A New Treatment for Dry Eye
Ever wonder why over the counter drops and even prescription drops don’t seem to resolve a chronic dry eye condition? Chances are you or your doctor is using the wrong approach.
Dry eye is a complex disease but the origin can be traced to two basic causes; lipid deficiency also called evaporative and aqueous deficiency or lack of tear production. Most eye drops including prescription, only deal with the aqueous component. They are missing the root cause of the dry eye.
In a 2012 study published by Lemp in the Journal Cornea* 85% of dry eye was evaporative, 15% aqueous only and 37% combined. If you’re one of the 85% drops are not dealing with the root cause.
With the introduction of clinical interferometers (an instrument used to measure tear lipid/oil layer thickness) doctors can now differentially diagnose a patients’ dry eye. The meibomian glands of the eyelids are responsible for secreting tear film oil. There are approximately 30 glands vertically oriented in each eyelid with the orifice on the eyelid margin. Not all glands secrete at one time and over time they can become clogged with meibum (congealed lipid) and stop working. When they are inactive for a long period they atrophy. Heating and expressing the glands can remove the meibum. When this is done, function of the glands is restored.
Meibum is like wax initially but once heated to 108 degrees it will liquefy and flow. This is accomplished by applying direct heat to the inside of the eyelid with a device called lipiflow. The device has a ceramic dome that vaults over the cornea and bellows that ride on the outside of the eyelid. When the device senses the inside of the eyelid reaches 108 degrees a controlled pressure is exerted on the outside of the eye to express the glands and clear the blockage.
Studies have shown following a single treatment an average of 2.5-3.0 times as many glands are functioning and continue to do so up to 2 years following treatment. To ensure the meibomian openings remain open; debris and epithelial tissue is mechanically removed about every 6 months. We believe the Lipiflow treatment does not need to be repeated frequently as long as good eyelid hygiene and removal of debrey is done on a regular basis.
Lipiflow treatment has been found to be successful at decreasing or improving dry eye in 85% of patients. Combined with additional treatment our clinical success rate is higher than the published 85%. In addition one in ten dry eye patients may have undiagnosed Sjogren’s disease. We are a CLIA approved lab and offer advanced testing for Sjogren’s disease. In Sjogren’s the first signs are dry eye and dry mouth. It is an auto-immune disease where white blood cells attack the mucous membranes of the body. We will assess whether this could be a contributing factor in each patients dry eye presentation.