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| meibomiantitis [2026/07/28 12:33] – [References] Scott Larson | meibomiantitis [2026/08/06 21:07] (current) – [Meibomianitis (Meibomitis): Causes and Treatments] Scott Larson | ||
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| ====== Meibomianitis (Meibomitis): | ====== Meibomianitis (Meibomitis): | ||
| - | FIXME | ||
| - | Meibomianitis refers to inflammation | + | * Inflammation |
| + | * A subtype of posterior blepharitis | ||
| + | * A form of meibomian gland dysfunction (MGD) | ||
| + | * Most common cause of evaporative dry eye disease. | ||
| ===== Definition ===== | ===== Definition ===== | ||
| - | The International Workshop on Meibomian Gland Dysfunction defines MGD as a " | + | The International Workshop on Meibomian Gland Dysfunction defines MGD as a " |
| ===== Causes and Risk Factors ===== | ===== Causes and Risk Factors ===== | ||
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| === Obstructive Mechanisms === | === Obstructive Mechanisms === | ||
| - | * **Hyperkeratinization** of the meibomian gland duct epithelium leads to terminal duct obstruction, | + | * **Hyperkeratinization** of the meibomian gland duct epithelium leads to terminal duct obstruction, |
| - | * Stagnation of meibum within obstructed glands promotes bacterial proliferation and secondary inflammation[[https:// | + | * Stagnation of meibum within obstructed glands promotes bacterial proliferation and secondary inflammation. |
| === Microbial Factors === | === Microbial Factors === | ||
| - | * **Bacterial colonization** — Proliferation of commensal bacteria (e.g., // | + | * **Bacterial colonization** — Proliferation of commensal bacteria (e.g., // |
| - | * **// | + | * **// |
| === Systemic and Dermatologic Associations === | === Systemic and Dermatologic Associations === | ||
| - | * **Acne rosacea** — One of the most important systemic associations; | + | * **Acne rosacea** — One of the most important systemic associations; |
| - | * **Seborrheic dermatitis** — Oily, greasy scaling of the lid margin with overlap into MGD[[https:// | + | * **Seborrheic dermatitis** — Oily, greasy scaling of the lid margin with overlap into MGD. |
| - | * **Fibrosing conjunctival disorders** — Trachoma, erythema multiforme, and ocular cicatricial pemphigoid can cause secondary MGD[[https:// | + | * **Fibrosing conjunctival disorders** — Trachoma, erythema multiforme, and ocular cicatricial pemphigoid can cause secondary MGD. |
| === Hormonal and Age-Related Factors === | === Hormonal and Age-Related Factors === | ||
| - | * Androgen deficiency reduces meibocyte lipid production via downregulation of androgen receptor (AR) and PPARγ signaling, contributing to altered meibum composition and gland atrophy[[https:// | + | * Androgen deficiency reduces meibocyte lipid production via downregulation of androgen receptor (AR) and PPARγ signaling, contributing to altered meibum composition and gland atrophy. |
| - | * Prevalence of MGD increases significantly with age, particularly above 50 years[[https:// | + | * Prevalence of MGD increases significantly with age, particularly above 50 years. |
| === Other Contributing Factors === | === Other Contributing Factors === | ||
| - | * Use of **isotretinoin** (causes meibomian gland atrophy)[[https:// | + | * Use of **isotretinoin** (causes meibomian gland atrophy). |
| * Contact lens wear, giant papillary conjunctivitis, | * Contact lens wear, giant papillary conjunctivitis, | ||
| Line 40: | Line 42: | ||
| === Conservative / First-Line Therapy === | === Conservative / First-Line Therapy === | ||
| - | * **Warm compresses** — Soften meibum, relieve duct obstruction, | + | * **Warm compresses** — Soften meibum, relieve duct obstruction, |
| - | * **Lid hygiene** — Mechanical cleansing of the eyelid margins (eyelid scrubs, baby shampoo, or commercial lid wipes) reduces bacterial load[[https:// | + | * **Lid hygiene** — Mechanical cleansing of the eyelid margins (eyelid scrubs, baby shampoo, or commercial lid wipes) reduces bacterial load. |
| - | * **Meibomian gland expression/ | + | * **Meibomian gland expression/ |
| * **Artificial tears** — Lipid-containing lubricants to supplement the deficient tear film lipid layer. | * **Artificial tears** — Lipid-containing lubricants to supplement the deficient tear film lipid layer. | ||
| === Topical Pharmacological Therapy === | === Topical Pharmacological Therapy === | ||
| - | * **Topical antibiotics** — Azithromycin ophthalmic solution has both antibacterial and anti-inflammatory properties[[https:// | + | * **Topical antibiotics** — Azithromycin ophthalmic solution has both antibacterial and anti-inflammatory properties. |
| - | * **Topical corticosteroids** — Short courses of low-dose glucocorticoids (e.g., loteprednol etabonate) for acute flares; requires monitoring for steroid-induced glaucoma and cataracts[[https:// | + | * **Topical corticosteroids** — Short courses of low-dose glucocorticoids (e.g., loteprednol etabonate) for acute flares; requires monitoring for steroid-induced glaucoma and cataracts. |
| - | * **Antibiotic–steroid combinations** — Topical combination drops/ | + | * **Antibiotic–steroid combinations** — Topical combination drops/ |
| - | * **Topical cyclosporine A** (Restasis, Cequa) — Immunomodulatory agent approved for dry eye disease; may be used as an adjunct, though evidence for superiority over placebo in MGD specifically is limited[[https:// | + | * **Topical cyclosporine A** (Restasis, Cequa) — Immunomodulatory agent approved for dry eye disease; may be used as an adjunct, though evidence for superiority over placebo in MGD specifically is limited]. |
| - | * **Lifitegrast 5%** (Xiidra) — LFA-1/ | + | * **Lifitegrast 5%** (Xiidra) — LFA-1/ |
| === Systemic Pharmacological Therapy === | === Systemic Pharmacological Therapy === | ||
| - | * **Oral tetracyclines** — Doxycycline (e.g., 50–100 mg daily for 6–12 weeks) or minocycline; | + | * **Oral tetracyclines** — Doxycycline (e.g., 50–100 mg daily for 6–12 weeks) or minocycline; |
| - | * **Oral azithromycin** — Pulsed regimens (e.g., 500 mg day 1, then 250 mg days 2–5) offer a shorter course with fewer gastrointestinal side effects; one RCT showed comparable or superior efficacy to doxycycline[[https:// | + | * **Oral azithromycin** — Pulsed regimens (e.g., 500 mg day 1, then 250 mg days 2–5) offer a shorter course with fewer gastrointestinal side effects; one RCT showed comparable or superior efficacy to doxycycline. |
| - | * **Omega-3 fatty acid supplementation** — May improve MGD symptoms and tear film stability[[https:// | + | * **Omega-3 fatty acid supplementation** — May improve MGD symptoms and tear film stability. |
| === Demodex-Directed Therapy === | === Demodex-Directed Therapy === | ||
| - | * **Tea tree oil** (terpinen-4-ol) — Effective for MGD associated with //Demodex// infestation; | + | * **Tea tree oil** (terpinen-4-ol) — Effective for MGD associated with //Demodex// infestation; |
| * **Lotilaner 0.25% ophthalmic solution** (Xdemvy) — FDA-approved for Demodex blepharitis. | * **Lotilaner 0.25% ophthalmic solution** (Xdemvy) — FDA-approved for Demodex blepharitis. | ||
| === In-Office Procedural Treatments === | === In-Office Procedural Treatments === | ||
| - | * **Thermal pulsation (LipiFlow)** — Automated device applying controlled heat (41–43°C) and pulsatile pressure to the eyelids for 12 minutes; may improve meibomian gland function and dry eye symptoms compared with warm compresses, though long-term durability is uncertain[[https:// | + | * **Thermal pulsation (LipiFlow)** — Automated device applying controlled heat (41–43°C) and pulsatile pressure to the eyelids for 12 minutes; may improve meibomian gland function and dry eye symptoms compared with warm compresses, though long-term durability is uncertain. |
| - | * **Intense pulsed light (IPL) therapy** — Broad-spectrum light applied to the periocular skin; when combined with meibomian gland expression, may improve tear film stability, ocular surface staining, and lipid layer thickness[[https:// | + | * **Intense pulsed light (IPL) therapy** — Broad-spectrum light applied to the periocular skin; when combined with meibomian gland expression, may improve tear film stability, ocular surface staining, and lipid layer thickness. |
| - | * **Meibomian gland probing** — Intraductal probing to relieve obstruction in refractory cases[[https:// | + | * **Meibomian gland probing** — Intraductal probing to relieve obstruction in refractory cases. |
| - | * **Other thermal devices** — TearCare, MiBoFlo, and Systane iLux systems offer alternative in-office heat/ | + | * **Other thermal devices** — TearCare, MiBoFlo, and Systane iLux systems offer alternative in-office heat/ |
| ===== Complications of Untreated Meibomianitis ===== | ===== Complications of Untreated Meibomianitis ===== | ||
| Line 75: | Line 77: | ||
| If left untreated, meibomitis can cause inflammation of the adjacent ocular surface, leading to: | If left untreated, meibomitis can cause inflammation of the adjacent ocular surface, leading to: | ||
| - | * **Meibomian keratoconjunctivitis** — corneal cellular infiltrates, | + | * **Meibomian keratoconjunctivitis** — corneal cellular infiltrates, |
| - | * Progressive **meibomian gland dropout** (acinar atrophy), which is considered a permanent pathological change[[https:// | + | * Progressive **meibomian gland dropout** (acinar atrophy), which is considered a permanent pathological change. |
| - | * Chronic evaporative **dry eye disease**[[https:// | + | * Chronic evaporative **dry eye disease**. |
| =====References===== | =====References===== | ||
| - | - Oral Antibiotics for Chronic Blepharitis. Onghanseng N, Ng SM, Halim MS, Nguyen QD. The Cochrane Database of Systematic Reviews. 2021; | + | - [[https:// |
| - | - Dry Eye. Clayton JA. The New England Journal of Medicine. 2018; | + | - [[https:// |
| - | - Inflamed Obstructive Meibomian Gland Dysfunction Causes Ocular Surface Inflammation. Suzuki T. Investigative Ophthalmology & Visual Science. 2018; | + | - [[https:// |
| - | - Molecular Mechanisms and Pathophysiology of Meibomian Gland Dysfunction. Yang L, Li Z. Experimental Eye Research. 2026; | + | - [[https://pubmed.ncbi.nlm.nih.gov/ |
| - | - A 6-Week, Prospective, | + | - [[https://pubmed.ncbi.nlm.nih.gov/ |
| - | - Pharmacological, | + | - [[https://pubmed.ncbi.nlm.nih.gov/ |
| - | - Pulsed Oral Azithromycin vs 6-Week Oral Doxycycline for Moderate to Severe Meibomian Gland Dysfunction: | + | - [[https:// |
| - | - Oral Antibiotics for Meibomian Gland-Related Ocular Surface Disease: A Report by the American Academy of Ophthalmology. Wladis EJ, Bradley EA, Bilyk JR, Yen MT, Mawn LA. Ophthalmology. 2016; | + | - [[https://pubmed.ncbi.nlm.nih.gov/ |
| - | - Interventions for Dry Eye: An Overview of Systematic Reviews. McCann P, Kruoch Z, Lopez S, et al. JAMA Ophthalmology. 2024; | + | - [[https://pmc.ncbi.nlm.nih.gov/ |
| - | - Thermal Pulsation in the Management of Meibomian Gland Dysfunction and Dry Eye: A Report by the American Academy of Ophthalmology. Tao JP, Shen JF, Aakalu VK, et al. Ophthalmology. 2023; | + | - [[https://pubmed.ncbi.nlm.nih.gov/ |
| - | - Intense Pulsed Light (IPL) Therapy for the Treatment of Meibomian Gland Dysfunction. Cote S, Zhang AC, Ahmadzai V, et al. The Cochrane Database of Systematic Reviews. 2020; | + | - [[https://pmc.ncbi.nlm.nih.gov/ |