In-office thermal systems for the treatment of dry eye disease

Dry eye disease affects millions of people worldwide, causing pain, vision disturbance, and reduced productivity. Meibomian gland dysfunction, a major cause of dry eye, is characterized by chronic glandular inflammation, thickening of the meibum, obstruction of terminal ducts, and glandular atrophy. Treatment of meibomian gland dysfunction can utilize heat and pressure applied to the meibomian glands, increasing meibum expression. With self-treatments, however, not all patients achieve lasting improvement, and compliance is often low. In-office thermal systems offer a second line of treatment and could be a much-needed addition for patients who do not respond to conventional treatment. We critically evaluated the efficacy and safety of LipiFlow, iLux, and TearCare based on existing literature. While the studies found a single in-office thermal treatment to be safe and effective in improving short-term signs and symptoms in patients with dry eye, long-term efficacy needs to be further evaluated. Thus, well-controlled, long-term efficacy studies are warranted to draw clear conclusions. The treatment seemed to provide rapid relief of symptoms that may last up to 1 year, but at a considerably higher cost than the at-home treatments. The choice of treatment depends on cost, compliance with at-home treatment, and personal preference.publishedVersio

Hot towels:The bedrock of Meibomian gland dysfunction treatment – A review

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Bruk av Budesonid som vedlikeholdsbehandling for Crohns sykdom: Hvordan unngå unødvendige bivirkninger og sikre riktig langtidsbehandling ved Sykehuset Innlandet, divisjon Gjøvik

Tema og problemstilling Dette forbedringsprosjektet omhandler bruken av budesonid som langtidsbehandling hos pasienter med Mb. Crohns ved Sykehuset Innlandet, divisjon Gjøvik. Formålet med prosjektet er å finne ut hvordan man kan optimalisere bruk av budesonid etter gjeldende internasjonale og nasjonale retningslinjer for å sikre sykdomskontroll samtidig som man unngår unødvendige bivirkninger. Kunnskapsgrunnlag Vi har gjennomført et pyramidesøk i McMaster Plus for å kartlegge kunnskapsgrunnlaget vedrørende langtidsbehandling med Budesonid i behandling av Mb. Crohns. Det ble definert et PICO-spørsmål, søkeord ble valgt på grunnlag av problemstillingen og inklusjons-/eksklusjonskriterier ble definert for å generere relevante treff. Oppsummert viser kunnskapsgrunnlaget at budesonid er effektiv for induksjon av remisjon, og har en viss effekt som vedlikeholdsbehandling ved å forsinke tilbakefall av sykdom, men denne effekten avtar dess lenger man anvender medikamentet. Således kan effekten ikke veie opp mot medikamentets ugunstige bivirkningsprofil på lang sikt, og anbefalingen er dermed at man bør trappe ned og seponere medikamentet innen 12 uker. Dagens praksis, mål, tiltak og kvalitetsindikatorer Etter kartlegging ved Sykehuset Innlandet, divisjon Gjøvik, viser denne at pasienter med Crohns kan bli stående på budesonid over 12 uker. Som kunnskapsgrunnlaget viser, er ikke dette hensiktsmessig. Etter vår vurdering skyldes dette avviket hovedsakelig mangel på lokale retningslinjer og nedtrappingsplan av budesonid, stor turnover av leger på avdelingen og for lite tilstedeværelse av overleger på poliklinikken som følger opp pasientgruppen. Den viktigste kvalitetsindikatoren er antall pasienter som bruker budesonid > 3 mnd. Prosess, ledelse og organisering Utgangspunktet for implementering av endringer i organisasjonen bygger på Kotters åtte råd for implementering og PUKK-sirkelen. I tillegg har vi gjennomført et grundig intervju med sykehusdirektøren ved Sykehuset Innlandet, divisjon Gjøvik, som danner et noe mer praktisk og erfaringsbasert bakteppe for denne delen. Konklusjon Vi mener det er anbefalt at det innføres lokale retningslinjer for behandling av Crohns sykdom og at opplæringen rundt disse styrkes, at pasientgruppen kontrolleres hyppigere på poliklinikken og at det fokuseres mer på nedtrappingsplan ved behandling med budesonid. Disse tiltakene til sammen vil kunne føre til at færre pasienter med Crohns sykdom behandles med budesonid i > 3 måneder, færre bivirkninger og mer korrekt bruk av steroider på riktig indikasjon

Change in Ocular Surface Staining during Eyelid Warming Is Related to Tear Cytokine Levels

Purpose: To investigate the changes in the tear cytokine profile of patients with meibomian gland dysfunction (MGD) treated with eyelid warming and to correlate these changes with clinical parameters for dry eye disease (DED). Methods: Seventy patients with MGD were included and treated with the warming of eyelids. Of these, 61 still used the treatment three months after baseline, while 48 completed the whole treatment period of six months. The concentrations of 39 cytokines in the tear fluid were measured at baseline and after three and six months of treatment. All participants were examined with tests for DED, including tear film break-up time (TBUT), ocular surface staining (OSS), and the self-reporting Ocular Surface Disease Index (OSDI). Changes in cytokine concentrations were assessed from baseline to three months, from three to six months, and from baseline to six months. Correlation analyses were performed between changes in the cytokine concentrations and changes in TBUT, OSS, and OSDI during the same time intervals. Results: No significant changes were found in the concentrations of the 39 cytokines during any of the three treatment intervals. However, several correlations were detected between changes in the level of cytokines and OSS from baseline to three months of treatment. Decreasing concentrations of granulocyte chemotactic protein 2 (GCP-2/CXCL6, mean effect 2.36, p=0.042), interleukin 10 (IL-10, mean effect 1.04, p=0.045), and IL-16 (mean effect 1.36, p=0.035) were associated with decreasing OSS. Decreasing concentrations of granulocyte macrophage colony-stimulating factor (GM-CSF, mean effect -2.98, p=0.024), IL-8 (IL-8/CXCL8, mean effect -1.35, p=0.026), and macrophage migration inhibitory factor (MIF, mean effect -2.44, p=0.033) were related to increasing OSS. Conclusions: Warming of eyelids did not change the concentration of cytokines in the tear fluid of patients with MGD significantly. However, alterations in the level of several cytokines were associated with changes in the OSS. This finding indicates a close connection between tear cytokines and OSS in MGD patients treated with eyelid warming

Change in Ocular Surface Staining during Eyelid Warming Is Related to Tear Cytokine Levels

Purpose: To investigate the changes in the tear cytokine profile of patients with meibomian gland dysfunction (MGD) treated with eyelid warming and to correlate these changes with clinical parameters for dry eye disease (DED). Methods: Seventy patients with MGD were included and treated with the warming of eyelids. Of these, 61 still used the treatment three months after baseline, while 48 completed the whole treatment period of six months. The concentrations of 39 cytokines in the tear fluid were measured at baseline and after three and six months of treatment. All participants were examined with tests for DED, including tear film break-up time (TBUT), ocular surface staining (OSS), and the self-reporting Ocular Surface Disease Index (OSDI). Changes in cytokine concentrations were assessed from baseline to three months, from three to six months, and from baseline to six months. Correlation analyses were performed between changes in the cytokine concentrations and changes in TBUT, OSS, and OSDI during the same time intervals. Results: No significant changes were found in the concentrations of the 39 cytokines during any of the three treatment intervals. However, several correlations were detected between changes in the level of cytokines and OSS from baseline to three months of treatment. Decreasing concentrations of granulocyte chemotactic protein 2 (GCP-2/CXCL6, mean effect 2.36, p = 0.042), interleukin 10 (IL-10, mean effect 1.04, p = 0.045), and IL-16 (mean effect 1.36, p = 0.035) were associated with decreasing OSS. Decreasing concentrations of granulocyte macrophage colony-stimulating factor (GM-CSF, mean effect −2.98, p = 0.024), IL-8 (IL-8/CXCL8, mean effect −1.35, p = 0.026), and macrophage migration inhibitory factor (MIF, mean effect −2.44, p = 0.033) were related to increasing OSS. Conclusions: Warming of eyelids did not change the concentration of cytokines in the tear fluid of patients with MGD significantly. However, alterations in the level of several cytokines were associated with changes in the OSS. This finding indicates a close connection between tear cytokines and OSS in MGD patients treated with eyelid warming

Change in Ocular Surface Staining during Eyelid Warming Is Related to Tear Cytokine Levels

Purpose. To investigate the changes in the tear cytokine profile of patients with meibomian gland dysfunction (MGD) treated with eyelid warming and to correlate these changes with clinical parameters for dry eye disease (DED). Methods: Seventy patients with MGD were included and treated with the warming of eyelids. Of these, 61 still used the treatment three months after baseline, while 48 completed the whole treatment period of six months. The concentrations of 39 cytokines in the tear fluid were measured at baseline and after three and six months of treatment. All participants were examined with tests for DED, including tear film break-up time (TBUT), ocular surface staining (OSS), and the self-reporting Ocular Surface Disease Index (OSDI). Changes in cytokine concentrations were assessed from baseline to three months, from three to six months, and from baseline to six months. Correlation analyses were performed between changes in the cytokine concentrations and changes in TBUT, OSS, and OSDI during the same time intervals. Results: No significant changes were found in the concentrations of the 39 cytokines during any of the three treatment intervals. However, several correlations were detected between changes in the level of cytokines and OSS from baseline to three months of treatment. Decreasing concentrations of granulocyte chemotactic protein 2 (GCP-2/CXCL6, mean effect 2.36, p = 0.042), interleukin 10 (IL-10, mean effect 1.04, p = 0.045), and IL-16 (mean effect 1.36, p = 0.035) were associated with decreasing OSS. Decreasing concentrations of granulocyte macrophage colony-stimulating factor (GM-CSF, mean effect −2.98, p = 0.024), IL-8 (IL-8/CXCL8, mean effect −1.35, p = 0.026), and macrophage migration inhibitory factor (MIF, mean effect −2.44, p = 0.033) were related to increasing OSS. Conclusions: Warming of eyelids did not change the concentration of cytokines in the tear fluid of patients with MGD significantly. However, alterations in the level of several cytokines were associated with changes in the OSS. This finding indicates a close connection between tear cytokines and OSS in MGD patients treated with eyelid warming

Change in Ocular Surface Staining during Eyelid Warming Is Related to Tear Cytokine Levels

Purpose. To investigate the changes in the tear cytokine profile of patients with meibomian gland dysfunction (MGD) treated with eyelid warming and to correlate these changes with clinical parameters for dry eye disease (DED). Methods. Seventy patients with MGD were included and treated with the warming of eyelids. Of these, 61 still used the treatment three months after baseline, while 48 completed the whole treatment period of six months. The concentrations of 39 cytokines in the tear fluid were measured at baseline and after three and six months of treatment. All participants were examined with tests for DED, including tear film break-up time (TBUT), ocular surface staining (OSS), and the self-reporting Ocular Surface Disease Index (OSDI). Changes in cytokine concentrations were assessed from baseline to three months, from three to six months, and from baseline to six months. Correlation analyses were performed between changes in the cytokine concentrations and changes in TBUT, OSS, and OSDI during the same time intervals. Results. No significant changes were found in the concentrations of the 39 cytokines during any of the three treatment intervals. However, several correlations were detected between changes in the level of cytokines and OSS from baseline to three months of treatment. Decreasing concentrations of granulocyte chemotactic protein 2 (GCP-2/CXCL6, mean effect 2.36, p=0.042), interleukin 10 (IL-10, mean effect 1.04, p=0.045), and IL-16 (mean effect 1.36, p=0.035) were associated with decreasing OSS. Decreasing concentrations of granulocyte macrophage colony-stimulating factor (GM-CSF, mean effect −2.98, p=0.024), IL-8 (IL-8/CXCL8, mean effect −1.35, p=0.026), and macrophage migration inhibitory factor (MIF, mean effect −2.44, p=0.033) were related to increasing OSS. Conclusions. Warming of eyelids did not change the concentration of cytokines in the tear fluid of patients with MGD significantly. However, alterations in the level of several cytokines were associated with changes in the OSS. This finding indicates a close connection between tear cytokines and OSS in MGD patients treated with eyelid warming

Chambered warm moist air eyelid warming devices – a review

Background Eyelid warming is an important treatment for meibomian gland dysfunction (MGD). Specialized chambered devices, using warm moist air have been developed. Purpose To critically evaluate the literature on the safety and efficacy of chambered warm moist air devices in MGD treatment and pinpoint areas of future research. Methods PubMed and Embase were searched on 06 June 2021. The search term was ‘(warm OR heat OR steam OR goggle OR spectacle OR moist air) AND (meibomian OR MGD OR blepharitis OR eyelid OR dry eye OR DED)’. All relevant articles with available English full text were included. Results Eighteen articles assessing the application of chambered warm moist air eyelid warming devices were identified. In single-application studies, steam-based eyelid warming increased the eyelid temperature and improved symptoms, lipid layer thickness, and tear film breakup time (TBUT). In treatment studies, the steam-based devices improved TBUT and symptom scores. However, in the only randomized controlled trial (RCT) comparing chambered steam-based heat to hot towel treatment, there was no difference between groups for the primary outcome measure; the proportion of subjects noting symptom improvement after 4 weeks. Conclusion Currently available chambered warm moist air eyelid warming devices are safe and effective at raising eyelid temperature to therapeutic levels and improving signs and symptoms of dry eye. However, it is not clear if they provide a greater benefit than other eyelid warming therapies. Further well-conducted RCTs comparing moist and dry heat devices should be conducted on patients across the range of DED severities and subtype spectrum.publishedVersio

TheraPearl Eye Mask and Blephasteam for the treatment of meibomian gland dysfunction : a randomized, comparative clinical trial

Meibomian gland dysfunction (MGD) is the most common cause of dry eye disease (DED). In this study, we aimed to compare the effects of eyelid warming treatment using either TheraPearl Eye Mask (Bausch &amp; Lomb Inc., New York, USA) or Blephasteam (Spectrum Thea Pharmaceuticals LTD, Macclesfield, UK) in a Norwegian population with mild to moderate MGD-related DED. An open label, randomized comparative trial with seventy patients (49 females, 21 males; mean age 53.6 years). Patients were randomly assigned to treatment with Blephasteam (n = 37) or TheraPearl (n = 33). All received a hyaluronic acid based artificial tear substitute (Hylo-Comod, Ursapharm, Saarbrucken, Germany). Patients were examined at baseline, and at three and six months initiation of treatment. Treatment efficacy was primarily evaluated by fluorescein breakup time (FBUT) and Ocular Surface Disease Index (OSDI) scores. Other outcome measures included ocular surface staining (OSS), Schirmers test, and meibomian quality and expressibility. Baseline parameter values did not differ between the groups. After six months of treatment, Blephasteam improved FBUT by 3.9 s (p &amp;lt; 0.01) and OSDI by 13.7 (p &amp;lt; 0.01), TheraPearl improved FBUT by 2.6 s (p &amp;lt; 0.01) and OSDI by 12.6 (p &amp;lt; 0.01). No difference between treatments was detected at 6 months (p = 0.11 for FBUT and p = 0.71 for OSDI), nor were there differences in the other tested parameters between the treatment groups. Blephasteam and TheraPearl are equally effective in treating mild to moderate MGD in a Norwegian population after 6-months of treatment. Clinicaltrials.gov ID: NCT03318874; Protocol ID: 2014/1983; First registration: 24/10/2017.Funding Agencies|Faculty of Medicine, University of Oslo; ABIGO; AlconNovartis; AllerganAbbVieAllergan; AMWO; BauschLomb; European school for advanced studies in ophthalmology; InnZ Medical; Medilens Nordic; Medistim; NovartisNovartis; Santen; Specsavers; Shire; Thea Laboratoires</p