Managing Blepharitis: Tried-and-True and New Approaches睑缘炎：尝试和正确

Thanks to the efforts of the International Workshop on Meibomian Gland Dysfunction, clinicians now have a road map for classifying and managing this condition.1 The workshop standardized the definition of meibomian gland dysfunction (MGD), which can be one component of eyelid inflammation, called blepharitis. Blepharitis, which often contributes to dry eye syndrome, can cause many ocular symptoms, including itching, grittiness, photophobia, eyelid crusting, and red, swollen eyes. Beyond causing patient discomfort, the presence of blepharitis can affect the outcomes of cataract and refractive surgery. And, as the prevalence of blepharitis increases with age, clinicians can expect to see a growing number of cases in the coming years. How can ophthalmologists best manage this common, yet complex, condition? Starting with how to assess symptoms to determine appropriate treatment, three experts outline their approaches—with an eye to the tried and-true, as well as to newer techniques—that maybe prove helpful for some patients. The Significance of Symptoms A thorough ophthalmologic evaluation, along with a careful history, is critical for zeroing in on the best treatment approaches. Henry D. Perry, MD, chief of the cornea service at Nassau University Medical Center in East Meadow, N.Y., asks patients to complete the Ocular Surface Disease Index questionnaire to determine their symptoms, environment, and overall functioning. “This gives me an ability to quickly assess the significance of the problem on a scale of mild, moderate, or severe,” he said. Tests. In addition, Dr. Perry performs a number of tests to pinpoint whether symptoms are related to dry eye or MGD plus dry eye; these may include Schirmer tests without anesthesia, tear osmolarity tests, and lissamine green and fluorescein staining. “We also do meibomian gland expression, which helps us further categorize the degree of the problem,” said Dr. Perry. Dear diary. J. Daniel Nelson, MD, professor of ophthalmology at the University of Minnesota, in Minneapolis, involves patients in tracking clues to their condition. When symptoms arise, he has patients ask themselves three basic questions: 1. Is it me? Do I have a systemic condition, such as rosacea or lupus that’s become active? Are my joints achy? How am I feeling overall? Where am I in my menstrual cycle? The last question can be important, Dr. Nelson noted, because estrogen promotes inflammation. 2. Is it something I did? Did I switch cosmetics or just get my nails or hair done? Did I start a new medication? 3. Is it my environment? Have I started a new job or moved into a new place? Have I taken up a new hobby, such as painting? If patients can predict when symptoms will worsen, they can also be more aggressive with treatment, as needed, said Dr. Nelson. And even though blepharitis is typically treated only when symptoms are present, asymptomatic blepharitis may also need to be addressed before ocular surgery, he added. First Step: Patient Self-Care Patient self-care plays a major role in the management of blepharitis. Fatty acids. Omega-3 fatty acids are known to be anti-inflammatory, said Dr. Nelson. He starts some blepharitis patients on supplements of 1 to 3 g, two to three times daily. He advises, however, that it can take six to 12 months to see a definite effect. A small randomized clinical trial shows that omega-3 supplements are beneficial for MDG and blepharitis,2 but more

由于国际睑板腺功能障碍研讨会的努力，临床医生现在有了分类和管理这种状况的路线图。1该研讨会标准化了睑板腺功能障碍（MGD）的定义，MGD是眼睑炎症的一个组成部分，称为睑缘炎。睑缘炎通常会导致干眼症，会引起许多眼部症状，包括瘙痒，沙哑，畏光，眼睑结s和眼睛红肿。除了引起患者不适之外，睑缘炎的存在还会影响白内障和屈光手术的结果。并且，随着睑缘炎的患病率随着年龄的增长而增加，临床医生可以期望在未来几年中看到越来越多的病例。眼科医生如何才能最好地管理这种常见而又复杂的状况？从如何评估症状以确定合适的治疗方法开始，三位专家概述了他们的方法-着眼于久经考验的，真实的以及更新的技术-可能对某些患者有用。症状的重要性全面的眼科评估以及仔细的病史对于确定最佳治疗方法至关重要。纽约州东梅多市拿骚大学医学中心角膜服务负责人亨利·D·佩里（Henry D.Perry）要求患者填写眼表疾病指数问卷，以确定其症状，环境和整体功能。他说：“这使我有能力以轻度，中度或严重程度快速评估问题的严重性。”测试。此外，Perry博士还进行了许多测试，以查明症状是否与干眼或MGD加干眼有关。其中可能包括未麻醉的Schirmer测试，泪液渗透压测试以及赖氨酰胺绿和荧光素染色。佩里博士说：“我们还进行睑板腺表达，这有助于我们进一步对问题的程度进行分类。”亲爱的日记。明尼阿波利斯明尼苏达大学眼科学教授J. Daniel Nelson要求患者追踪病情线索。当出现症状时，他会让患者问三个基本问题：1.是我吗？我有全身性疾病，例如酒渣鼻或狼疮活跃吗？我的关节疼痛吗？我总体感觉如何？我月经周期在哪里？尼尔森博士指出，最后一个问题可能很重要，因为雌激素会促进炎症。 2.我做了什么吗？我是否换过化妆品，或者只是修剪指甲或头发？我开始新药了吗？ 3.是我的环境吗？我是否已开始新工作或搬到新地方？我是否有新的爱好，例如绘画？尼尔森博士说，如果患者能够预测何时症状会恶化，他们也可以根据需要采取更积极的治疗。他补充说，即使通常仅在出现症状时才治疗眼睑炎，但也可能需要在眼科手术之前解决无症状眼睑炎。

第一步：患者自我护理患者自我护理在睑缘炎的治疗中起着重要作用。脂肪酸。尼尔森博士说，已知Omega-3脂肪酸具有抗炎作用。他开始以1至3 g的补充剂开始某些睑缘炎患者，每天2至3次。但他建议，可能要花6到12个月才能看到明确的效果。一项小型的随机临床试验表明，omega-3补充剂对MDG和睑缘炎有益2，但更多

(1) Eyelid margin examination reveals inspissated glands (arrows) in meibomian gland dysfunction.

眼睑边缘检查显示睑板腺功能异常的腺体（箭头所示）

and larger studies are needed to clarify the role of supplementation and other factors. Can’t beat heat. “In my mind, the key treatment for these patients is heat,” said Dr. Nelson. “I have patients apply five minutes of moist heat at bedtime and first thing in the morning.” 我让患者在就寝时间和早晨的第一件事上施加五分钟的湿热 Dr. Perry prefers heat in the form of warm saltwater soaks, 佩里博士更喜欢以温暖的盐水浸泡的形式加热，他说这是等渗的which he says are more isotonic and thus more comfortable and less likely to wrinkle the eyelid skin. His regimen is four times a day for two weeks, then twice a day for a month, and twice a week after that. （面部肌肤比较敏感，眼部皮肤更加敏感，长时间热敷会让皮肤内环境发生变化，因此热敷需要遵循时间原则，不能常年每日多次热敷，博士建议一天4次，持续2周，然后一天2次，持续一个月，然后一周2次，）He explains to patients how the meibomian glands can become clogged, leading to a change in meibum composition from long-chain fatty acids to free fatty acids. 他向患者解释了睑板腺如何被堵塞，从而导致睑板组成从长链脂肪酸变为游离脂肪酸 “FFAs, combined with inflammation, cause saponification,” FFA与炎症相结合会导致皂化

(The meibomian glands are dilated and full of meibum that can be easily expressed. Frequently, soapy-looking bubbles are seen along the inferior lid margin. This saponification occurs when excess lipid secretions react with protein in the tears睑板腺扩张，充满了容易表达的睑板。 通常，在下眼睑边缘会看到肥皂泡。 当过多的脂质分泌物与眼泪中的蛋白质反应时，就会发生皂化)

 said Dr. Perry, who photographs the patient’s foamy tear film to demonstrate. He tells patients how heating the eyelid margin transforms fats—solid at room temperature—to a liquid, which gets secretions flowing again. 他告诉患者，加热眼睑边缘如何将脂肪（在室温下为固体）转化为液体，并使分泌物再次流动。Eyelid scrubs. Hygiene products come and go, said Dr. Perry. “And about 10 percent of people have an allergic component such as eczema or atopic dermatitis,” he said. “When you put a chemical on these patients, they won’t do well. That’s why I stick to saltwater soaks.” 卫生产品来来往往。他说：“大约10％的人患有过敏性成分，如湿疹或特应性皮炎。” “当您对这些患者使用化学药品时，他们的病情不会好转。这就是为什么我坚持盐水浸泡的原因。Dr. Nelson added that while lid scrubs can occasionally be irritating, part of the problem lies in technique. “Patients often pull down the lid and scrub the conjunctiva, rather than the lid margin,” said Dr. Nelson, “so they actually irritate their lids.” 尼尔森博士说：“患者经常拉下眼睑并擦洗结膜，而不是眼睑边缘，所以他们实际上会刺激眼睑。”Thus, dexterity can be an issue, and instruction is critical. Eyelid compression. Dr. Nelson has largely dispensed with lid scrubs and focuses instead on gentle compression, not rubbing, of closed eyelids—with or without the use of an eye pad. If blepharitis is severe, however, he instructs patients on how to use a cotton-tipped applicator to remove the cap of oil from the gland orifice. 眼睑压缩。纳尔逊（Nelson）博士在很大程度上省去了眼睑磨砂，而侧重于轻柔地按压而不是揉合闭合的眼睑（无论是否使用眼垫）。He also advises the daytime use of artificial lubricants to help wash out the eyes. 他还建议白天使用人造润滑剂帮助洗眼。。

需要进行更大的研究来阐明补充剂和其他因素的作用。无法击败热。尼尔森博士说：“在我看来，这些患者的主要治疗方法是加热。” “我让患者在就寝时间和早晨的第一件事上施加五分钟的湿热。”佩里博士更喜欢以温暖的盐水浸泡的形式加热，他说这是等渗的，因此更舒适，并且不太可能使眼睑皮肤起皱。面部肌肤比较敏感，眼部皮肤更加敏感，长时间热敷会让皮肤内环境发生变化，因此热敷需要遵循时间原则，不能常年每日多次热敷，博士建议一天4次，持续2周，然后一天2次，持续一个月，然后一周2次。他向患者解释了睑板腺如何被堵塞，从而导致睑板组成从长链脂肪酸变为游离脂肪酸。佩里博士说：“ FFA与炎症相结合会导致皂化。”他拍摄了病人的泡沫泪膜以进行演示。他告诉患者，加热眼睑边缘如何将脂肪（在室温下为固体）转化为液体，并使分泌物再次流动。眼睑磨砂。佩里博士说，卫生产品来来往往。他说：“大约10％的人患有过敏性成分，如湿疹或特应性皮炎。” “当您对这些患者使用化学药品时，他们的病情不会好转。这就是为什么我坚持盐水浸泡的原因。”纳尔逊博士补充说，尽管擦洗盖子有时会很烦人，但部分问题在于技术。尼尔森博士说：“患者经常拉下眼睑并擦洗结膜，而不是眼睑边缘，所以他们实际上会刺激眼睑。”因此，敏捷性可能是一个问题，而指导至关重要。眼睑压缩。纳尔逊（Nelson）博士在很大程度上省去了眼睑磨砂，而侧重于轻柔地按压而不是揉合闭合的眼睑（无论是否使用眼垫）。但是，如果睑缘炎很严重，他会指导患者如何使用棉签涂抹器从腺孔口取下油帽。他还建议白天使用人造润滑剂帮助洗眼。

Although the connection between Demodex mite infestation and blepharitis has been reported since at least the early 1960s,1 it may be overlooked by clinicians. Recent research points to a strong correlation between levels of Demodex and the severity of blepharitis (Fig. 2).2 “When we eradicate or cut down infestations, we can see patients improve,” said Scheffer C. G. Tseng, MD, PhD, medical director of the Ocular Surface Center in Miami. Subset susceptibility. More than 8 in 10 people over age 60 are infested with Demodex. 2 But some are troubled by the presence of Demodex mites, while others have no symptoms, said Dr. Tseng. He drew an analogy to the house-dust mite—some people can live with it and never get sick, but others have asthma attacks. In addition to precipitating hypersensitivity reactions, mites may cause direct damage, such as eyelash disorders, and may block meibomian glands. “They may also be a vector for a species of bacillus that causes rosacea-like problems,” said Dr. Tseng. Demodex diagnosis. “Demodex infestation is much more commonly found in patients who don’t respond to other treatment,” said Dr. Perry. With recalcitrant cases, Dr. Perry first uses a slit lamp to check for cylindrical dandruff (Fig. 2A), a very common sign of mites. If he finds it, he removes an eyelash and checks for mites under a microscope. When mites mate. On average, mites have a three-week lifespan, and hygiene is critical for interrupting their life cycle, said Dr. Tseng. “Mites should die out if you don’t let them mate.” Unfortunately, eyelids are less accessible to thorough cleaning because they are surrounded by the nose, eyebrow, and cheekbone. ”不幸的是，眼睑被鼻子，眉毛和che骨所包围，因此很难彻底清洁。面部如何控制螨虫数量？Tea tree oil. With both antimicrobial and anti-inflammatory effects, tea tree oil has been effective at eradicating mites, said Dr. Tseng, in either 50 percent lid scrubs or 5 percent lid massages. Because higher concentrations can be irritating, however, his team (with research supported by the National Eye Institute) worked to identify the active ingredient in tea tree oil for killing mites. They have developed a treatment containing this ingredient, which is better tolerated by patients. Dr. Tseng said, “This new lid scrub regimen, known as Cliradex, will be available this year.”

尽管至少自1960年代初以来就已经报道了蠕形螨螨感染与睑缘炎之间的联系，[1]但临床医生可能会忽略它。最近的研究表明，蠕形螨病的严重程度和眼睑炎的严重程度之间存在很强的相关性（图2）。2“当根除或减少侵染时，我们可以看到患者有所改善，”医学总监Scheffer CG Tseng博士位于迈阿密的眼表中心。子集敏感性。在60岁以上的人群中，有十分之八以上的人感染了蠕形螨。 2曾博士说，但有些人因蠕形螨的存在而感到困扰，而另一些则没有症状。他比喻为屋尘螨-有些人可以忍受而不会生病，而其他人则患有哮喘。除引起过敏反应外，螨虫还可能引起直接伤害，例如睫毛疾病，并可能阻塞睑板腺。曾博士说：“它们也可能是引起像酒渣鼻样问题的芽孢杆菌的媒介。”蠕形螨病诊断。佩里博士说：“对其他疗法无反应的患者更常出现脱德莫克斯病。”对于顽强的病例，Perry博士首先使用裂隙灯检查圆柱形头皮屑（图2A），这是螨虫非常常见的迹象。如果找到了，就移开睫毛，并在显微镜下检查螨虫。螨交配时。曾博士说，平均而言，螨虫的寿命为三周，而卫生对于中断其生命周期至关重要。 “如果不让螨交配，螨应该灭绝。”不幸的是，眼睑被鼻子，眉毛和che骨所包围，因此很难彻底清洁。茶树油。曾博士说，茶树油具有抗菌和消炎作用，可以有效根除螨虫，无论是50％的眼睑磨砂膏还是5％的眼睑按摩膏。但是，由于较高的浓度可能会令人烦恼，因此，他的团队（在国家眼科研究所的支持下进行了研究）致力于确定茶树油中的杀螨活性成分。他们开发了一种含有这种成分的治疗方法，患者对此病的耐受性更好。曾博士说：“这种名为Cliradex的新盖擦洗方案将于今年推出。”

(2) Ocular manifestations of Demodex infestation. (A) typical cylindrical dandruff at the root of the eyelashes (red arrow); (B) misdirected lashes (blue arrow); (C) meibomian gland dysfunction (orange arrow); (D) lid margin inflammation (black arrow); (E) bulbar conjunctiva inflammation; (F) corneal infiltration and pannus (yellow arrow).

（2）蠕形螨病的眼部表现。 （A）睫毛根部的典型圆柱形头皮屑（红色箭头）； （B）睫毛方向错误（蓝色箭头）； （C）睑板腺功能障碍（橙色箭头）； （D）眼睑缘发炎（黑色箭头）； （五）延髓结膜发炎； （六）角膜浸润和血管pan（黄色箭头）。

Blinking. 眨眼

 Expression of the meibomian glands is also important.睑板腺的挤压也很重要Meibomian glands secrete oil by nerve action and the mechanical action of blinking, said Dr. Nelson. But the rate of blinking decreases with age and near vision tasks such as computer use. 睑板腺通过神经作用和眨眼的机械作用分泌油脂。但是，眨眼的速度会随着年龄的增长和近距视觉任务（例如计算机的使用）而降低。“I’ve been amazed how symptoms will resolve just with heat and blinking exercises,” 他说：“令我惊讶的是，仅通过加热和眨眼运动，症状就会如何解决。he said, noting that this is the main change he’s instituted in recent years. 他指出，这是他近年来做出的主要改变。He advises patients to concentrate on blinking at least 20 times, four times a day. 他建议患者每天至少眨眼20次，一天四次。Add Medications If Needed If self-care measures are not effective, medication may be needed. Topical antibiotics. Dr. Nelson adds an antibiotic, such as erythromycin or bacitracin ointment, if inflammation remains a problem. “I start with erythromycin ointment at bedtime because it has both antibiotic and anti-inflammatory effects and is really cheap.” 添加一种抗生素，例如红霉素或杆菌肽软膏。 “我从睡前开始就用红霉素软膏（部分用户会感到刺激性，盐酸左氧氟沙星眼膏眼毒性和刺激性相对较小），因为它既具有抗生素作用又具有消炎作用，而且确实很便宜。Instead of squirting the medication into the eye, Dr. Nelson has patients put a little on a fingertip and wipe it across the closed eyelid near the lashes. 尼尔森博士没有将药物喷入眼中，而是让患者将手指放在指尖上一点，然后在靠近睫毛的闭合眼睑上擦拭。他说，以这种方式使用的药物可以非常有效地到达睑板腺和结膜。对于急性前眼睑睑炎Medication applied in this way reaches the meibomian glands and conjunctiva quite effectively, he said. For acute anterior blepharitis, Dr. Perry prefers bacitracin ointment, a potent option with good results over short periods of time. He noted that erythromycin has a place for infectious blepharitis in patients who are sensitive to bacitracin, but resistance rates as high as 50 percent remain a big concern. 但高达50％的耐药率仍然是一个大问题。3 A new option. For chronic cases of blepharitis, Dr. Perry routinely uses AzaSite after lid massage. This new option consists of azithromycin in a viscous, mucoadhesive ophthalmic formulation that is effective against gram-positive and gram-negative bacteria.4 “It has good penetration and lasts a long time—usually for a week or two.” Oral antibiotics. For posterior blepharitis, long-term oral tetracycline, minocycline, or doxycycline is more effective than topical antibiotics, said Dr. Perry, especially for patients一个新的选择。对于慢性眼睑炎，Perry医生在盖按摩后通常使用AzaSite。这种新的选择包括粘性，粘膜粘附性眼科制剂中的阿奇霉素，该制剂对革兰氏阳性和革兰氏阴性细菌有效。4“它具有良好的渗透性，并且持续时间很长，通常持续一到两周。

with rosacea. “As little as one pill twice a week can maintain a relatively good therapeutic dose in these patients for long periods.” Cyclosporine. Dr. Nelson finds topical cyclosporine to be more effective for blepharitis than for severe dry eye, although the results are not instantaneous.5 “If I’m considering it, I’ll start out with a topical steroid and then switch to cyclosporine.” One disadvantage, he said, is that it can lead to eye irritation. Steroids. Although steroids such as loteprednol ointment and antibioticsteroid combinations such as tobramycin-dexamethasone (TobraDex) or prednisolone-sulfacetamide (Blephamide) can work well, they’re not ideal, said Dr. Nelson. “As you increase the intensity of therapy, you increase the risk of side effects or complications,” he said. 他说：“随着治疗强度的增加，副作用或并发症的风险也会增加。“With steroids, you always have to worry about infection, cataract development, and increased IOP.” Dr. Perry added another cautionary note: “Not all cases of blepharitis are due to MGD or allergy or staph infections. Some are actually caused by herpetic infections. I’ve seen two or three cases that worsened from corticosteroid use.” ”佩里博士补充了另一条警告提示：“并非所有的睑缘炎病例都归因于MGD或过敏或葡萄球菌感染。有些实际上是由疱疹感染引起的。我发现有两到三例因使用皮质类固醇而恶化。1 Report of the TFOS Workshop on Meibomian Gland Dysfunction. Invest Ophthalmol Vis Sci. Special Issue. 2011;52(4):1917-2085. Available at: www.iovs.org/content/ 52/4.toc.

眨眼

闪烁睑板腺的表达也很重要。尼尔森博士说，睑板腺通过神经作用和眨眼的机械作用分泌油脂。但是，眨眼的速度会随着年龄的增长和近距视觉任务（例如计算机的使用）而降低。他说：“令我惊讶的是，仅通过加热和眨眼运动，症状就会如何缓解。”他指出，这是他近年来做出的主要改变。他建议患者每天至少眨眼20次，四次。如果需要，请添加药物如果自我护理措施无效，则可能需要药物治疗。外用抗生素。如果炎症仍然存在问题，Nelson博士会添加一种抗生素，例如红霉素或杆菌肽软膏。 “我从睡前开始就用红霉素软膏，因为它既具有抗生素作用又具有消炎作用，而且确实很便宜。”尼尔森博士没有将药物喷入眼中，而是让患者将手指放在指尖上一点，然后在靠近睫毛的闭合眼睑上擦拭。他说，以这种方式使用的药物可以非常有效地到达睑板腺和结膜。对于急性前眼睑睑炎，Perry博士更喜欢杆菌肽软膏，一种有效的选择，短期内效果良好。他指出，对杆菌肽敏感的患者，红霉素在感染性睑缘炎中占有一席之地，但高达50％的耐药率仍然是一个大问题。3一个新的选择。对于慢性眼睑炎，Perry医生在盖按摩后通常使用AzaSite。这种新的选择包括粘性，粘膜粘附性眼科制剂中的阿奇霉素，该制剂对革兰氏阳性和革兰氏阴性细菌有效。4“它具有良好的渗透性，并且持续时间很长，通常持续一到两周。

”口服抗生素。佩里博士说，对于后睑缘炎，长期口服四环素，米诺环素或强力霉素比局部抗生素更有效。

与酒渣鼻。 “每周两次低至一丸可以长期维持这些患者相对较好的治疗剂量。”环孢霉素。尼尔森博士发现，局部环孢菌素对睑缘炎比对严重干眼症更有效，尽管结果并非瞬间。5“如果考虑的话，我将从局部使用类固醇开始，然后改用环孢菌素。”他说，缺点之一是会导致眼睛刺激。类固醇。纳尔逊博士说，尽管类固醇（例如洛特泼诺软膏）和抗生素类固醇的组合（例如妥布霉素-地塞米松（TobraDex）或泼尼松龙-磺胺乙酰胺（Blephamide））效果良好，但并不理想。他说：“随着治疗强度的增加，副作用或并发症的风险也会增加。” “使用类固醇，您总是必须担心感染，白内障发展和眼压升高。”佩里博士补充了另一条警告提示：“并非所有的睑缘炎病例都归因于MGD或过敏或葡萄球菌感染。有些实际上是由疱疹感染引起的。我发现有两到三例因使用皮质类固醇而恶化。

Novel Therapies

A few newer treatments have made it to market, said Dr. Nelson, but have not undergone sufficient randomized clinical trials to prove their benefit and cost-effectiveness. Intense pulsed light. Developed by Rolando Toyos, MD, intense pulsed light (IPL) therapy was first used by dermatologists for treating rosacea, said Dr. Nelson. Operating much like a heat lamp, the treatment is now also used for patients with MGD. Thermal pulsation. “LipiFlow is an interesting device that provides heat and expresses the lacrimal gland, similar to the combined action of blinking and warm compresses,” said Dr. Nelson. Approved by the FDA, the 12-minute LipiFlow Thermal Pulsation Treatment (TearScience) is not yet covered by insurance, and it generally costs approximately $1,500 to $2,000 for both eyes. It appears to provide months of relief, said Dr. Perry. “But I’m troubled by the expense.” Duct probing. Meibomian gland duct probing, using probes invented by Steven Maskin, MD, works by physically opening up the occlusion caused by MGD. “Due to discomfort, it requires anesthetizing the patient’s lids before passing a small blunt cannula probe into the meibomian glands,” said Dr. Nelson.

新型疗法

尼尔森博士说，一些较新的治疗方法已经投放市场，但是还没有经过足够的随机临床试验来证明其益处和成本效益。强烈的脉冲光。尼尔森博士说，由医学博士Rolando Toyos开发的强脉冲光（IPL）疗法首先被皮肤科医生用于治疗酒渣鼻。这种治疗方法就像加热灯一样，现在也用于MGD患者。

热脉动。纳尔逊博士说：“ LipiFlow是一种有趣的装置，可以提供热量并表达泪腺，类似于眨眼和热敷的联合作用。”经FDA批准，12分钟的LipiFlow热脉动治疗（TearScience）尚不包括在保险范围内，通常两只眼睛的治疗费用约为1,500至2,000美元。佩里博士说，这似乎可以减轻数月的负担。 “但是我为这笔费用感到困扰。

”管道探测。 Meibomian腺导管探测使用的是MD的Steven Maskin发明的探头，其作用是通过物理打开MGD引起的阻塞。尼尔森博士说：“由于不舒服，需要先麻醉病人的眼睑，然后再将一个小的钝头套管探针穿入睑板腺。”