What is Lipiflow Treatment? Will it Work for MGD?

What is Lipiflow Treatment? Will it Work for MGD? 0

Lipiflow Effectiveness 

Does Lipiflow Work for MGD?

That is what Lipiflow is designed for. You're literally doing warm compresses and massage at the same time during the Lipiflow procedure. It’s got two different pads, one is a heating pad, one is a pausing pad. So, it heats and then it pauses. It heats up the oil and then it breaks it apart with the pauses, and then it heats up the oil, and then it breaks it apart. 

Dr. Jenna actually had it done at an Ophthalmology office in Columbia, South Carolina. Basically, the way it works is, they clamp your eyelids in between those pads and it heats on one side, it pulses, and it kind of works those oils out. Now, it’s very different for everybody whether it works for you or not. I recommend trying it if it’s something you’ve never tried. It’s worth the try. Keep in mind that after warm compresses and after lipiflow, your eyes can actually feels worse because of those oils that were expressed. Over time, as your eyelids make better oils, that goes away and you shouldn't have an issues with it. 

One Love,

Dr. Jenna Zigler and Dr. Travis Zigler

Dr. Travis Zigler and Dr. Jenna Zigler answer your questions LIVE on Sundays at 7:00pm EST.

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Best Treatments for Posterior Blepharitis, MGD, and Brittle Eyelashes

Best Treatments for Posterior Blepharitis, MGD, and Brittle Eyelashes 0

What is the best treatment for Posterior Blepharitis when it involves Demodex mites?

Demodex mites are actually more of an anterior blepharitis issue, because it involves your eyelash follicles. Demodex is a parasite that lives in your hair lash follicles, which are on the anterior surface of your eyelid. Treating anterior blepharitis, posterior blepharitis, and demodex are all three separate areas of your eyelid and require different treatments. Posterior blepharitis involves treating the meibomian glands and benefits from IPL, Mibo Flow, warm compresses, and omega-3s. Anterior blepharitis is best soothed with our hypochlorous acid spray. Demodex treatment is best treated with tea tree oil. Our tea tree oil soap is a fantastic treatment for this. When we decided to release our soap, we were looking at different treatment options and we saw that some shampoos on the market were $240 and had a lot of unnecessary ingredients. With any tea tree oil product, you do have to be careful not to get it directly in your eyes because it can burn and if you use it really often it can dry up your skin and dry up your eyelids. If that happens to you and it seems like it’s making things worse because it’s making your eyelids dry, simply cut it back to once a day or every other day.

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Will eyelid margin swelling/redness ever subside? Compresses seem to make the redness worse.

You are correct. Warm compresses can make redness worse because when you apply heat to any inflammation, that usually makes it worse. If you’re trying to get rid of red eyelids, that’s where cool compresses will come in. You might want to alternate warm compresses for your meibomian glands with cold compresses for the redness. Eyelid margin swelling and redness will subside if you keep your eyelids clean. Again, our Heyedrate Tea Tree Oil Soap and our Heyedrate Lid and Lash Spray will help with this. Also, if you have Rosacea, that can definitely cause eyelid redness so you want to be using tea tree soap to help calm down the redness and inflammation from that.

Does Lipiflow treatment work well for MGD? My doctor recommends the treatment, but it is pricey and not covered by insurance.

Liiflow can be great for meibomian gland dysfunction. If you have MGD, it’s worth a try to try it out for yourself. It doesn’t work for everyone, but for some people it can be life changing. Is it worth the cost? That’s up to the opinion of the patient. Some would say absolutely, and others would say it’s not. Things to note...during the first week after you get it done, your eyes might actually feel worse because what that Lipiflow does is gets all of the stagnant oils out of your glands. When those release onto your eyelids and eyes, it can cause more inflammation for a bit.  A lot of doctors would put you on a steroid eye drop for few days to a week just to calm down the inflammation and get you feeling better more quickly. If you haven’t tried it, it might be something to look into and see how it makes your eyes feel!

Meibomian Gland Dysfunction

What do you think about Blephasteam goggles, and do you think they are effective?

We looked into this a little bit and it seems like a pretty great product. It’s almost like a home version of a Lipiflow. It steams up, heats up your eyelids, and does a similar thing. Currently, this device is only available in the UK and the only downside is you do need to buy replacement rings for it every few times you use it.

My eyelashes have gotten very dry and brittle and have dropped downward. Any suggestions on the cause and what to do for it?

You may have something known as ectropion, where the eyelids lose the elasticity they once had. This causes them to droop down and the eyelids start to open up. This is absolutely going to cause dry eyes as well because the pump used to pump tears in and out of the eyes may not be working properly. Ectropion is usually just due to aging, and you can think of the lost elasticity as losing muscle tone in your eyelids. There is a muscle in your eyelid that keeps everything toned and tight and just think of any muscle that has atrophied...you can’t lift as much as you could when you were 20. It’s the same thing with your eyelids. Treatment for this is most often surgery, which is in the form of an eyelid lift or a blepharoplasty. Aside from that, some people can begin to notice brittle eyelashes and they start to lose eyelashes because of blepharitis. Make sure you’re keeping your eyelids nice and clean, like we've talked about in this article!

Are you having issues with meibomian gland dysfunction? What has worked for you?

One Love,

Dr. Travis

Dr. Travis Zigler
SeeEO of Eye Love
Director of the Dry Eye Syndrome Support Community
Click Here to learn how to cure dry eye naturally

 

Warm Compresses for Meibomian Gland Dysfunction

Warm Compresses for Meibomian Gland Dysfunction 5

Dr. Travis and Dr. Jenna

Treatment for Dry Eye - Warm Compresses

What Are Meibomian Glands?

Meibomian glands are located on the posterior or back surface of your eyelid.  Their primary responsibility is to secrete an oil called meibum into the eye which prevents your tears from evaporating. This leads to more comfortable and less dry eyes.  If meibomian glands are disrupted in any way, it can lead to meibomian gland dysfunction (MGD), which results in symptoms of dry eyes, grittiness, irritation, inflammation, redness, and that feeling like you have “sand in your eye.”

NERD ALERT → Meibomian glands have little oil producing factories, called acini, that produce oil.  Acini release the oil into the meibomian gland and, with the help of the eyelid muscle (the orbicularis oculi), milks the oil down the gland and out the opening called the terminal duct.  This occurs every time you blink.  The oil is then released onto the eye’s surface to help prevent evaporation of your tears.

Dr. Travis and Jenna

What is Meibomian Gland Dysfunction?

Meibomian gland dysfunction (MGD), or posterior blepharitis, occurs when any part of the process discussed above is dysfunctional.  The muscle can lose its function, the oil factories can stop working, and the opening can become clogged.  Treatment is directed at helping avoid these problems and will be discussed below.  

MGD Symptoms and Signs

Meibomian gland dysfunction (MGD) is going to cause the following signs and symptoms of blepharitis:

  • Red, inflamed eyes
  • Itchy eyes
  • Gritty eyes
  • Irritated eyes
  • Dry eyes

MGD Treatment

Meibomian gland dysfunction treatment can be as simple as warm compresses at home (which are shown to provide symptom relief), to diet changes and supplements, to in-office procedures such as IPL, MiBiFlo, or Lipiflow.

Warm Compresses

Warm compresses are best performed with a mask that is specifically formulated for dry eye, like our Heyedrate Dry Eye Warm Compress, which contains flaxseed and lavender in a silk mask.  You can also make a warm compress by taking dry rice or whole flax seed and putting it into a clean sock.  

Instructions for our Home Spa Therapy (aka Warm Compresses)

  1. Microwave the Heyedrate Dry Eye Warm Compress for 20 seconds.
  2. Shake the mask to ensure even heating.
  3. Test on the inside of your wrist for temperature as to not burn the eyelids.  
  4. Place over closed eyes and tie onto head.   
  5. RELAX…. For 20 minutes!

We recommend applying warm compresses at least every night, but you cannot overdose, so feel free to do it as often as you want for symptom relief.  More recent studies have shown that warm compresses are not as effective as other treatment options for meibomian gland dysfunction, but we still consider it a staple in the routine of our dry eye patients.  Other treatment options are more expensive, but not as convenient.  We will discuss these briefly below and in more detail later.

Meibomian Gland Expression After Warm Compresses

Meibomian gland expression is the process of expressing the meibomian glands after heating.  Heating up your meibomian glands helps turn the oil into more of a liquid (think of placing a stick of butter on the stove... it melts).  After doing this you can milk the glands by rolling a q-tip starting away from your eyelid margin and rolling towards it (or you can use your finger).  


After you perform your warm compresses and meibomian gland expression, it is essential to clean your eyelids with a great lid scrub to eliminate all the exfoliated oil from the surface.  Heyedrate Lid & Lash Cleanser is the lid scrub we recommend in our clinic.  This spray is a natural antiseptic and mimics your body’s natural ability to heal. It is free of any harsh chemicals, alcohol, parabens, sulfates, or other preservatives.   It is great for all skin types as it does not clog pores and is hypoallergenic.  It is also vegan, natural, and organic. Another similar product that is prescription and just as effective is Avenova.  We do NOT recommend products like baby shampoo, as was used commonly in the past.


Other MGD Treatments

Lipiflow

Lipiflow applies heat to the inside of the eyelids while simultaneously applying a pulsation to the outer eyelids.  This helps to liquefy meibum (oil) and express the meibomian glands at the same time.  This procedure usually lasts about 15 minutes.  

MiBo Thermofllo

Treating the outer eyelids only, this is very similar to a Lipiflow procedure.  MiBo Thermoflo is also a spa-like setting that delivers consistent heat for ten minutes, which will lead to a melting of hardened oil leading to less symptoms and signs of meibomian gland dysfunction.  This is usually more affordable than Lipiflow.

IPL (Intense Pulsed Light) Therapy

Originally used as a treatment for Rosacea, patients that were having IPL, or Intense Pulsed Light Therapy, on their skin condition noticed improvement in their dry eye symptoms.  IPL is also used for laser hair removal. IPL is brief, powerful bursts of light that cause changes in the blood vessels near the surface of the skin, which raise the skins temperature, and eliminates problematic flora (bacteria) on the skin and eyes.  For meibomian gland dysfunction, the increase in temperature acts like the world’s best warm compress and helps eliminate stagnate oil from the glands.  It will also decrease inflammation from the treatment area due to changes in the blood vessels.  

Warm compresses should still be done in conjunction with these in-office procedures. Another great treatment option are omega-3 fatty acids, which will be discussed in depth in the next section.

One Love,

Dr. Travis and Dr. Jenna

Dr. Travis Zigler

How to Express Meibomian Glands at Home | What is a Meibomian Gland?

How to Express Meibomian Glands at Home | What is a Meibomian Gland? 7

 

What is a Meibomian Gland?

Meibomian ("my-BOH-mee-an") glands are large sebaceous oil glands that line the edge of the eyelids alongside the eyelashes. Meibomian glands produce an oil called meibum that secretes onto the surface of the eye every time we blink. This oil is important for your eye health, as it keeps your eyes lubricated and prevents your tears from evaporating too quickly. Tears are made up of meibum, water, and mucus. The meibum oil helps to prevent the water layer from drying out. There are between 20 to 30 meibomian glands in the lower eyelid and 25 to 40 meibomian glands in the upper eyelid. 

 

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What is Meibomian Gland Dysfunction?

Meibomian gland dysfunction (MGD) is a common eye condition, yet some people may not realize they have it. MGD is the result of a blockage of the meibomian glands, causing them to be unable to secrete oil into the tears. MGD is associated with dry eye syndrome because the oil blockage causes tears to dry up too quickly. 

MGD is actually a type of blepharitis, which is a term used to describe an inflammatory and sometimes infectious condition in the eyelids. Anterior blepharitis impacts the front part of the eyelid and lashes that can cause the eyelids to become red and inflamed. Anterior blepharitis can also cause crusty eyelashes and is often caused by staphylococcus bacteria. Posterior blepharitis, on the other hand, is what’s referred to as MGD.

Changes to the meibomian glands or the amount or quality of the meibum oil can lead to MGD. Most commonly, a combination of factors contribute to MGD. Obstructive MGD occurs when the gland openings become clogged, causing less oil to reach the surface of the eye.

The number of meibomian glands that a person has decreases as we age. Ethnicity also plays a role; for example, Asian people are three times more likely to get MGD than people of European decent. In addition to your age and ethnicity, people who wear contact lenses are also more likely to get MGD.

There are a number of common medical conditions linked to MGD including:

  • High cholesterol and triglycerides
  • Inflamed or damaged eyelids or cornea
  • Allergic conjunctivitis and other eye diseases
  • Bacterial infection
  • Autoimmune diseases including rosacea, lupus, rheumatoid arthritis, and Sjögren's syndrome

Some medications can interfere with oil production, including:

  • Estrogen replacement therapy
  • Retinoids, from acne medication to anti-aging creams 
  • Drugs that reduce androgens

As MGD progresses, you will likely notice more and more symptoms begin to arise. These may include burning, itching, irritation, and dryness in and around the eye. MGD can feel like you have a small particle, like dust or sand, in your eye. You may also notice your eyelids become inflamed, irritated, and therefore red in color. Some people also experience moments of blurred vision, which may come and go.

Symptoms may worsen if you spend a lot of time on the computer, or if the air in your house or place of work is dry from air conditioning or heating.  Many people who experience MGD complain about their symptoms when stepping out of a hot shower. They say that after a shower, their eyes become very red and painful. This is due to the humidity in the bathroom, which causes the tear film to quickly become unstable. This can result in a drying out of the eye, specifically the cornea. 

How Long Does Meibomian Gland Dysfunction Last?

If left untreated, MGD can become more severe and alter the quality of your life. The cornea can become desiccated and dry, potentially leading to the development of scar tissue. Chronic MGD can cause the meibomian glands to atrophy, which can make it difficult to have them function normally again. MGD can turn into ocular rosacea as well, which requires more aggressive medical treatment.

Can Meibomian Glands Regenerate? 

Once glands have atrophied, we don’t usually think of them as having the ability to regenerate (unfortunately). However, there has been some recent promising research into this topic. A study in the British Journal of Ophthalmology has found that probing meibomian glands in patients who have MGD could lead to the growth and regeneration of meibomian gland tissue. 

In addition to this, a small ongoing study has also shown that LipiFlow, used over time, may help to regenerate the meibomian glands. This 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. Click here to read more about how LipiFlow may be able to regenerate your glands.

Can Meibomian Gland Dysfunction Be Cured?

Thankfully, MGD can be treated, although there is no cure. All treatment really requires is the release of the blockage of the glands. This can be done at home or, in more severe cases, by an optometrist or ophthalmologist, who will perform a treatment to extract the blockages.

During manual expressions, doctors will use tiny paddles to compress the eyelid to squeeze out the contents of the clogged meibomian glands. In most cases, this procedure is painless, however if the eyelid is quite inflamed, it can be anaesthetised. 

Some patients will only need one treatment, while others may benefit from multiple sessions. In addition to this, there are now more effective machines, such as LipiFlow, that work incredibly well for many people.

How to Unclog Meibomian Glands | How to Express Meibomian Glands at Home

Treatment of meibomian gland dysfunction will vary based on the severity of the blockages. When MGD is severe, it’s best for meibomian gland expression to be performed by a doctor, optometrist or ophthalmologist. For milder cases, there are a couple things you can do at home to help unclog the meibomian glands. For some people, one type of treatment will be enough, but for others, a complete regimen is needed to alleviate their symptoms. Here is a list of things you can do to unclog your meibomian glands at home:

 

Warm Eye Compress

Apply a Warm Compress

Most doctors recommend applying a warm compress to the eyes every day, followed by a lid hygiene routine. Although you can use a washcloth and hot water, that’s super tedious. We recommend purchasing the Heyedrate Warm Compress Eye Mask and heating it in the microwave for 20 seconds. Place it over the eyes and keep the compress on the eyes for 10-15 minutes. Adjust the heat as necessary to suit your comfort levels, however keep in mind that the heat is what is causing the blockages to dissolve. You can also gently massage the mask into your eyes to stimulate the glands during compression, just make sure to do this gently. We recommend using a warm compress after removing makeup but before your eyelid hygiene (more on this below).

Lid hygiene

Lid hygiene is the number one most important step in treating MGD! Here are some of the main steps:

 

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Remove makeup 

If you wear makeup, it’s important to make sure you clean the products off your eyes every night before bed because it can contribute to the clogging of the meibomian glands. To make sure your skin is clean, use the Heyedrate Eye Makeup Remover. Not only will this oil remove your makeup, but it is specially formulated for dry, itchy, and inflamed eyes. Made with tea tree oil, this makeup remover will moisturize your skin while it kills microorganisms, neutralizes inflammation, and prevents the reproduction of eyelash mites. To use, apply 2-5 drops to a cotton round and gently cleanse the eyelid area, motioning back and forth to remove any eye makeup. 

 

Tea Tree Oil Soap

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Cleanse face

After removing your makeup, it’s time to cleanse your face. Use the Heyedrate Tea Tree Soap, which will support skin blemishes, soothe irritated eyes, and calm itchy, inflamed skin conditions. The tea tree oil will remove contaminants and leave your skin feeling refreshed. To use, wet your face and hands with warm water. Lather the soap in your hands, and massage the lather onto your skin and closed eyelids in a gentle circular motion. Rinse off the soap and pat your face dry with a soft towel. Repeat every morning and evening. 

 

Heyedrate Lid and Lash Cleanser

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Use a Lid and Lash Cleanser

Using a lid and lash cleanser can make all the difference if you have MGD. After you’ve used your warm compress, this eyelid cleanser should be used for both gland expression and hygiene. To use it, spray a Q-tip with the Heyedrate Lid & Lash Cleanser until damp. Looking in the mirror with one eye closed, roll the damp Q-tip on your eyelid in a downward motion, starting in the inner corner of the eye and making your way to the outer corner. Repeat this on the bottom lid by keeping your eye closed and rolling up toward the lash line.

Once you’ve done both the top and bottom lids, use your damp Q-tip (spray more Heyedrate Cleanser if it’s no longer damp) and run it across the lid margin or waterline of the upper and lower lashes. The last step is to close your eyes and spray your eyelids with the Heyedrate Lid & Lash Cleanser and let it dry. Repeat once or twice per day! 

 

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Omega-3 Supplements

Omega-3 fatty acids have been shown to normalize the meibomian glands by improving the gland oil consistency and quality. Other nutrient supplements that may help with MGD are flaxseed oil and fish oil. Try the Heyedrate Omega 3 for Eye Health, which works from the inside of your eyes to the outside to address the underlying cause of irritation. With powerful anti-inflammatory properties, this supplement with moisturize your eyes and provide comfort and relief. 

 

Tips on Meibomian Gland Expression:

  • Do this once a day. It is not necessary to do it more than that.
  • There are a couple of different options on what to use:

Using a Q-tip

  • Use Heyedrate Lid & Lash Cleanser by Eye Love and spray on the Q-tip so you know that it's damp.
  • Look in the mirror.
  • Start on one corner of your eye and roll down and across your entire eyelid.
  • Use a little pressure, but don't put too much.
  • Then, on the bottom lid, keep your eye closed and roll up.
    • The bottom lid's a bit tougher, so if you want you can just press right below that lower lash line all the way across.
  • Once you've done that, make sure your Q-tip is damp with Heyedrate Lid & Lash Cleanser and run it across the lid margin to get all of the oil out.  

Using your finger

  • You're going to do essentially the same thing...
  • Start on one corner and roll down all across your eyelid.
  • You can also just press the eyelid with your fingertip.
  • Then, using the Heyedrate Lid & Lash Cleanser, spray your eyelids with it and let dry.

That's it! You don't have to wash off the cleanser, either, as it's safe to let dry on your eyelids. Your eyes will feel better after a couple of weeks of following this protocol. You just really have to be consistent with it. Do this once a day. And let us know in the comments below if you have any questions or if you have any comments. 

Do you have a routine for treating your MGD? Let us know what it looks like in the comments below!

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