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Nevertheless, a warm compress to the eyelids is recommended as the 1st step for all 4 Stages of Meibomian Gland Dysfunction (MGD), Dry Eye, Blepharitis, Stye, or Chalazia as a summary of the research below.  Our treatment pathway is based on the 3rd party material below and feedback from you...the medical community.  Feel free to send us your peer reviewed papers involving the Scorpion 1-Touch system or the Heated Eye Pad.

Third Party Papers

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Referenced Treatment Algorithm

Treatment Algorithm for MGD Reprinted with permission from Investigative Ophthalmology & Visual Science


Stage
Clinical DescriptionTreatment
1

No symptoms of ocular discomfort, itching, or photophobia


Clinical signs of MGD based on gland expression
Minimally altered secretions: grade ≥2–4


Expressibility: 1


No ocular surface staining

Inform patient about MGD, the potential impact of diet, and
the effect of work/home environments on tear evaporation,
and the possible drying effect of certain systemic medications


Consider eyelid hygiene including warming/expression as
described below (±)

2

Minimal to mild symptoms of ocular discomfort, itching, or photophobia


Minimal to mild MGD clinical signs
Scattered lid margin features
Mildly altered secretions: grade ≥4–<8

Expressibility: 1


None to limited ocular surface staining: DEWS grade 0–7;
Oxford grade 0–3


Advise patient on improving ambient humidity; optimizing
workstations and increasing dietary omega-3 fatty acid intake (±)


Institute eyelid hygiene with eyelid warming (a minimum of
four minutes, once or twice daily) followed by moderate to
firm massage and expression of MG secretions (+)


All the above, plus (±)
Artificial lubricants (for frequent use, nonpreserved preferred)
Topical azithromycin
Topical emollient lubricant or liposomal spray
Consider oral tetracycline derivatives

3

Moderate symptoms of ocular discomfort, itching, or photophobia with limitations of activities


Moderate MGD clinical signs
↑ lid margin features: plugging, vascularity
Moderately altered secretions: grade ≥8 to <13
Expressibility: 2


Mild to moderate conjunctival and peripheral corneal staining,
often inferior: DEWS grade 8–23; Oxford grade 4–10

All the above, plus
Oral tetracycline derivatives (+)
Lubricant ointment at bedtime (±)
Anti-inflammatory therapy for dry eye as indicated (±)
4

Marked symptoms of ocular discomfort, itching or photophobia
with definite limitation of activities


Severe MGD clinical signs
↑ lid margin features: dropout, displacement
Severely altered secretions: grade ≥13
Expressibility: 3


Increased conjunctival and corneal staining, including central staining: DEWS grade 24–33; Oxford grade 11–15


↑signs of inflammation: ≥moderate conjunctival
hyperemia, phlyctenules

All the above, plus
Anti-inflammatory therapy for dry eye (+)
“Plus” disease Specific conditions occurring at any stage and requiring treatment. May be causal of, or secondary to, MGD or may occur incidentally

1. Exacerbated inflammatory ocular surface disease
2. Mucosal keratinization
3. Phlyctenular keratitis
4. Trichiasis (e.g. in cicatricial conjunctivitis, ocular
cicatricial pemphigoid)
5. Chalazion
6. Anterior blepharitis
7. Demodex-related anterior blepharitis, with cylindrical dandruff
1. Pulsed soft steroid as indicated
2. Bandage contact lens/scleral contact lens
3. Steroid therapy
4. Epilation, cryotherapy
5. Intralesional steroid or excision
6. Topical antibiotic or antibiotic/steroid
7. Tea tree oil scrubs
At each treatment level, lack of response to therapy moves treatment to the next level. A ± sign means that the evidence to support the use of the treatment at that level is limited or emerging; thus its use should be based on clinical judgment. A + sign indicates that the treatment is supported by the evidence at that stage of disease.
Meibum quality is assessed in each of eight glands of the central third of the lower lid on a scale of 0 to 3 for each gland: 0, clear; 1, cloudy; 2, cloudy with debris (granular); and 3, thick, like toothpaste (total score range, 0–24). Expressibility is assessed on a scale of 0 to 3 in five glands in the lower or upper lid, according to the number of glands expressible: 0, all glands; 1, three to four glands; 2, one to two glands; and 3, no glands. Staining scores are obtained by summing the scores of the exposed cornea and conjunctiva. Oxford staining score range, 1–15; DEWS staining score range, 0–33.