Eye Express is the expression of Meibomian gland oils along the lid margin. There have been no studies to show that this is better or worse than Intense Pulse Light (IPL) Meibomian Gland expression where the expression occurs after the IPL treatments have been applied to the lower lid area.
Below is an Meibomian Gland Expression after IPL. You can see how the oils come out like toothpaste which is abnormal. The oil should come out like yellowish or amber colored olive oil. These toothpaste like secretions we believe, clog up the glands and make them scar and disappear from view on the Lipiview or Lipiscan.
Eye Express is similarly done without the prior IPL treatment. Warm/hot compresses are placed on the eyelids for approximately 10-12 minutes and then the expression occurs. Some patients are concerned about the safety of IPL and prefer to not have the IPL before eye expression. IPL has been shown to be safe. Here is a previous post about all the reported risks of IPL: https://drcremers.com/2017/02/intense-pulse-light-ipl-risks-and.html?q=IPL
I have tried the Mastrota paddle and the titanium, Flexx MGE Broad 9mm, 12 Degree Angle from Ocu Sci. The most effective thus far has been using 2 cuetips soaked in proparacaine or fluorocaine so we can show the contrast of the white toothpaste secretions against the white cuetip when we video tape the results of the gland expression.
I have had 2 more patients who showed an improvement on their Lipiscan/Lipiview of the amount of oil in their glands. I am still not sure how to explain this as we have no studies showing a scarred or disappearing gland can be restored to life. If you are a patient who has been treated with IPL, Lipiflow, Meibomian gland probing and your eyeMD says you have an improvement in the gland length and oil content of the gland, please let me know and send me the before and after photos. I am trying to publish a case series on this.
Here are some recent papers on the subject.
Sandra Lora Cremers, MD, FACS
Can J Ophthalmol. 2016 Aug;51(4):249-53. doi: 10.1016/j.jcjo.2016.01.005. Epub 2016 Jun 22.
Outcomes of intensepulsedlight therapy for treatment of evaporative dry eye disease.
To determine the clinical outcomes of intensepulsedlight (IPL) therapy for the treatment of evaporative dry eye disease (DED).
DESIGN:
Multicentre cohort study.
PARTICIPANTS:
Patients with a diagnosis of meibomian gland dysfunction (MGD) and dry eye presenting to the ophthalmology clinic at either the Duke Eye Center, Durham, NC, or Matossian Eye Associates’ private practice in Pennington, NJ, and Doylestown, PA.
METHODS:
Clinical data were reviewed from 100 patients with diagnosis of MGD and DED who underwent IPL therapy from September 2012 through December 2014 at 1 of 2 centres (Duke Eye Center or Matossian Eye Associates). Demographics, clinical history, examination findings (eyelid and facial vascularity, eyelid margin edema, meibomian gland oil flow, and quality score-all graded on a scale of 0 to 4), tear break up time (TBUT), and ocular surface disease index (OSDI) scoring data were collected from each visit.
RESULTS:
On average, patients underwent 4 IPL sessions. There was significant decrease in scoring of lid margin edema (mean = -0.3; range -1.5 to 0), facial telangiectasia (mean = -0.7; range -2.5 to 0), lid margin vascularity (mean = -1.2; range -2.5 to 0), meibum viscosity (mean = -1.1; range -3 to 0), and OSDI score (mean = -9.6), all with p < 0.001. There was a significant increase in oil flow score (mean = 0.9, range -0.5 to 2) and TBUT (mean = 3.4 seconds, range -2 to 7), both p < 0.001. No significant changes in intraocular pressure or acuity were noted. There were no cases of adverse ocular effects.
CONCLUSIONS:
IPL therapy for evaporative DED is a safe procedure. The positive change in objective clinical examination findings and subjective OSDI scoring data suggest that IPL is an effective treatment for patients with evaporative DED.
Dry eye disease (DED) is a tear film disorder resulting in hyperosmolarity of the tear film and inflammation of the ocular surface. DED is also referred to as keratoconjunctivitis sicca (KCS) and dry eye syndrome. DED represents a significant public health issue, particularly in older adults, and needs more research and attention. Despite the urgent need for safe and effective pharmacotherapies, there is currently only one approved medication, Restasis®, to tackle DED. In this review article, we present an overview of DED, classification, epidemiology, pathophysiology, diagnosis, and risk factors of DED. Special emphasis is placed on current treatment options for DED such as artificial tears, lipid-containing lubricants, liposomal spray, inserts, anti-inflammatory or immunosuppressant drops, antibiotics, dietary omega-3 essential fatty acids, autologous serum, intense–pulsed–light (IPL), punctual plugs, moisture-retaining eyeglasses, hydrophilic bandage contact lenses and secretagogues. The review also summarizes trends in DED treatment that are patented and are currently under investigation in clinical trials.
