When it comes to chronic dry eye problems, many wonder what more they can do. Are there any other options besides artificial tears and prescription strength dry eye drops? The answer is yes!
Once more basic treatments have been exhausted, your doctor may recommend a dry eye treatment such as MiBoFlo, Lipiflow, or Intense Pulsed Light (IPL) therapy. But what are these therapies and how do they work?
Understanding Dry Eye Causes
To begin to understand dry eye treatments, it is best to have a basic understanding of what causes dry eye in the first place.
Dry eye can occur due to one of two different processes–either the tears produced by the eyes are of poor quality and evaporate too quickly, or the eyes do not produce enough tears. In many cases, a combination of both processes are present.
The tears are composed of 3 different layers–lipid, aqueous (water), and mucin. If one layer is lacking, the structural integrity of the tears will be compromised. All three layers are needed for good tear quality.
The lipid layer of the tears is created by glands that run vertically within the eyelids. These glands are called Meibomian glands.
The aqueous layer of the tears is created by the lacrimal gland–a gland located on the outer edge of each eyebrow.
The mucin layer of the tears is created by specialized cells along the surface of the eye called Goblet Cells.
In many individuals with dry eyes, the main issue causing their symptoms is meibomian gland dysfunction resulting in tears with too little lipid in them.
Lipids are needed to help keep the tears on the eyes to prevent the eye from drying out. Too little lipid within the tears results in an unstable tear film that evaporates quickly.
On average, it should take more than 10 seconds for the tears to evaporate. In many individuals with meibomian gland dysfunction, the tears evaporate in as little as 1-3 seconds!
Meibomian gland dysfunction typically begins by the glands becoming clogged. When the lipids cannot smoothly express out of the glands, the lipids remain stagnant and can harden within the glands–blocking further lipids from being expressed out into the tear film.
Generally speaking, the lipids coming out of the meibomian glands should be crisco-like consistency–thin and oily. In those with advanced meibomian gland dysfunction, the oils secreted by the meibomian glands are more similar to a chunky toothpaste.
If the glands are left like this for too long, they will begin to die–or atrophy. Once the glands die, there is no solution to repair the glands, leading to chronic, irreversible dry eye.
Dry eye treatments, therefore, work on trying to unclog meibomian glands and get the glands to function the best they can–therefore improving tear quality and reducing dry eye symptoms–prior to reaching meibomian gland atrophy.
Dry Eye Treatments
MiBoFlo Thermoflo Treatment
MiBoFlo Thermoflo is a treatment that uses thermoelectric radiation to warm the eyelids, and therefore meibomian glands, to loosen the material clogged-up within the meibomian glands.
The patient is laid down on the exam chair and lubricating drops are applied to the outer eyelids. A technician then uses a specialized heated wand to gently massage each eye for 10 minutes.
Post-treatment, the doctor will come into the room and use a special tool to express the oils and debris out of the meibomian glands.
This treatment is often repeated 3-4 times (normally 1-2 weeks apart) to really clear out the glands and help get them back to functioning properly.
After completion of the treatment series, warm compresses and massages of the eyelids at home are often sufficient treatment, although some doctors recommend maintenance MiBoFlo treatments 1-2 times a year.
LipiFlow Treatment
LipiFlow is a treatment that uses vector thermal pulsation technology to essentially do the same thing as MiBoFlo treatments–unclog the meibomian glands to encourage the glands to naturally produce healthy-consistency lipids for the tears.
LipiFlow differs from MiBoFlo, however, in the way the treatment is performed.
The LipiFlow machine consists of a warming machine and sterile disposable activator devices for each eye. These devices are essentially little cups that are inserted into the eyes to rest on both the outer eyelid and inner eyelid.
The sterile activator devices gently clasp the eyelids. The activator device will massage and express the meibomian glands while the heat is being applied to the glands–thus theoretically clearing out the glands more easily in comparison to MiBiFlow.
The LipiFlow treatment lasts 12 minutes in total, as each eye is heated and expressed at the same time. The doctor will not need to come in and express the meibomian glands post-treatment.
In other words, for MiBiFlow treatment, heat is applied to the eyelids and the doctor then must express the glands manually. In LipiFlow treatment, the machine both heats and expresses the glands at the same time.
LipiFlow treatments are also often performed in a series of 1-2 visits. After completing the series, your doctor will likely recommend you continue with warm compresses and eyelid massages at home, with maintenance treatments 1-2 times a year.
Intense Pulsed Light (IPL) Treatment
Intense Pulsed Light therapy, or IPL, is a treatment adopted to the optometry world from dermatologists.
IPL is historically a skin treatment used to treat skin conditions such as acne rosacea, telangiectasias, rosy cheeks, wrinkles, unwanted freckles, and even for removing unwanted hair.
The IPL system is similar to a laser–it emits light energy onto a target, which is then conformed into heat energy by the body.
The IPL system has varying amounts and strengths of energy that can be emitted, this allows it to be used on various skin types and blemishes simply by adjusting the strength of the light.
IPL works as a dry eye treatment through heating the glands so that they are easier to express (similar to MiBiFlow) but also destroy unwanted blood vessels called telangiectasias that deliver inflammation to the eyelids/eyes.
In other words, not only does IPL help to improve the expressibility of the meibomian glands to increase lipid production and secretion into the tears, but it also decreases the amount of inflammation within the eye–thus reducing dry eye symptoms and improving tear quality.
Prior to an IPL treatment, your doctor will run several tests to determine your skin type and what strength is needed to properly treat your eyelids.
During the IPL treatment, an anesthetic drop is applied to the eyes. An ocular shield is then placed onto the eyes (similar to a contact lens) to protect the eye from radiation damage. Next, the doctor will apply short bursts of laser energy to targeted areas across your eyelids.
At the conclusion of treatment, the doctor will express the glands, similar to MiBiFlow.
IPL treatments can be done on an individual level, or may be part of a series of 1-4 treatments.
0 Comments