Successful Tear Lipid Layer Treatment for Refractory Dry Eye in Office Workers by Low-Dose Lipid Application on the Full-Length Eyelid Margin

Purpose: To test tear lipid layer treatment by low-dose lipid application on the full-length eyelid margin for the treatment of office workers with dry eyes refractory to conventional treatments. Design: Prospective interventional case series. Methods: Thirty eyes of 30 office workers with dry eyes with dark tear interference images, which did not respond to conventional treatments, were included. To supply lipid using a commercially available nonpreserved topical medication having both polar and nonpolar lipid base, ofloxacin eye ointment (Santen Pharmaceutical, Osaka, Japan) was selected. Low-dose ofloxacin ointment application on the full-length eyelid margin was carried out three times a day for two weeks. The symptom of ocular dryness using a visual analog scale, tear interferometry to assess lipid layer thickness (LLT), corneal fluorescein staining, tear-film breakup time (BUT), and meibum expressibility gradings were compared. Results: After the treatment, the symptom score of ocular dryness decreased from 91.4 ± 11.9 to 33.6 ± 21.0 (P < .0001), LLT increased from 39 ± 4 nm to 161 ± 91 nm (P < .0001), BUT was prolonged from 2.6 ± 1.6 seconds to 4.8 ± 2.1 seconds (P = .01), and meibum expressibility gradings decreased from 2.8 ± 1.3 to 1.6 ± 1.3 (P = .0005). Conclusion: For office workers with refractory dry eyes, tear lipid layer treatment by low-dose ointment applied on the full-length eyelid margin was shown to be an effective approach. The applied lipid formed a uniform lipid layer, which contributed to tear stability, leading to the improvement of the symptom.