Does Lipiflow Work? Does it improve Meibomian Gland Function? Yes, Lipiflow can improve Meibomian gland structure and function.

When Lipiflow first came out in 2011, many eyeMDs and ODs were very skeptical. Would it really do anything? Would it help patient relieve their dry eye symptoms? Would it help regenerate meibomian glands? I too was very skeptical. At an initial price of $2000 when it first came out, it seemed to expensive for most patients to even try it.

Years later, we are seeing many patients improve after Lipiflow. While it is technically indicated to save meibomian glands, I am seeing many patients feel a significant improvement and even being pain free after Lipiflow. It is not a guarantee, but it is worth having performed if you have enough glands remaining. If you have too few glands left, it might be too late to have Lipiflow, which does not hurt and usually takes about 12 minutes.

I am seeing more and more patients have a clear improvement on meibography after the Lipiflow. A previous post is noted below, but the below photos are of a patient who feel almost immediate relief of chronic eye burning and her meibomian gland structure clearly improved.

This patient below’s symptoms went from a 8 out 10 pain to about a 2 out of 10 pain.
The oil that is expressed at her lid margin with lid pressure also looks more clear and less thick.

Look at the infrared images also. You can see that her right lower lid had what appears to be absent-glands and they seemed to have filled up. 

This is the photo of the Right Eye Before Lipiflow (11/2/2017) and After 12/14/17.
You can see improvement in the filling of the meibomian gland both on the regular photo and on the infrared photo. No PRP was injected.

 This is the Infrared photo of the Right Eye Before Lipiflow (11/2/2017) and After 12/14/17

This is the left eye Before Lipiflow (11/2/2017) and After 12/14/17.

The left eye also looks a bit better.

 This is the Infrared photo of the left eye Before Lipiflow (11/2/2017) and After 12/14/17. You can see less “black” empty spaces  after the Lipiflow.

Not everyone gets this improvement in symptoms or meibomian gland structure and function after Lipiflow. I am not sure why. It could be related to a patient’s immune status, how much scar tissue are in the meibomian glands to start with (microscopically….and meibography cannot tell us this), how much Omega 3 they are on, how much screen time do they have, any history of chronic allergy or blepharitis which I believe causes more microscopic scar tissue to form. 
What I have learned about the Lipiflow and meibography:
1. Meibography likely has an inherent “false positive” and “false negative rate” rate that depends on who does the meibography and how far down the lid is pulled down. It can be hard in some patients to image the full lid. It will be important to follow a patient’s meibography over time to see how gland structure looks with aging. There is a learning curve to getting a great meibography and a good technician is a must to decrease variability between scans. The only way to know for sure if the meibomian glands have more oil is to take a biopsy or sample of the eyelid, which is not possible. I await animal studies that can do this to prove there is more oil in the glands after Lipiflow, IPL, and Meibomian gland probing. This could determine which is over all better. 
Currently we need really good controls of all ages of patients that:
a. do not spend more than 3-4hrs on any electronic screens per day, especially children
b. do not have a history of chronic blepharitis, allergy
c. have never had Accutane
d. no history of autoimmune disease
e. no history of cancer, radiation, trauma to eyelid.
If anyone out there fits the criteria for a “Normal Control” please let me know: we need to image your glands and follow them. 

Soon there will be no one in this country or world who fits “a” as everyone is on some sort of screen more than 4hr a day it seems…..especially kids. 

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