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18 | EYEWORLD DAILY NEWS | JULY 24, 2021 ASCRS ANNUAL MEETING DAILY NEWS option to titrate to patient needs and comfort, Dr. Gupta said. Stud- ies have shown non-inferiority of iLux to LipiFlow, she added. Lastly, she mentioned TearCare (Sight Sciences), an external heating device and man- ual expression with forceps. The applicator is applied to the up- per and lower eyelids externally, Dr. Gupta said. The patients can actually blink during the treat- ment. There is a 15-minute cycle of heating followed by manual forceps expression. Marguerite McDonald, MD, spoke on clinical findings and diagnosis of lid margin disease. In her presentation, she touched on the use of meibography and noted that it's an invaluable tool to help the doctor make the diagnosis of MGD and to classify it; to teach the patient about their disease; to encourage compliance with the at-home regimen; to recommend an office treatment, if appro- priate; and to track response to treatment. Editors' note: Dr. Gupta has finan- cial interests with Alcon, Allergan, Aurea, Carl Zeiss Meditec, Johnson & Johnson Vision, Kala, New World Medical, Novartis, NovaBay, Ocular Science, ReGenTree, Shire, Sight Sciences, Sun Pharmaceuticals, and Tear Lab. Dr. McDonald has finan- cial interests with Alcon, Allergan, Bausch + Lomb, BlephEx, Johnson & Johnson Vision, Kala, Quidel, and Sun Pharma. MGD (especially when meibomian gland atrophy is not present). Meibography can also be helpful to identify those who will do bet- ter with the procedure, Dr. Gupta said. Another option is intense pulsed light (IPL) therapy, which is a non-laser light source, broad spectrum light. Optilight (Lume- nis) is FDA approved. This option, Dr. Gupta said, can be used in almost any patient and is gener- ally most successful for dry eye patients with any of the following: advanced MGD, telangiectasias lid margins, rosacea, or seborrheic dermatitis. It can be used to treat a range of severity of evaporative dry eye disease. In discussing effi- cacy, Dr. Gupta mentioned a study she participated in that showed that IPL increased TBUT, oil flow, and decreased telangiectasias. Microblepharoexfoliation is another option. BlephEx (Alcon) is a tool for mechanical debride- ment of the keratinized layer covering gland orifice and biofilm. Removing orifice obstruction can allow for better oil flow, and this can also help with a potential re- duction of Demodex and bacteria that are pro-inflammatory. In the literature, she said it's been shown to improve TBUT, symptoms, and gland function. iLux (Alcon) is a handheld device with a magnifier to inspect, heat, and express glands. This option focally applies heat via an LED light source to blocked glands. There is direct visualiza- tion of the glands during heating and expression, and there is the Cornea Day session focuses on the ocular surface D uring a session at ASCRS Cornea Day focused on the ocular surface, Preeya Gupta, MD, presented on office-based treatments for meibo- mian gland disease (MGD). It's becoming apparent that MGD is a real disease causing real symptoms, and it needs treatment, Dr. Gupta said. She pointed to things that are helping to improve diagnosis of dry eye disease and MGD, like point-of- care testing (MMP-9, osmolarity, OSI, TBUT) and better imaging (meibography). With so many options for in-office treatments of MGD, Dr. Gupta said it may be hard to know what is best to adopt. The good news, she said, is that many are effective, and there are more options for MGD treatment than ever before. Sometimes the best thing to do is to pick one and start there, she said. Dr. Gupta then went into specifics of several treatment options. LipiFlow thermal pulsation (Johnson & Johnson Vision), which was FDA approved in 2011, is a 12-minute office-based pro- cedure. It consists of precise heat and vectored pulsation applied to the posterior eyelid, and it can treat the upper and lower lids si- multaneously. Studies of LipiFlow have shown improved TBUT and gland flow, and it can be helpful to reduce surgical planning errors. This option is easy to use and pa- tients are comfortable, Dr. Gupta said. It may take 2–4 months to see the peak effect, she added, but it's an effective treatment for

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