Guidelines for the treatment of dry eye caused by meibomian gland dysfunction (Meibomian Gland Dysfunction) according to the guidelines of DEWS II (2017) divide the treatment into 4 main steps as follows:

Step 1:

1.1 Provide knowledge about the disorder, cause of dry eye disease, necessary diagnosis, treatment and prognosis

1.2 Adjust the environment that causes dry eye disease, such as allergies to the conjunctiva, which is often caused by the environment that causes allergies. 80% of Thai people are often allergic to dust mites, such as in bed, so maintaining cleanliness and eliminating mites Dusting the bed or vacuuming the bed on a daily basis will play an important role in the treatment of allergic conjunctivitis, especially in patients with red eyes or discomfort after waking up.

1.3 Provide knowledge about the use of supplements that help maintain dry eyes (Meibomian Gland Dysfunction) Currently, essential fatty acids are used Fatty Acid) dietary supplement

1.4 Try to find out the causes and risk factors of the drugs used, both eye drops and oral drugs, that may cause dry eyes and avoid the use of such drugs, which may worsen dry eyes.

1.5 Eyelid cleaning and warm eyelid compress play a very important role in the treatment of chronic dry eye disease, the importance of which should be explained to the patient and practiced as a daily personal routine.

Step 2:

This second-stage treatment is recommended to be started and practiced if the first-stage treatment is not sufficient:

2.1 Using Preservative-Free Ocular Lubricants to reduce the incidence of preservatives in eye drops, which can cause eye skin toxicity.

2.2 In case of detection of eyelid infection from Demodex blepharitis, the recommended treatment is to use an eyelid cleanser containing tea tree oil (Tea Tree Oil Treatment).

2.3 Treatment by increasing the accumulation of tears on the surface of the eyes (Tear Conservation) There are two methods:

Punctal occlusion

-Using windproof glasses that increase moisture to the skin and eyes (Moisture Chamber Spectacles/Goggles)

2.4 Treatment to increase the moisture of the skin and eyes at night (Overnight Treatment), such as using artificial tear gel or wax patches to coat the skin of the eyes at night, or using glasses that moisturize and dissolve fat on the eyelids for treatment. (Moisture Chamber Devices) Currently, there are heated glasses to treat dry eyes, such as Blephasteam Goggles

2.5 Warm compresses and massage to remove fat from the tear gland (Meibomian Gland Expression) regularly. It may be massage with a glass stick for treatment called Eyelid Spa or Eyelid Hygiene Treatment. Eyelid massage should be done for about 1 -2 times a month

2.6 Use of light to treat glandular lachrymal fat blockage and chronic inflammation (Meibomian Gland Dysfunction or Blepharitis) This method of treatment is called IPL or Intense Pulsed Light

2.7 Treatment of dry eye with eye drops includes:

- Ointment-shaped eye drops that are antibiotics or drugs that contain antibiotics and steroids for inflammation of the eyelids.

- Topical Corticosteroid eye drops for a short period of time

- Topical secretagogues (topical secretagogues)

- Topical Non-Glucocorticoid Immunomodulatory Drugs

Edited by Dr. Nattawut wa dew

Ophthalmologist specializing in eye surgery to beautify and enhance

Reference: TFOS DEWS II Management and Therapy Report. Jones L', Downie LE?, Korb Di

Benitez-Del-Castillo JM4, Dana RP. Deng SX, Dong PN7 Geering G& Hida RY9, Liu Y10 Seo KY", Tauber J'2, Wakamatsu TH13, Xu J14, Wolffsohn JS15, Craig JP16. Ocul Surf, 2017

Jul;15(3):575-628. doi: 10.1016/jtos.2017.05.006. Epub 2017 Jul 20