Dry Eye Disease

Dry eye can result from various problems. As we age, everyone’s tear production drops. This is especially true of women after menopause. Often, tear quality is diminished when the Meibomian gland is blocked because tears evaporate too quickly from the eye without the protection of the outer oil layer. A variety of medications can also reduce tear production: antihistamines, diuretics, beta-blockers, sleeping pills, nerve medications, and pain relievers.

Dry eye really comes down to one of these (or a combination of) three problems:

Lack of saline water

Dysfunctional Meibomian oil glands

Inflammation of the glands that make the saline water and oil

Research has helped to understand what is behind most cases of dry eye syndrome — in 86 percent of cases it is Meibomian Gland Disease. The reduction or full blockage of these glands is what causes tear film to evaporate on the eyes, rather than providing necessary lubrication. That creates the irritation that is common with dry eye.

LipiFlow is the only electronic device cleared by the FDA for the treatment of Meibomian gland dysfunction. To gain this clearance, clinical studies needed to show the effectiveness of LipiFlow.

LipiFlow utilizes Vectored Thermal Pulsation technology and a patented algorithm of precise heat that is applied to the inner eyelids with directed gentle massage to remove blockages from the Meibomian glands. This treatment is designed to restore the natural oil flow to the tear film that covers the eye’s surface.

You’re a good candidate for LipiFlow if the basis of your dry eye is the quality of your tears. When the Meibomian glands are blocked, necessary lipids are not released, so your tears don’t have the necessary oils to effectively regulate evaporation. To assess your candidacy for LipiFlow, we evaluate your tears’ lipid layer and identify gland blockage.

LipiFlow is a painless treatment that provides immediate relief to most patients. By clearing the blocked or impeded Meibomian glands, normal tear production is returned. This condition can be chronic, so most patients will need to repeat LipiFlow treatments on a yearly basis.

LipiFlow has been cleared by the FDA for treatment of dry eye due to Meibomian gland dysfunction. To gain this approval, LipiFlow had to be proven safe and effective in clinical studies. This is a very safe, very low-risk procedure. LipiFlow simply delivers controlled heat and pulsating gentle massage movement to the eyelids. This is completely non-invasive and safe.

Certain patients with various eye conditions cannot have LipiFlow. These are patients who have had ocular surgery or injury within the past 3 months. Those with active ocular infection or ocular herpes within the last 3 months. Also, abnormalities with the eyelid, such as entropion, ectropion, severe ptosis, and others, can preclude a patient from being eligible for LipiFlow.

There are a few things to do before your LipiFlow treatment:

Don’t wear your contact lenses for at least 4 hours prior to your appointment.

Don’t use any artificial tears for 24 hours prior to your appointment.

Don’t use any eyelid creams or ointments for 24 hours prior.

Don’t use any oil-based ophthalmic drops (Restasis) for 24 hours prior.

Don’t swim in a chlorinated pool at least 12 hours prior to your appointment.

Remove all make-up.

You’ll be in our Story Avenue offices for about 45 minutes to one hour. We place mild anesthetic eye drops in both eyes. Plus, we loosen any debris around the edge of your eyelids prior to your LipiFlow treatment. The actual treatment is usually done on both eyes at the same time. The LipiFlow device has two six-minute cycles. There is a warming phase, followed by intermittent pulsations, and then constant pressure.

At The Eye Care Institute, our LipiFlow treatments are not painful at all. The treatment simply involves the application of controlled heat to the inner eyelids while at the same time applying intermittent gentle pressure to the outer eyelid. This is akin to a massage of the eyelids, and it is very effective for then helping the eyelids secrete the lipids that have blocked the Meibomian glands. There isn’t any pain involved with a LipiFlow treatment.

If you’re not one of the 86 percent of people whose dry eye is due to blocked Meibomian glands, our other treatments for dry eye, such as various medications that can either control cornea inflammation, reduce eyelid inflammation, or stimulate tear production are all painless treatments. If your tears are exiting your eyes too quickly, we may insert punctal plugs to partially or completely close your tear ducts. These are painless treatments, and the plugs can be removed later if your condition changes.

Many treatments for dry eye symptoms only provide short-term, fleeting relief. Eyedrops simply add fluid to the eyes temporarily. Warm compresses applied to the front of the eyelids also provide temporary relief because they don’t completely clear blocked Meibomian glands. Treatments, such as fish oil, can reduce irritation from other issues, but again they don’t clear the blocked glands.

John C. Meyer, MD said “science has finally caught up to the symptoms and conditions of dry eye disease.” He continued “Previously, our treatment options were limited to only one prescription eye drop, Restasis, over the counter tears and suggestions such as eye vitamins and using warm compresses. Finally, there is an instrument which can diagnose and treat Meibomian Gland Disease, which is the cause of over 86% of all dry eye disease.” I personally had the treatment and it works. My eyes are much more comfortable, continued Dr. Meyer.

At The Eye Care Institute, we’ve found that a single LipiFlow treatment works for most patients. The procedure is painless, and we treat both eyes at once. The entire LipiFlow treatment takes around 20 minutes and you should allow 60 minutes for your total visit time.

While LipiFlow doesn’t need a series of treatments, in most patients with Meibomian Gland Dysfunction their dry eye can be chronic. For that reason, for some patients, we recommend a yearly LipiFlow treatment to keep the glands open and functioning.

There isn’t any recovery required after LipiFlow treatment. You can get right back to your normal activities.

The Meibomian Gland is a protective gland which produces oils helpful to eye health and the production of tears. When production from the Meibomian Gland slows or is blocked, oil production is reduced. This stoppage, or reduction, in gland production causes tear film to evaporate. Since the surface of the eye is not being protected due to tear film loss, discomfort (dry eye disease) occurs.

It’s not a guarantee, but you can lessen your risks of developing Meibomian Gland Dysfunction (MGD) by performing some cleaning of your eyelids. Most people don’t think about cleaning their eyelids as a part of their regular personal hygiene, such as washing your face or brushing your teeth, but caring for your eyelids can provide the first line of defense against developing MGD.

Healthy blinking — When we blink, we activate the Meibomian glands in our eyelids to release and spread essential protective oils across the tear film on the eye surface. A complete healthy blink at the proper frequency helps to maintain healthy conditions on the eye surface, and it helps you keep from developing Meibomian Gland Dysfunction.

This can seem to be an odd exercise, but it can be quite effective. After all, you don’t realize it, but use of digital devices involves infrequent blinking and partial blinking. So does reading. Blink awareness and performing some simple blinking exercises can keep your Meibomian glands healthy.

Blinking exercise:

Close your eyes, squeeze your eyes closed, then relax the squeeze while keeping your eyes closed.

Open your eyes and repeat the above 5 times.

Perform this exercise 3 to 4 times a day.

Set a regular reminder or tie blink exercises with other daily activities, such as using the restroom, taking a break from your desk, eating, and the like.

Cleaning your eyelids — We all wash our faces and brush our teeth, and we need to add cleaning our eyelids to our hygiene routine. Cleaning the lid margins removes debris that can build up over time and contribute to gland obstruction, ultimately resulting in MGD. Cleaning your eyelids regularly is a good idea.

Here’s how you can properly clean your eyelid margins:

Wash your hands and moisten a cotton swab with mineral oil, petroleum jelly, or saline water.

Using your thumb and index finger, squeeze off excess mineral oil, petroleum jelly, or saline.

Pull the lower lid down away from your eye to expose your lid margin. Visually divide the lower lid into three sections and gently scrub each section 5 times.

For upper lid scrubs, grasp the upper lid to expose the upper lid margin. Use the same technique to clean it.

The blinking exercises and cleaning instructions listed above are effective for maintenance. If your Meibomian glands are blocked, it’s unlikely you can fully clear them; that’s what we use LipiFlow to do. But you can help to at least partially clear them or keep them open.

When you’re in the shower, take a washcloth and get it quite warm under the shower water. Now fold it lengthways and hold it on your eyelid or eyelids (if it is long enough). Hold it on there for at least 30 seconds and apply light pressure. This heat can liquefy viscous meibum and open the glands. You can also massage the glands lightly with the cotton tip of a swab at the sink.

This may not fully clear blocked Meibomian glands, but it can open glands that are moving toward becoming blocked.

Science is finding that increased use of phones, tablets and computers shows a direct correlation with blinking less often. When that happens, dry eye disease increases. So, yes, there is a medical reason to get your family members to stay off their cellphones.

Another cause is Roaccutane, formerly known as Accutane; an acne medication used by over 16 million people. A study published in 2012 showed that over 14% of those Accutane users were treated by an eye doctor for dry eye disease symptoms within a year of starting the drug.

Menopause is another condition which can cause dry eye symptoms.

Ceiling fans as well as blowing air from air conditioners or furnaces also cause discomfort.

At The Eye Care Institute, our clinical trials have resulted in three FDA approved dry eye treatments including Xiidra, Eysuvis, and TruTear. In fact, we don’t know of any US ophthalmology practice that has been behind more FDA approved eye treatments than The Eye Care Institute. Since clinical trials have various start and end dates, and because science always evolves, please contact us so we can help determine if there are any ongoing dry eye clinical trials that might be right for you.

At The Eye Care Institute, we charge $800 for LipiFlow. Although Dry Eye Disease is a real condition, Medicare considers LipiFlow to be an elective non-covered, cash-paying service. Commercial insurance carriers generally follow Medicare rules, so this procedure is always considered elective. If you have an HSA or a consumer account with Care Credit, Lipiflow does qualify as a covered service, however. If you are wondering why Medicare doesn’t yet cover LipiFlow, please consider the matter of mammography where Medicare took more than a decade to approve payment coverage of this life saving diagnostic test; unfortunately, sometimes progress happens slowly.

It is estimated that almost 40 million Americans suffer from Dry Eye Disease. While Dry Eye Disease is uncomfortable, it is not usually vision threatening, nor is it life threatening. Insurance companies would bear great cost if this diagnosis and treatment were suddenly covered. So, for now, insurance carriers are not covering LipiView II and LipiFlow. By way of comparison, it took almost 20 years for most insurance carriers to cover mammograms from the time that potentially life-saving diagnostic test became FDA approved.