EVAPORATIVE DRY EYE TREATMENT
Dry eye is complicated. For most patients, dry eye complaints are caused by an unstable tear film that evaporates too quickly, leaving dry spots that create blur and discomfort. This “Evaporative Dry Eye” (or meibomian gland dysfunction = MGD) is usually caused by abnormally thick or a reduced amount of oils or lipid in the tears due to blockages of the Meibomian (eyelid oil) glands. Simply described, the oils function as “chapstick” to prevent evaporation of otherwise thin, watery tears.
Making dry eye even more complex, 50-70 of patients have BOTH evaporative dry eye AND insufficient production of tears (water component). We treat low tear production with: (1) Supplementation with artificial tears and bedtime ointment; (2) Stimulation of tear production (Restasis®); (3) Prevention of rapid tear runoff (plugs for tear drains).
Diagnosing and treating evaporative dry eye is more difficult than low tear production. Traditionally, doctors could only evaluate the oil quality by squeezing the eyelid margin during a routine eye exam. Now, accurate analysis can be performed with LipiView®, an advanced device that measures the thickness of the oil layer in the tears. This greatly assists us in diagnosing abnormalities related to either blocked or excessive eyelid oils in the tear film. Once evaporative dry eye has been diagnosed, appropriate treatments can be prescribed.
LipiView also checks whether a patient’s blinking is normal or incomplete. Not closing the eyelids completely with each blink affects the spread of oils on the eye surface.
Today, we have several procedures to treat evaporative dry eye (or Meibomian gland dysfunction) with intensive, in-office “thermal pulsation procedures” that first warm the eyelids then squeeze the lids in a way that causes retains oils to be expressed (removed) from the blocked glands. This is highly effective in relieving symptoms in all but highly blocked glands, that need a more advanced treatment call meibomian gland probing.
LipiFlow® is a new procedure designed to treat the root cause of evaporative dry eye. LipiFlow® applies regulated warmth to the inner eyelid with an on / off massaging action, draining oils from the glands. Some describe this as “power cleaning.” It is believed this thorough emptying encourages more natural production of the oils needed to stabilize the tear film.
The comfortable 12 minute treatment is performed in a doctor’s office — and in some cases, on the same day as your evaluation. Many publications have reported great success with LipiFlow® treatment in as many as 79% of patients within four weeks of the start of treatment and lasting for nine months or longer.
- No longer feel dependent on eye drops for relief.
- Feel more productive at work and at school.
- Able to watch television and read even after a long day at work or during dry season.
- Able to go outdoors in the middle of day and enjoy sunny, warm weather.
- No longer feel as if “something is stuck under your eyelid”.
- Able to wear contact lenses again.
- Able to see the road clearly without squinting even on the sunniest of days.
- No longer have headaches and tiredness from eye problems.
iLux® is a new procedure that allows individualized targeted treatment of evaporative dry eye. The iLux treatment applies light-based heat to the eyelid, melting the trapped oils within the glands. After warming each lid in two different spots, focus-guided compressions are performed to express oils out of the glands. This allows the doctor to verify treatment effectiveness by viewing the gland oils as they are expressed. More difficult areas can be retreated until oils are expressed.