Although dry eyes sounds rudimentary, it has significant impact on sufferers. It brings about lot of discomfort and pain to many individuals with this disease. Dry eyes can become a disease state when the ocular surface is compromised due to its physiology, an individual’s lifestyle and the environment. The symptoms include dry gritty sensation, burning, itchy, watery, intermittent visual blur, light sensitivity and can affect overall mental wellbeing.
There are two main causes of dry eyes: aqueous deficiency and evaporative dry eyes. Approximately 80% of people who have dry eyes are considered to have evaporative dry eyes. Evaporative dry eyes is a disease state and unfortunately there is no cure for it. However, there are long term treatment options available that provide symptomatic relief.
What is evaporative dry eyes? To not experience evaporative dry eye symptoms the water aqueous layer of tears is essential. The tears consists of three layers: 1) the innermost mucin layer that acts as a cement to the epithelium/skin of the cornea, 2) the water aqueous layer for hydration of the cornea and 3) the outermost fatty oil layer for protection and prevention of evaporation of the water aqueous layer. Evaporative dry eyes occurs when the water aqueous layer evaporates at a faster rate because either the protective oil layer is turbid or not present. This oil is produced and released by meibomian glands that sit along the upper and lower eyelid margins. The rapid evaporation of water aqeuous layer leaves the cornea exposed and less hydrated, which can in turn bring on inflammation causing further harm to the ocular surface in a viscous cycle.
The meibomian glands need to function properly in order to reduce the evaporative tear rate. For loads of reasons these glands become turbid, i.e. its pores get clogged over time and eventually the glands die or drop out. This is called Meibomian Gland Dysfunction (MGD). Patients with MGD have an increased rate of water aqueous evaporation and inflammation which bring about the symptoms.
LipiScan and LipiFlow Thermal Pulsating Treatment
The LipiScan and LipiFlow treatment by Johnson & Johnson is a new, promising revolutionary technology for patients who want long term relief from their evaporative dry eyes and MGD symptoms. This treatment system targets both the structure and function of the meibomian glands. To view the structure the LipiScan scans your meibomian glands to determine how many are still present and how many have been dropped out or disintegrated. A special device is used to check the function of these glands by pressing the lid margins to determine the extent of plugged glands. If majority of the glands are present but turbid and plugged, then the LipiFlow treatment has a high potential of unplugging these glands with thermal and mechanical energy providing symptom relief within days.
During LipiFlow treatment a device called an activator is placed in each eye. This activator a hard shell that can, on one side, heat up to 42 Celsius while ensuring the cornea is protected. Maintaining the temperature softens the oils and allows mechanical rollers to massage the glands and unclog them by squeezing the meibum oil out through its pores. This treatment takes approximately 12 minutes from start to finish. Initially the treatment may cause some increased symptoms for a day or two, but the symptoms improve and resolve thereafter. The glands take approximately six weeks to fully regenerate and produce new, clear meibum once again
In a clinical study where symptom relief was calculated using standardized questionnaires, 79% of patients reported improved overall dry eye symptoms due to MGD within four weeks of a single LipiFlow treatment. This treatment can provide symptomatic relief for at least 9-12 months and, in some cases, up to 2 years.