New Frontiers in Dry Eye Treatments:
As new treatments enter the marketplace, clinical practice patterns are still being optimized. Future head-to-head studies will clarify the optimal method for treatment, number of treatments, frequency intervals of these new exciting options.
Currently, we are beginning a head to head study at Visionary Ophthalmology to see which of these options works the best based on Severity Scores of Ocular Rosacea and Dry Eye. I am not a paid consultant for any of the companies discussed below nor is anyone on my team, so we hope to bring a more objective measure to outcomes assessments for the treatments below. Currently many of the eyeMDs who tout the benefit of each of the new technologies below are paid by the respective companies which removes a level of objectivity needed in assessing which modality is best for your eyes.
IPL:
Intense Pulse Light Therapy (IPL) is a new therapy to unplug the meibomian glands which are the glands at the base of each eyelash along the upper and lower lid margins.
IPL uses intense pulses of non-coherent light (so it is not a LASER) distributed over a range of wavelengths from 500 nm to 1200 nm to open these glands.
These glands produce the lipid or fatty part of the tear. This complex lipid material is made up of about 90 different proteins and helps prevent it from evaporating too fast and allows the tear to properly lubricate the cornea.
IPL works as a powerful warm compress to liquefy the toothpaste-
like secretion plugging the Meibomian glands and to improve their pumping
mechanism when blinking. Relief is immediate and the frequency and intensity
of flare-ups of Blepharitis– an inflammation of the margins of the eyelids- gets
dramatically reduced.
In addition, many people with Blepharitis also suffer from Rosacea, a redness
and inflammation of the central part of the face (specially nose and cheeks). IPL,
in addition to reducing Blepharitis, reduces the signs and symptoms of Rosacea.
IPL therapies are relatively comfortable and quick. They require a set of monthly
10 to 15 minutes sessions at the beginning usually for 6 session and then maintenance treatments on an annual basis. It can take 4 sessions before an improvement is noted.
Lipiflow:
Is a revolutionary new mechanism for treating dry eye. A soothing, warm heating machine is gently placed on the eye and a massaging motion is used on the inner and outer surfaces of each eyelid to attempt to restore the function of the meibomian gland and allow the lipid material to flush out.
In a clinical study, 79% patients reported improvement of their overall dry eye
symptoms within four weeks, ranging from 10% to 100% improvement. LipiFlow
is a new procedure designed to treat the root cause of Evaporative Dry Eye,
blocked Meibomian glands. Opening and clearing these blocked glands can allow
them to resume natural production of lipids (oils) needed for a healthy tear film.
Some treatments attempt to add more liquid to your tears, but without the
complex natural oil, tears continue to evaporate faster than produced. LipiFlow®
is intended for the application of localized heat and pressure in adult patients with Meibomian Gland Dysfunction
(MGD), also known as evaporative dry eye or lipid deficient dry eye. Unlike
traditional dry eye treatments (e.g., warm compresses, wetting drops and
ointments) that address dry eye symptoms, LipiFlow treats the root cause, the
obstructed Meibomian glands. The goal of unblocking the glands is to allow
them to resume their natural production of lipids required for a healthy tear
film.
Meibomian Gland Probing (MGP):
Meibomian Gland Probing (MGP) is highly successful in restoring meibum secreting lid functionality persisting up to at least 7 months. MGP a more invasive procedure where a cannula (not a needle) is used to probe the meibomian glands. Sometimes steroids are injected into the gland to open the gland and break open scar tissue.
Many people have felt immediate relief, though it can take two or three sessions and time for dry eye symptoms to improve. MG Probing has been shown in studies to rapidly increased number of expressible glands per lid which was maintained up to at least 7 months post probing.
If most of the meibomian glands are scarred and no longer functioning, it is possible to have minimal relief even with MGP. (See Step Ladder to see of other options if MGP does not help).
MGP with steroid injection may enable even greater symptom reduction than MGP alone in select cases of moderate to severe symptoms and/or signs, significant co-morbid disease, retreatment and possibly chalazion.