NuSight Medical Releases New Dry Eye Treatment Device 6
Will The NuLids System Be The Answer For Your Dry Eye Disease?
For those with dry eye disease due to meibomian gland dysfunction (which is a whopping 85% of you!), finding reliable treatment options can be exhausting.
There are so many treatments out there and, unfortunately, you may need to use quite a few before finding relief. So, enter a new device and procedure for your dry eye arsenal...
How To Use The NuLids Device
What It Is And How It Works
At the American Optometric Association (AOA) meeting this month, NuSight Medical announced their release of the NuLids system. This system can be complementary to other procedures performed in your eye doctor's office, and the system is also meant to be taken home and used there.
In just 60 seconds per day (morning or evening use is fine), patients can find relief for their dry eyes. NuLids increases meibomian gland output by decapping and stimulating the glands responsible for oil production.
Once the scurf and biofilm is removed from the top of the glands, they are free to emit the oil they should.
Also, there's a gentle massaging motion to this procedure, which helps to increase positive blood flow to the area.
So far, no adverse events have been noted, including trauma to the conjunctiva and cornea (which sit right there next to the meibomian glands!)
Is It For You?
We'll let you be the judge, but in a study performed by the company, the NuLids system produced a 65% improvement in tear breakup time (TBUT) and an 81% improvement in meibomian gland oil secretions.
Nearly 95% of those surveyed post-treatment were satisfied with the product! This is promising, in my opinion, and is not a treatment to be overlooked.
How Do I Try It Out? What Is The Price Of NuLids System?
Although this is a relatively new device, the NuSight website indicates that a starter kit (including one hand piece, one NuLids charger, one NuLids Charger Cord, and a 30-day supply of NuLids Daily Disposable tips) is available. Click here to purchase.
Since it is new, many doctors may not be aware of the new technology, so make sure to let your doctor know that you'd love for them to have the product available. NuLids is likely not covered by insurance, but the price tag isn't too high to be attainable for those suffering from dry eyes.
I believe it is a great option for those patients with MGD and especially for those who have tried other avenues of treatment without much success.
If you have any other questions not answered above, the NuSight Website has a great FAQ page worth a read!
Have you heard of the NuLid system? Would you try it for your dry eyes?
Dr. Travis Zigler
SeeEO of Eye Love
The Dry Eye Show June 10, 2018 | Exercise To Help Dry Eye 1
The Dry Eye Show - June 10, 2018
How are you doing there dry eye supporters? Dr. Travis Zigler here, and Dr. Jenna Zigler, and welcome to The Dry Eye Show.
We've got a quick announcement... we are giving away a six-month supply of our Heyedrate Lid and Lash cleanser. It is in the description and it is in the comments. So, make sure you click that link, head on over there and enter the contest.
You get three entries when you sign up and then there are multiple ways to get more entries. So, make sure you take advantage of every way to make more entries. You also get three entries for every friend you have sign up so be sure to share it on Facebook, Twitter wherever else you would like to share your posts and everything. So, make sure you're doing that because it will pay off and we're giving away six-month supply. So, we're pretty excited about that.
What we're going to be talking about first today is exercise. It's important, and just five minutes a day can help treat disease more than you think. Five minutes of exercise a day is what we'd recommend starting out with, and we recommend working up to about thirty minutes a day.
We do anywhere from 30 to 60 minutes a day and yes, we do take days off, but that's what we try to shoot for. When we say exercise, we mean both strenuous exercise and very relaxed exercise so this is something that we're really passionate about.
Unfortunately, the stats show (according to CBS News) 80 to 90% of adults and teens do not exercise. That is 9 out of every 10 people that do not exercise! We believe that all disease starts with drinking plenty of water and exercising daily. Exercise can be walking, running, weightlifting, yoga, it can be anything. So, the problem with only 1 out of 10 people exercising is that it's causing health care costs to rise in the United States especially and it's one of our biggest problems that we face as practitioners. The lack of exercise and the sedentary lifestyle causes people just completely ignore exercise.
So if you really want to start feeling relief from these diseases, and this is all disease, start drinking your water, wake up a half hour earlier just to get a little exercise in and an example is we have a seven minute workout app and we do that when we're pressed for time and then we'll go for a lunchtime walk where we'll just walk for 10 to 20 minutes and sometimes we get sweaty sometimes we don't.
So, with that being said, don't rely on your practitioner to heal your disease, we always talk about this, it is up to you to heal your disease through diet, through water, through exercise.
What are some of the benefits of exercise?
Exercise is one of the best ways for you to decrease heart disease, helps you lose weight, control your weight, battles all types of health conditions, all types of diseases, especially diabetes and things like that. It definitely improves your mood and combats depression.
If I'm in a bad mood or I'm not feeling right, if I go out and I go for a run or even just a walk, I'm going to feel so much better if I do that because it boosts your energy, it helps you sleep better, puts a spark in your life and that's what we really want to see for you. Those are just a few of the benefits of exercise
Now, we do like to see you mix it up. You can go for a walk every day if you want to but it's best if you mix it up, so go for a walk then lift some weights another day, do some yoga another day. It also keeps you from getting bored with it and the reason that exercise helps so much is the dopamine it provides. You've heard of runner's high before. A runner's high occurs because you get a dopamine hit when you exercise. Dopamine helps increase your calmness so it makes you more calm, increases your awareness, increases your presence in life, decreases anxiety, depression, and anger.
I use exercise to make myself feel better and whether I'm just anxious that day or even when I'm tired, even just going for a walk is going to lift your spirits and make you feel better about yourself.
So, again a sedentary lifestyle causes your depression, anxiety, you significantly increase your risk for cancer, you have memory loss, you increase your blood sugar, risk for diabetes, you decrease your sex drive, you have terrible sleep and increase back pain especially lower back pain when you don't exercise.
How much to exercise is recommend?
210 minutes of exercise per week averages 30 minutes per day. Now, this may sound like a daunting task but just remember when you go to eat an elephant you don't just think, "I'm going to eat this whole elephant", you eat it one bite at a time. So, if 30 minutes seems like a lot, don't start there, start with whatever you're comfortable with maybe just one minute, maybe it might be five minutes, but start at five minutes per day and just start adding five minutes per week.
I've seen a patient of mine, she started by just going to the mailbox and back and that was her exercise and that was walking very slowly. Then she went up to a brisk walk and then she started doing five minutes of brisk walking a day, then 10 minutes, got up to 30 minutes then 60 minutes and then she started jogging and now she does marathons.
It's not crazy but you have to start somewhere and just start with five minutes a day or whatever you're comfortable doing. Basically a lot of you may be wondering why we're talking about exercise in the first place but it's really all about combating inflammation in your body and aside from that it's about the anxiety and depression that comes along with dry eyes too. You really want to control that when you have dry eyes because it's going to make things worse if you're stressed out all the time and so exercise really does play into it.
So, we really want to see you guys try this out and I think that everyone can get out there and just move their bodies every day.
How long do permanent punctal plugs last?
They are permanent. So, they should last until they fall out essentially and hopefully they won't. Insurance companies won't pay for permanent ones until you do temporary ones first. So, they'll do temporary ones to begin with and then they'll add the permanent ones and they should last, as long as they don't fall out.
Which is a better steroid to use: Lotemax or fluorometholone (FML)?
Normally, we would go with Lotemax. There is a non preserved version of Lotemax and FML does have preservatives. So, either one is fine, either one you know is going to be a softer steroid but overall I like to use Lotemax if I can.
FML is great though, I have used it to a lot for people where their insurance doesn't cover Lotemax or something like that. Both are considered soft steroids and by soft steroids that just means that they are at a lower chance of causing a steroid response as far as IOP. So, you're not going to get an increase in pressure as likely.
I've very rarely seen it with Lotemax and FML but with things like Durezol and Prednisolone those are very common to see. I think I've seen it with Lotemax and FML once, so that's why we use those for dry eye because you're going to be taking a longer term and Lotemax tends not to get inside the eye and that's why it's a little safer. FML I believe does get inside the eye versus Lotemax because they're two different types of steroids but one may work better for you than the other.
I have psoriasis on my scalp and on my eyelids. Is this pretty normal - having psoriasis on my scalp and itchy eyelids?
Psoriasis tends to be on your elbows and your knuckles where eczema tends to be on the insides of all these things. I think it all comes down to they are caused sort of by the same type of immune response.
So, you know if you have psoriasis you're probably more likely to have eczema and things like that. That can show up on your eyelids so if you have psoriasis on your scalp definitely you can get a similar thing on your eyelids, but it's not going to be psoriasis. We don't really see that, but I would say eczema or some type of dermatitis.
It is pretty common to have that at the same time probably more likely a dermatitis that you're getting on your eyelids and scalp but it's all inflammatory and so inflammation is causing all these problems. Figuring out what's causing the inflammation with your psoriasis (most likely a diet and what you're eating). You're eating something that's causing this inflammation and figuring out what that is and eliminating it is going to be huge.
I tried Lumify and it did not clear up my bloodshot eyes, how can this be?
Lumify is a new eye drop that we've talked a little bit about in the group. It is brimonidine which is a glaucoma medication that they found a side effect that made your eyes whiter and takes away the redness in your eyes.
That's where Lumify came from and studies have shown at least so far that have been done by the company that it does not cause rebound redness. However, it does contain benzalkonium chloride (which is BAK for short) and that is a preservative that has been known to really irritate dry eyes.
So, Lumify is not a dry eye medication, it's a redness reliever. Yes, it normally does work for most people pretty quickly but if it didn't work for you it could be possible that you're just sensitive to the preservative that's in it.
What can I do for dry eye after cataract surgery?
Start at dryeyecommunity.com! Sign up there and just start going through our email series that talks about how to heal dry eye naturally. There's really no eye drop either that's going to be the cure-all for your dry eye.
A lot of the time we don't even recommend eye drops because they don't do anything to treat the problem, they just cover up the symptoms. Cataract surgery is something that's known to cause dry eye. Any surgery that's done on the front of the eyes is going to most likely cause dry eye and it's just because it's disrupting the front surface of your eye, your cornea, and it does take a little bit for that to heal. In some people it never goes back to how it was before.
It's also possible that you had dry eyes before and unfortunately there is no one thing that's going to cure it. Definitely start at dryeyecommunity.com and go through everything that we talked about. We give you a lot of information on ways that you can naturally treat your dry eyes instead of using eye drops. We're here every Sunday if you have more questions along the way.
I had false eyelashes and they used wood glue which made my eyelids stick shut. I got an allergic reaction and now have Meibomian Gland Dysfunction as a result.
So, how do we heal meibomian gland dysfunction? I'm going to post a comment with an article that we wrote about meibomian gland dysfunction, but to summarize the article we want to use a warm compress because that warm compress is going to heat up the glands.
You can make a warm compress by putting rice into a sock and non-instant rice and then heating it up for about 15 to 20 seconds. Then, put it on your closed eyes for about 20 minutes. That's going to warm up those oil glands. When you warm up an oil it tends to melt that oil making it more of a liquid. Then after you do that you want to gently express the glands. You can just massage the eyelids gently or take a q-tip and roll down or you can do eye exercises.
Then step 3 we want to use a hypochlorous acid eyelid cleanser just to keep your eyelids clean. Keeping your eyelids clean helps avoid any problems. So, hypochlorous acid eyelid cleanser, you can spray it on a cotton round and then just scrub it into your eyelids, or just spray it directly on the eyelids. We have one it's called Heyedrate Lid and Lash cleanser.
Also, we always recommend using a high quality omega-3 or increasing your diet with more omega-3 and omega-6's so a wild caught salmon, walnuts, chia seeds, flax seeds, avocados. Then taking a triglyceride based omega-3 supplement as well those are going to really help with your meibomian gland dysfunction.
What else can I do to help my dry eyes other than non-preserved artificial tears every one to two hours? I have an extra row of lashes that grow into my eyes, and I have to pluck them every two to three months.
You have a condition called distichiasis or trichiasis where you have more than one row of eyelashes and they're growing inwards, probably causing a lot of irritation. Getting them plucked is probably the best option for that. Some people do get them cauterized but I don't recommend that just because it's so close to other glands and that could cause some problems.
Regarding the non-preserved artificial tears, we recommend starting with hydration (drinking more water). 80% of people are dehydrated and 90% of people don't exercise enough. So, start exercising and then changing your diet by eating more of a vegetable-based diet, leafy green vegetables like kale and spinach. Eating higher fats like we just talked about with nuts and avocados.
Then, you can start at dryeyecommunity.com to learn more about that. Also, get rid of all the processed food that is in your home. You should not be eating anything that is processed.
I have evaporative dry eye. I've seen two specialists and I do the heat, massage and cleansing twice a day but I'm still pretty miserable.
Someone else kind of has that same question. She has evaporative dry eye. Go to dryeyecommunity.com to get started with that! Also, when we talked about meibomian gland dysfunction a little earlier, I posted a link to the article that we wrote with a video that will talk more about what to do for meibomian gland dysfunction. So, very very helpful article. I'll post it in a comment to your question.
Is it safe to use castor oil in the eyes?
You have to use high quality castor oil if you're going to use it in your eyes. It's still commonly used in eye drops and I believe in Restasis and so it's used as a vehicle for Restasis so it is safe to use. You have to remember Restasis uses pharmaceutical grade and they get it from a trusted source so you have to know where it's coming from if you're going to put it in your eye and you have to make sure it's safe.
So, do we recommend putting in your eye? No, because we know what kind of junk is on the market. We don't really recommend the castor oil just because it's very hard for us to find one that we trust.
How do you feel about tea tree oil mixed with water to clean your eyelids?
Mixed with water kind of makes me a little bit nervous just because you don't really know how much tea tree oil you're putting on to your skin and tea tree oil can be very drying for some people.
I would highly recommend using a tea tree oil soap. This soap can be used all over your face, you can use it in your hair, whatever you want. It's a bar soap, it's a tea tree oil soap, it's wonderful for fighting demodex and everything that you're wanting it to. It will still burn if you get it in your eyes because tea tree oil does burn, so you know keep your eyelids tightly closed and rinse it well.
We made this soap for this purpose and it's mainly something that I wanted to use. We formulated it and we had a friend formulate it for us and we tried a couple different recipes and this is the one we kind of stuck with. I use it because it's great for my eczema, my dandruff, and everything in between. I can tell when I haven't been using it, my skin is completely different.
I need a doctor that will understand what I'm going through and I've tried things but nothing is working.
We also have a group called “Rethinking Dry Eye Treatment”. We have 50 people going through the beta version of it right now and we're seeing some pretty good results. It's pretty much an eight week challenge and you are challenged to change a different part of your lifestyle each week and if you follow the challenge then you will see results. We wanted to get 50 people through it first and we'll probably open it back up for more people after we get these 50 people through.
The book "Rethinking Dry Eye Treatment" is really wonderful. It goes through all the natural ways that we know to treat dry eyes. It talks about diet, it talks about hydration, and really goes into what you should be eating and what you shouldn't be eating. It can really help with inflammation in your body which is really what dry eye strands from. So, grab that book, it's super cheap on Amazon and it's in a Kindle version for $.99, or a paperback for around $3.99.
My eye doctor wants me to use Pataday once a day. Can the BAK in this be harmful?
The BAK gets a bad wrap, but it's used obviously because it does work and it works as a great preservative. We prefer you to be on a non-preserved artificial tear, but BAK is still there because it still works well and it is still gentle but the people that have an allergy to it tend to be very vocal and a lot of people do have an allergy to it.
I'm not trying to downplay that, but I would say 80% of people don't have an allergy and so using it once a day is not going to be harmful. Using it more than four times a day can start to cause harm and Pataday is meant to be once a day. Pataday is for allergies and so I'm guessing that you have some allergies going on. That's what your doctor is having you use it for and it's meant to be once a day so it's not meant to be used as needed. It will work just as once a day.
How does Pataday work? So, Pataday works two different ways. You can use it as needed. It's got an antihistamine in it to use as needed. If your eyes feel itchy you put it in and it relieves that itch. It also has what's called a mast cell stabilizer that builds up in your system over two weeks and it doesn't work for about two weeks.
It has two different medicines in it and you're getting the relief from the antihistamine, but you're getting the long-term stabilization of the allergies from the mast cell stabilization. So, if you use it every day it's going to be a great drop for that, but if you're just using it as needed you're using a very expensive drop for that. There are over-the-counter ones that work just as well as Pataday. A great over-the-counter drop example would be, Alaway and that's twice a day.
At my most recent eye exam, they found that I no longer have astigmatism. I've had it for over 20 years. Is it okay for an astigmatism to just go away?
I'd be super happy if my astigmatism just went away! It's probably the case where you didn't have a very high amount of astigmatism anyway. So, we've talked a little bit about this in our group, but your vision and your prescription can fluctuate on different days and it can fluctuate with what's going on in the front of your eye.
If you've got a episcleritis going on or some corneal condition like dry eye, then that can all affect your prescription too. That can cause you're astigmatism to go away, or possibly to come back. It may be that next year when you go in you might have a little bit and this year you just didn't.
Are rose water spray and hyaluronic acid safe for the eyes?
I'm not sure what's in rose water spray... I'm guessing roses and rose oil or something to that effect. Since I'm not really sure what the ingredients are, I wouldn't recommend that unless there's something proven out there.
Hyaluronic acid is safe for your eyes it's actually a natural component of your body too. Kind of like our hypochlorous acid spray, so it's very safe to use. We'll have you look it up at dryeyecommunity.com.
What about using tea tree oil and water with one drop of shampoo for cleaning blepharitis on the lower lids?
I wouldn't recommend that either because using shampoo will actually cause more problems because it's not really PH balanced for your eyelids. It actually causes more problems. Don't use shampoo.
What do you recommend for my itchy eyelids if it is from dermatitis?
Whenever we have a dermatitis patient come in we actually put them on triamcinolone cream 0.1% and you just rub it on your eyelids and just let it sit when you go to bed at night. Sometimes you can put it on three times a day and that seems to be very effective. So, you can ask your doctor about that triamcinolone cream.
Why do I have aqueous deficiency yet I am able to cry normally?
The interesting thing about this is that your lacrimal glands that produce your tears respond differently to whether your eyes are dry and they respond differently to your eye needing moisture versus your emotional crying.
So, it's a different type of tear actually that your lacrimal glands produce so that's why you're able to cry normally just like everyone else but your eyes just aren't able to produce the correct amount, or the correct type, of tears that your eyes need.
I have calcium or salt deposits in the outer corner of my left eye. I've tired pretty much everything. What do you think the problem is?
They're a sign that you have a lot of inflammation and so figuring out what's causing the inflammation and fixing that is going to be your best bet to get rid of the concretions.
Without seeing it in person it's very hard because the salt deposit could be a lot of things. My guess is it's just showing excess inflammation. Figuring out what's causing the inflammation and getting rid of it is the key.
What kind of diet do I need to help with dry eye?
We could talk about diet all night. Water to begin with, and drinking lots of it! You should be drinking half your weight in ounces of water every day. If you're not drinking at least that much water you need to up the amount of water that you're drinking. It will help tremendously if you're not already drinking that much.
Really start with the water increase and then it's about getting rid of the junk in your diet like the processed foods that we already talked a little bit about and adding in plants. You want to be on more of a plant-based diet, healthy fats like avocados and coconut oil are really going to help you avoid the inflammation that comes along with dry eye. We recommend a very vegetable based diet. I'm going to post in the comments a blog post that we just wrote last week about foods to avoid and don't kill us.
It's going to be tough but if you really want to do it, then this is the way to do it. We're not perfect! I mean we eat a mostly vegetarian-based diet and we do eat meat occasionally. We had meat last night and I had five cookies at a wedding and we ate a cupcake! But who's judging... and maybe a couple drinks on cheat day. So, you have your cheat days, you have a little fun, and then you get back on the wagon. We had a green smoothie for lunch and we had roast vegetables for dinner with some quinoa and then tomorrow morning I'll have a smoothie and then lunch I'll have a smoothie and then we'll get back on eating vegetables again and then maybe next weekend we'll go out and have some meat again. The main take away point is that we don't eat it that often.
How do you treat punctate keratitis?
The definition of this is superficial punctate keratitis. Keratitis means you have an inflammation of your cornea. Punctate, means they look like little needle pinholes. Superficial, means it's on the very outer surface of your eye so usually it's caused by something.
Dry eye is a common culprit, allergies are common culprit, hypersensitivity like a solution is a common culprit, but usually since it is inflammation we figure out what's causing the inflammation first. Then if I do see superficial punctate keratitis on a patient that usually means they have a little bit more of a moderate dry eye. So, I will treat them with the steroid at that point but then we'll also address inflammatory causes like your diet, your water intake, and everything like that to get rid of that inflammation and really try to figure out the cause of it too.
Restasis or Xiidra - do you have a preference?
Neither! We really don't prescribe these eyedrops very often. Of course, sometimes we do but they are very different. Restasis was the first one that came out about fifteen years ago and it does take a little bit longer to start working.
We usually have to tell people that it will take at least six months for you to notice a difference in your symptoms, if at all. Some people just don't notice the difference at all. Then, Xiidra has been shown to work within two weeks in some people so it does work a little bit more quickly.
Do we have a preference? Probably Xiidra if I were going to pick one just because it works more quickly. But we also don't love Xiidra... it's so-so. The funny thing about Restasis and Xiidra is they do take a long time to fully kick in and to really start feeling benefits and we see results with something like drinking more water within three days and eating green smoothies for breakfast and lunch within a week, if not sooner.
Doing these other things first before you get on prescriptions is what we push hard because it works a lot faster. There's no studies out there because nobody's going to study green smoothies and the effects of dry eye, maybe we will in the future, but it helps to change those things first. If you just add a green smoothie for breakfast every morning you will notice a more significant difference than adding Restasis or Xiidra to your regimen. No that's not studied, but that's something I truly believe in and what I've seen with my patients.
Could MGD be caused by going to bed without removing eye makeup?
Absolutely! MGD can be exacerbated by going to bed with your eye makeup on. If you have dry eyes, I don't care if you don't have dry eyes, everybody needs to be removing your eye makeup before you go to bed.
There has been a post circulating, at least in the optometry community, about a lady who never removed her mascara and it ended up she has mascara deposits stuck under the skin of her eyelids and it's permanently there causing irritation for her eyes.
So, absolutely you know it's a little bit different than what you're asking but remove that makeup because it can really cause a lot of problems.
Which goggles can I wear while sleeping?
This is a great question! We do get this question about goggles every once in a while. I don't recommend them very often, so I don't really have a specific brand that we recommend.
However, if you go in our dry eye support community, and go to the search bar and search "goggles", I know that there are many conversations about goggles in there from people that have actually used them and that use them on a daily basis.
I would highly recommend searching goggles in our group and let us know if you can't figure out how to do that. It'll come up with a bunch of different posts about the goggles that you're asking about.
What's your opinion on permanent eyeliner?
I feel like I would be more okay with permanent eyeliner than sleeping in your eye makeup. If you're brave enough to have somebody tattoo that on, then go for it because that's just external. They'll do it! It's going to be under or in-between your eyelashes it's not going to be on the inside.
Recipe for your green smoothies please!
That is in the green smoothie chart and we're actually starting to come out with some recipes and everything too. We do have a green smoothie group on facebook as well and it's called the Green Smoothie Challenge. We have a bunch of live videos in there so click the video section and you'll find all of the different smoothies that we've made and how to make it.
What is the best mascara to use for dry eyes?
Also, you can go to dry eye in our support community and in the search bar type mascara and we've definitely had the conversation before and I've posted suggestions on makeup and things like that and you can find them in there as well.
Which food sensitivity test do you recommend?
So, we follow a naturopathic doctor by the name of Dr. Steven Cabral and he's pretty great. We've met him in person as well and he's just a great guy who knows his stuff and really knows a lot about diet, more than we do.
Do you recommend the Lipiflow system?
Yes, we do! We recommend the lipiflow system quite a bit. There's a couple different ones out there but lipiflow's very very early prelim studies are starting to show that it's starting to cause gland regeneration which is pretty awesome. So, you actually get some function back from your meibomian glands and we recommend getting lipiflow done every six months. We recommend like January and June getting lipiflow, some doctors will recommend less depending on your severity, but we recommend getting it in January and June. Then getting BlephEx done in April and October. BlephEx is a cleanser for your eyelids. It's a very thorough cleanser, but then use our maintenance schedule for blepharitis in the mean time. But yes, lipiflow every six months, BlephEx every six months, and then using our blepharitis maintenance.
Dr. Jenna Zigler and Dr. Travis Zigler
Lipiflow Reduces Meibomian Gland Atrophy 2
Can Lipiflow Reduce Atrophy of the Meibomian Glands in MGD?
Meibomian Gland Dysfunction, also known as MGD, meibomitis, or Posterior Blepharitis, occurs when the glands of your eyelids, meibomian glands, are not functioning properly. These glands produce the oil needed for your eyes to function properly and feel comfortable. However, in MGD, these glands can become chronically obstructed. When this occurs, they can begin to atrophy and die off, meaning that they will no longer function to produce the proper oils your eyes need. For years, we have thought that this atrophy is irreversible, but recent research shows that this may not be the case.
In today's article, I will be discussing whether or not the Lipiflow procedure can reverse the atrophy we often see with the meibomian glands.
The Study and Findings
A recent retrospective, observational study has revealed that 70% of those patients treated with Lipiflow showed a reversal in their meibomian gland atrophy vs. those patients who had not undergone Lipiflow. In these patients where improvement was noted, small positive changes were seen in the glands. Researchers also found long term improvements in tear break up time, tear osmolarity, and corneal staining.
How was it measured?
The researchers looked at the visible gland structure, or the amount of atrophy present in the patients studied, both before and after their treatments with Lipiflow. The Lipiview 2 was used to visualize the glands and, in an interesting and smart twist, Photoshop was used to assess the gland details down to the pixel level. The Meibum Scale, or the gold standard scale used to assess meibomian gland structure, changes by 25% increments so could not easily be used in this study because of the precise comparisons needed.
My opinion on this study
Although a VERY low treatment population, the results are very promising. For years, we have told patients that their atrophy was irreversible. This research provides us with hope that MGD can be overcome. As I prefer to use more natural treatments for MGD, it's great to see that Lipiflow is potentially able to make these positive changes without the use of harsh medications. Because of this study, I am much more likely to prescribe Lipiflow for a patient with Meibomian Gland Dysfunction because of the positive outcomes we've seen.
Although Lipiflow can be financially and time inhibited, I believe it is a great option for those patients with MGD and especially for those with known atrophy of the glands. Patients who have previously taken Accutane come to mind, since this medication itself causes atrophy of the glands.
Have you had the Lipiflow procedure and seen great results for your dry eyes?
Let me know your successes or failures in the comments below.
Dr. Travis Zigler
SeeEO of Eye Love
Do you have dry eyes or meibomian gland dysfunction?
Does BlephEx Help With the Treatment of MGD and Dry Eye? 0
Meibomian Gland Dysfunction, also known as MGD or Posterior Blepharitis, is where the meibomian glands in your eyelids are not working like they should. The meibum (oil) that these glands produce is used to moisturize and lubricate the eye. So without meibum your eyes will feel dry, irritated, gritty, and dry eye syndrome will develop. Dry eye is just a manifestation in a continuum of diseases starting with inflammation in the body, and with the eyelids, blepharitis and meibomian gland dysfunction.
There are many ways to treat meibomian gland dysfunction naturally and at home, which I discuss in great detail in another article [Click Here to Read].
In today's article I will be discussing an in-office procedure called BlephEx, which is used to clean the eyelids.
In a recent study, James Rynerson, MD, and Henry Perry, MD proposed that dry eye and blepharitis are the same disease process. Dr. Rynerson states "We get biofilms, they lead to inflammation, and then the inflammation affects the different structures in the lid." This, they proposed, is what leads to dry eye, decreased contact lens wear time, and decrease tear breakup time (TBUT).
Increasing Contact Lens Wear Time
Patients believe that as they age, they have to discontinue contact lenses due to irritation and dryness that occurs. Practitioners over and over again will switch solutions and switch contact lens brands to try and keep these patients in contact lenses.
Dr. Rynerson reveals that these practitioners should be focusing on cleansing the eyelid margins and getting rid of the biofilm formation. Once biofilm is removed, the source of inflammation goes away, and an immediate relief can be felt from the patients.
In their practice they use BlephEx, which is a hand--held instrument with a spinning sponge soaked in cleaning solution that removes biofilm from the patient's lid margins and reduces inflammation.
"Once you remove the biofilm, the source of inflammation goes away, and patients begin to feel so much better immediately," Rynerson said.
TBUT (Tear Breakup Time)
Tear breakup time is when a practitioner looks at the tears to assess the quality. When a patient blinks, the tears should hold steady for at least ten seconds. With a less than ten second TBUT, treatment with eyelid cleansing should be initiated.
Studies with BlephEx showed a 60% increase in TBUT. An increase in TBUT reveals an increase in meibomian gland function. This study evaluated 20 patients at initial examination and at four weeks post BlephEx treatment. Another study showed a 66% increase in TBUT and evaluated 90 patients.
My opinion on this study and the data
These results are great, and I have used BlephEx first hand in my practice with the success stated in the articles.
My recommendation for treatment and the use of BlephEx is to find a doctor in your area and have BlephEx done every four-to-six months depending on your severity of dry eyes, blepharitis, and/or meibomian gland dysfunction.
In between visits, using other natural therapies as a compliment to BlephEx will promote even better results. I recommend the following:
1. Begin with a warm compress
2. Safely express the meibomian glands
3. Clean your eyelids twice per day with a hypochlorous acid based solution
4. Eat healthy omega-6 and omega-3 fatty acids
Have you had BlephEx for your MGD or dry eyes?
Let me know your successes or failures in the comments below.
Dr. Travis Zigler
SeeEO of Eye Love
Do you have dry eyes or meibomian gland dysfunction?