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Boston, MA, United States

Knop E.,Charite - Medical University of Berlin | Korb D.R.,Korb Associates | Blackie C.A.,Korb Associates | Knop N.,Hannover Medical School
Developments in Ophthalmology | Year: 2010

Purpose: The structure of the lid margin is insufficiently understood and defined, although it is of obvious importance in ocular surface integrity. Methods: The structure and function of the different zones of the lid margin are explained with a focus on dry eye disease. Results: The posterior lid margin, which is of particular significance for the integrity of the ocular surface, includes the meibomian glands that open within the cornified epidermis. Their obstructive dysfunction is a main cause of dry eye disease. The orifice is followed by the mucocutaneous junction, which extends from the abrupt termination of the epidermis to the crest of the inner lid border. The physiological vital stainable line of Marx represents its surface, and can be used e.g. as a diagnostic tool for the location and functionality of the meibomian gland orifices and lacrimal puncta. The marginal conjunctiva starts at the crest of the inner lid border and forms a thickened epithelial cushion. This is the point closest to the globe, and represents the zone that wipes the bulbar surface and distributes the thin preocular tear film. It is hence termed the 'lid wiper' and pathological alterations that result in a vital staining are a sensitive early indicator of dry eye disease. Conclusions: The margin of the eyelid is an important but currently underestimated structure in the maintenance of the preocular tear film and of the utmost importance for the preservation of ocular surface integrity and in the development of dry eye disease. © 2010 S. Karger AG, Basel. Source


Korb D.R.,Korb Associates | Korb D.R.,TearScience | Blackie C.A.,Korb Associates | Blackie C.A.,TearScience
Cornea | Year: 2010

A new and previously unpublished thermodynamic treatment device, which for the first time applies heat directly to both inner eyelid surfaces with a precision-controlled resistive heater while pulsating pressure is simultaneously applied to the outer eyelids using an inflatable air bladder, was used to restore meibomian gland functionality for a subject with severe evaporative dry eye. The subject, a 39-year-old white woman of light complexion with severe symptoms and corroborating objective signs of dry eye, had been unsuccessfully treated for 3 years by 7 practitioners. Using a new standardized meibomian gland expression device, a diagnosis of nonobvious meibomian gland dysfunction, where none of the approximately 24 meibomian glands of the right lower eyelid and 1 meibomian gland of the left lower eyelid were functional, was made. The patient underwent a single 12-minute treatment per eye with the treatment device. The treatment restored the functionality of 8 glands in each eye, doubled the fluorescein break-up time (FBUT) from 5 to 10 seconds, and decreased the symptom scores by approximately 80% for the entire follow-up period of 3 months. © 2010 by Lippincott Williams and Wilkins. Source


McMonnies C.W.,University of New South Wales | Korb D.R.,Korb Associates | Korb D.R.,Tear Science Inc. | Blackie C.A.,Korb Associates | Blackie C.A.,Tear Science Inc.
Contact Lens and Anterior Eye | Year: 2012

Purpose: To examine the role of elevated corneal temperature in the development of rubbing/massage-related corneal deformation and the possibility that warm compresses in the management of meibomian gland dysfunction or chalazion could contribute to such adverse responses. Methods: With reference to reports of corneal deformation associated with meibomian gland dysfunction, chalazion, dacryocystoceles and post-trabeculectomy, the mechanisms for increased corneal temperature due to ocular massage, especially when combined with warm compresses are examined. Results: Several mechanisms for rubbing/massage to elevate corneal temperature have been described, apart from the application of warm compresses or other forms of heat. Conclusions: Raised corneal temperature helps to explain corneal deformation which develops in association with rubbing or massage in conditions such as keratoconus, chalazion, post-trabeculectomy, post-laser assisted in situ keratomileusis, post-graft and dacryocystoceles. When combined with warm compresses or other methods of heat delivery to the eye, the elevation of corneal temperature appears to explain how meibomian gland dysfunction treatment involving warm compresses and massage could induce rubbing-related deformation. Patients whose management involves iatrogenic ocular massage appear to require screening for risk of corneal deformation. Risk may be increased for patients with a concurrent habit of rubbing their eyes abnormally in response to allergic itch for example. It appears to be possible to modify ocular massage techniques to reduce the risk of corneal deformation. Careful tutoring and follow-up using corneal topography appears to be required when massage is prescribed, especially when used in conjunction with heat application. © 2012 British Contact Lens Association. Source


Korb D.R.,Korb Associates | Korb D.R.,TearScience | Blackie C.A.,Korb Associates | Blackie C.A.,TearScience
Eye and Contact Lens | Year: 2010

Objective: To determine whether Marx's line of the upper lid is visible in upgaze without lid eversion, thus raising the possibility that the line may not be the contact area for the upper lid wiping of the ocular surfaces. Methods: Consecutive patients in a broad-spectrum practice were enrolled. Exclusion criteria included patients of Asian descent, active anterior segment pathology, obvious lid alterations or deformities, strabismus more than 20Δ. A 20-μL drop of 2% fluorescein was instilled into the lower eyelid conjunctival sac. The complete length of the upper lid margin, in upward fixation (∼45°, with the eyes open), was examined for Marx's line. Results: Sixty-eight males and 131 females were enrolled. The age range was 18 to 80 years; mean age = 51.7 ± 14.3 years. Before eyelid eversion, Marx's line was visible in 99.0% of eyes and was visibly continuous for the entire eyelid margin length in 93.2% of eyes. Conclusions: Marx's line of the upper lid is visible in upgaze, without lid eversion, suggesting that is not the contact area for the upper lid wiping of the ocular surfaces in that position of gaze. Further research is required to determine the position and visibility of the line through all other lid positions during blinking. Copyright © Contact Lens Association of Ophthalmologists, Inc. Source


Korb D.R.,Korb Associates | Korb D.R.,TearScience | Blackie C.A.,Korb Associates | Blackie C.A.,TearScience
Eye and Contact Lens | Year: 2013

Objective: The aim of this study was to investigate whether a single case of meibomian gland dysfunction (MGD), with significant MG dropout resulting in evaporative dry eye, could be effectively treated with the LipiFlow (a new Food and Drug Administration-approved thermodynamic pulsatile treatment). Materials and Methods: A 39-year-old white woman experienced severe dry eye symptoms because of MGD with considerable MG dropout resulting in evaporative dry eye. Standardized diagnostic MG expression and meibography led to the tentative diagnosis of nonobvious MGD (only 1 functional MG on each lower lid) and MG dropout (∼50% of the lower lid MGs were missing with the remaining MGs being severely truncated). The patient underwent a single 12-min LipiFlow treatment per eye and returned for follow-up at 1 and 7 months posttreatment. RESULTS: The LipiFlow treatment increased the number of functional lower lid MGs from 1 to 5 glands OD and 1 to 7 glands OS at 1 month with slight regression at 7 months (4 OD and 4 OS); increased fluorescein break-up time from 4 to 7 sec OD and 4 to 9 sec OS at both 1 and 7 months; and decreased symptom scores by approximately 50% at 1 month and approximately 75% at 7 months. Conclusions: These results demonstrate the effectiveness of the LipiFlow in restoring MG function and improving ocular comfort even in this particular case of significant MG dropout and MG truncation. © 2013 Contact Lens Association of Ophthalmologists. Source

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