments (manual expression, microblepharoexfoliation, thermal pulsation, intense pulsed light, intraductal probing). Topical ophthalmic prescription medications attempt to alter various factors that may contribute to DED (e.g., inflammation, bacterial growth, inadequate tear production). In this review, clinical evidence regarding available treatments and emerging therapies from randomized studies in patients with DED associated with MGD is summarized. Although some treatment modalities have been evaluated specifically for DED patients with MGD, large-scale randomized controlled trials are needed to confirm efficacy and safety in this patient population. Currently, there are no approved prescription pharmacologic treatments specifically indicated for DED associated with MGD, and those medications approved for the treatment of DED do not target the key driver of the disease (i.e., excessive evaporation). NOV03 (perfluorohexyloctane; under review with the US Food and Drug Administration) is the most advanced emerging therapy for DED associated with MGD and has demonstrated statistically significant improvements in both signs and symptoms in randomized controlled trials. Development of novel pharmacotherapies will improve therapeutic options and allow for a more individualized approach for patients with DED associated with MGD.

CITATION EXPORT

John D. Sheppard, Kelly K. Nichols. Dry Eye Disease Associated with Meibomian Gland Dysfunction: Focus on Tear Film Characteristics and the Therapeutic Landscape. Ophthalmology and Therapy. (2023). https://doi.org/10.1007/s40123-023-00669-1

AUTHORS

2 · 3 CENTRES

John D. Sheppard, Kelly K. Nichols

1grid.255414.30000 0001 2182 3733Virginia Eye Consultants and Eastern Virginia Medical School, Suite #210, 241 Corporate Blvd, Norfolk, VA 23502 USA
2Eyecare Partners, St. Louis, MO USA
3grid.265892.20000000106344187School of Optometry, University of Alabama at Birmingham, Birmingham, AL USA