Lid Margin Disease

These standardized, photovalidated scales have recently been used in numerous studies to evaluate therapeutics for the treatment of blepharitis.

Ora has used anatomical and structural classifications to develop the Ora Lid Margin Disease Digital Image Grading System for blepharitis and meibomitis. These standardized, photovalidated scales have been used in multiple recent studies to evaluate therapeutics for the treatment of blepharitis. 123

Meibomian Gland Disorder (MGD) can be defined through the use of Ora’s Lid Margin Disease Digital Image Grading System scales. These validated scales have been used in previous IND clinical trials (see above) in order to accurately assess lid margin redness, palpebral conjunctival redness, lid edge shape, keratinization, lash folliculitis, lash debris, meibomian gland secretion viscosity, meibomian gland secretion color, meibomian gland alignment, perigland redness, and lash loss and represent the only standardized scale for evaluating diseases of the lid margin.

Gland secretion grading is determined by rating the quality of secretion, the secretion viscosity and the secretion color, on scales from 0-3. Gland evaluation is determined by applying pressure to the lower lid with a sterile cotton swab, and grading the secretions of each chosen gland. Quality of secretion is evaluated from 0 (clear excreta) to 3 (secretions retain shape after expression). Secretion viscosity is determined from 0 (an oily secretion that flattens or beads briefly after expression) to 3 (a non particulate paste-like thickness that maintains its shape briefly after expression). Secretion color is graded from 0 (clear) to 3 (yellow).

Lid Margin Evaluation is also performed and involves analyzing regional lid edge redness separated by regions of the lower lid (temporal, medial, and nasal), lash folliculitis, lid hyperkeratinization, lash madarosis, cross-sectional posterior lid edge shape, and lash debris, all with scales from 0(normal) to 3 (severe). Using this system, we define control patients and MGD patients by certain criteria and are able to distinguish patients with MGD and without into two distinct groups.

  • 1. InSite Vision. Comparative study of AzaSite plus compared to AzaSite alone and dexamethasone alone to treat subjects with blepharoconjunctivitis. 2008 Oct. Available at: www.clinicaltrials.gov/ct2/show/NCT01102244?term=azasite+chronic+blephar...(Accessed October 2010).
  • 2. Alcon Research. A study to evaluate the clinical efficacy and safety of TobraDex ST compared to AzaSite in the treatment of subjects with moderate to severe chronic blepharitis. 2010 Apr. Available at: www.clinicaltrials.gov/ct2/show/NCT01102244?term=azasite+chronic+blephar... (Accessed October 2010).
  • 3. Torkildsen GL, Cockrum P, Meier E, et al. Evaluation of clinical efficacy and safety of tobramycin/dexamethasone ophthalmic suspension 0.3%/0.05% compared to azithromycin ophthalmic solution 1% in the treatment of moderate to severe acute blepharitis/blepharoconjunctivitis. Curr Med Res Opin. 2010 Dec. [Epub ahead of print]