DESTROYING Blepharitis and Dry Eye with BlephEx CEO Dr James Rynerson
This was, by far, one of my favorite interviews I’ve had on the Dry Eye Show to date. Usually my episodes are around 30 to 45 minutes, but Dr. Rynerson, CEO of BlephEx, and I went on for much longer than that. This is one of the episodes you will want to get out a pen and piece of paper to take a lot of notes, because Dr. Rynerson drops a ton of valuable information for blepharitis, dry eye, and meibomian gland dysfunction treatment.
According to their website, BlephEx® is the first and only doctor eyelid cleaning procedure to help maintain clean and healthy lids. Over 50% of all patients suffer from some type of eyelid symptoms associated with insufficient eyelid hygiene. BlephEx® is a new, in-office procedure that allows your doctor to take an active role in cleaning your eyelid margins. BlephEx® removes excess bacteria, biofilm and bacterial toxins, the main causes of eyelid symptoms. BlephEx® cleans eyelids to maintain eyelid hygiene. With regular treatments, the eyelids stay clean and symptom-free. The BlephEx® treatment only takes a few minutes to perform.
What do your eyelids have to do with dry eye disease? Everything! Experts have been looking at the causes of dry eye disease for decades, and one of the major contributors is biofilm (otherwise known as scurf). This sneaky substance is produced everywhere by bacteria, and brings about Dry Eye Blepharitis Syndrome (DEBS). Anywhere there’s bacteria, there will be biofilm, including on our eyelids. Biofilm is like armor for bacteria because it’s indestructible. As it migrates, it can begin to invade the meibomian glands and other outer parts of the eyes. The thicker the biofilm gets, the more bacteria can accumulate and cause issues.
Once there’s a significant number of bacteria and significant biofilm, it begins producing toxins designed to break down tissue and produce more food for the growing bacteria. This biofilm (and the toxins) infiltrate the eyelash follicles of the eyelids and cause folliculitis, leading to redness, edema, and irritation. This is where doctors need to be proactive with their patients and catch patients in this stage, before the condition worsens.
After this, meibomitis occurs when biofilm invades the meibomian glands. We first see telangiectatic vessels on the eyelids, which is a big sign of meibomian gland issues. If the biofilm is not removed, meibum can become stagnant in the glands and the glands cease to work.
Stage three of this process is aqueous deficiency. Biofilm has the ability to migrate over the conjunctiva as far up as the lacrimal glands, contributing to this issue. We used to think that this was a different form of dry eye disease, but we’re beginning to think they’re connected by biofilm and a slow, chronic inflammation that takes over. Rarely will doctors see an aqueous issue without accompanying meibomian gland dysfunction.
If it gets to this point, we then have to worry about neuropathy and destruction of nerve endings. We worry about ectropion, where the eyelids turn out, or entropion, where the eyelids begin to curl inward. This is end stage, of course, but it can be prevented!
Prevention of Dry Eye Disease with BlephEx
According to Dr. Rynerson, every single patient should have their eyelids debrided every six months in order to prevent biofilm. If you keep your eyelids clean, just like you keep your teeth clean, you can prevent many of the issues that biofilm causes. This looks like daily eyelid hygiene in addition to scheduled debridements in your doctor’s office.
As you can see, the best treatment is prevention of biofilm in the first place. Removing biofilm is number one, and BlephEx is obviously Dr. Rynerson’s preferred method. After this, daily eyelid cleansing at home is so important (like brushing your teeth). He recommends using a hypochlorous acid eyelid cleanser or eyelid scrubs for this. In addition to this, for those who have a lot of inflammation, steroid eye drops can be very effective four times per day to stop the inflammation in its tracks. The sooner you can stop the inflammation, the better off your eyelids will be.
For eyelid hygiene, if they work for you then continue them. If you find them difficult to use or you’ve never found benefit, BlephEx alone can be done every 4-6 months in the doctor’s office. Regarding prescription medications, Restasis, Xiidra, or Cequa may be beneficial to reduce inflammation and protect the glands, although not every patient will benefit from them.
For those who seem to have tried everything, sometimes a “medication vacation” is exactly what is needed. Have BlephEx done, and then stop medications for a week or so and see how things go.
BlephEx Procedure and Cost
BlephEx is a procedure that debrides and removes biofilm from the eyelids. According to Dr. Rynerson, every single patient should have BlephEx done for prevention of eyelid margin disease and eventual MGD. Preventative treatment is so important, and we’ve touched on this so much already.
This procedure will cost anywhere between $100-400, depending on where you live. It should be done every 4-6 months. Currently, insurance does not cover BlephEx because once you give something to insurance, controlling the pricing of the procedure becomes tough, and this isn’t great for doctors or patients.
Contraindications for BlephEx
Recurrent Corneal Erosion
BlephEx, the FDA, and Long Term Studies
BlephEx is a 510K exempt procedure, meaning that the company has demonstrated safety to the FDA. There are no disease claims made by BlephEx and they are technically a cleaning procedure. Two studies have looked at tear break up time after this procedure. The first showed a 60% increase in TBUT after one treatment, and the second demonstrated a 66% increase in TBUT after only one treatment. These results show how important this procedure is.
Lightning Round on BlephEx - Questions From the Community
1:07:15 - Yashwanth Chakka - I have MGD due to inflammation (not bacteria or demodex or blepharitis). Is BlephEx really helpful for me?
1:08:08 - Tracy Tulloh Galloway and Joseph Pytcher - Plans for a do at home BlephEx product?
1:08:30 - Michelle France - I have MGD and dry eyes from PRK, would this help me?
1:09:30 - Ali Ali - How is BlephEx different than debridement of the lids?
Is it better to use BlephEx or debridement before doing lipiflow?
Does BlephEx help with demodex?
What is the best wash for drs to use for BlephEx?
I see Lid Hygenix is made by you, but does that have tea tree in it to kill demodex? Can drs use the cliradex foam for BlephEx?
1:13:20 - Kon Bar - Is there a new device on the way that might be even more effective than BlephEx?
About Dr. James Rynerson, CEO of BlephEx
Dr James Rynerson received his medical degree from University of Louisville in 1990 and went on to complete an ophthalmology residency at LSU in Shreveport. After being in private practice for 17 years with an emphasis on LASIK and cataract surgery, Dr Rynerson became convinced that eye doctors could much more effectively treat blepharitis and dry eye, if they only had a tool that allowed for a complete exfoliation of the inflammatory biofilm on the lid margins of these patients.
In 2011, Dr Rynerson began to devote his full attention to bringing just such a device to the market, for the benefit of the millions of patients worldwide who suffer from these conditions. BlephEx was introduced to the market in 2013, as the first and only doctor treatment for blepharitis and dry eye. The device is now in 15 countries around the world and is quickly being adopted as the new standard of care in blepharitis, MGD and dry eye treatment.
Dr Rynerson became a pioneer in the understanding and treatment of lid margins disease, and was the first to propose the etiology of biofilms and exotoxins along the lid margin as the source of low-grade inflammatory damage to the tear glands. He was also first to recognize the similarities between the benefits of dental hygiene in keeping our own teeth, and lid hygiene in keeping our own tears.