Please select the eligibility criteria that correspond to the clinical trial below.
Title: Eyelid Warming Technology for Relief of Meibomian Gland Dysfunction in an Asian Population
Brief Summary: Meibomian gland dysfunction (MGD), an extremely common clinical condition (seen in more than half of some Asian populations), affects the lipid producing meibomian glands in the eyelids. One function of the glandular secretions is to reduce evaporation of the tear film. In MGD the meibomian glands may become blocked for various reasons. The consequential retention and stasis of the secretion increases immune response as well as scarring response. This eventually results in an abnormal tear film and dry eye symptoms.

The current standard treatments include warm moist compresses, regular lid hygiene, oral antibiotics, topical antibiotic ointments and Omega 3 supplementation. Heating for an extended duration is important because it relieves the occlusion of blocked meibomian glands. However, improvised methods of heating are cumbersome and inefficient requiring repeated measures, often leading to lack of compliance. Today, there is a wider range of commercially available devices that help to unblock meibomian glands and relief dry eye symptoms. These devices may improve MGD treatment dramatically, but have not been tested in the warm climate of Singapore, and are not readily available.

The current study aims to test the efficacy of treatment for devices that utilize A) warm moisture (Blephasteam) and B) warmth (EyeGiene) in patients suffering from meibomian gland dysfunction. Patients will be asked to use Blephasteam and EyeGiene for a period of 4 weeks. The study will monitor patients for changes in tear film and lipid composition, as well as changes in the anatomy of meibomian glands. Additionally, dry eye symptoms will be documented in form of questionnaires. If the newer methods of managing MGD are found to be efficacious and safe, these treatment measures can be made available to patients in Singapore.


Options:
A: Key Inclusion Criteria:

* At least 22
* Subject has dry eye symptoms and uses artificial tears/lubricants regularly
* Subject has moderate to severe symptoms based on a dry eye questionnaire
* Subject has an abnormal tear break-up time
* Subject's eyelid glands secrete a low amount of meibum
* Best corrected visual acuity 20/100 or better
* Willing and able to comply with protocol
* Willing and able to provide consent
* English-speaking

Key Exclusion Criteria:

* Use of medications that treat dry eye disease or that are known to cause ocular dryness.
* Use of topical ophthalmic antibiotics, anti-glaucoma medications, steroids, NSAIDs
* Prior office-based dry eye treatment within the past 12 months, gland expression within the past 6 months, debridement within the past 3 months, punctal plus within 30 days, TrueTear within the past 2 weeks, or meibomian gland probing.
* History of eyelid, conjunctival or corneal surgery within the past year.
* Contact lens use within past 2 weeks
* Ocular conditions or diseases that could limit the safety or effectiveness of the study treatment.
B: Inclusion Criteria:

* Understand and sign an Informed Consent document;
* Have Meibomian Gland Dysfunction with evaporative dry eye disease at the screening visit;
* Agree not to wear contact lenses for the duration of the study;
* Other protocol-specified inclusion criteria may apply.

Exclusion Criteria

* History of eye surgery, as specified in the protocol;
* Eye infection or inflammation, as specified in the protocol;
* Eyelid abnormalities; eyelid tattoos;
* Treated with LipiFlow or iLux in either eye in the last 12 months;
* Contact lens wear within the 1 month prior to Screening;
* Other protocol-specified exclusion criteria may apply.
C: Inclusion Criteria:

* Eyelids must present with blocked meibomian gland openings (plugs), at least 1 visible MG plug in the 4 eyelids, or discernable change in consistency of meibum when MG expressed in upper or lower eyelids.
* At least one out of 8 questions on dry eye symptoms is answered with often or all the time (Appendix C, Questionnaire modified after Schein et al.,1997).
* Eyes should not show any other ocular surface pathology which required more treatment than eye lubricant and conventional eyelid hygiene.

Exclusion Criteria:

* Known history of thyroid disorders (diagnosed by physician).
* No ocular surgery within the previous 6 months and LASIK within the previous 1 year.
* Any intake of central nervous system and hormonal drugs within last 30 days and inability to withhold such drugs for at least 6 weeks.
* Active ocular infection or pterygium.
* Anticipated necessity to wear contact lens in the duration of the study.
* Living in the same household as another participant of the study.
* Any other specified reason as determined by clinical investigator, for example, the need to use any treatment or eyedrops (eg. Restasis) not permitted by the study.
D: Inclusion Criteria:

* All patients with meibomian gland dysfunction requiring treatment (defined below),
* who have given their written consent to the study.
* Meibomian gland dysfunction requiring treatment is classified by us as:
* Speed score\> 7, Lipiview \<61 nm, MGE \<5 of 15 open glands

Exclusion Criteria:

* Excluded are patients who, due to other diseases would not be able to fulfill the follow-up appointments or give an informed consent to the study
* Systemic medication with tetracyclin derivatives, antihistamines, isotretinoin, or nutritional supplements for MGD that started \<3 months before baseline examination
* Topical cyclosporine-A or steroids that started \<1 month before baseline examination
* Ocular surgery or trauma \<3 months before baseline examination
* Any eyelid abnormalities
* Systemic diseases resulting in dry eye.

Answer: C