Dry Eye Dx and Tx

Test Driving a New Treatment

BY KATHERINE M. MASTROTA, MS, OD, FAAO

In my last column, I confessed my preoccupation with the eyelids. So, as you can imagine, when the chance to try a LipiFlow (TearScience) treatment presented itself, I was first in line. Before my treatment, I had previewed a number of YouTube video segments of LipiFlow in action, but there’s no better way to understand the new technology than a real, live personal session.

How the Device Works

LipiFlow, invented by Donald Korb, OD, is a thermal pulsation treatment of the eyelids developed to treat meibomian gland dysfunction. It received FDA clearance in July 2011.

Figure 1. My unilateral LipiFlow treatment.

The LipiFlow system integrates direct heat to the meibomian glands, combined with eyelid massage in an automated design. The LipiFlow heating element is positioned on the palpebral side (i.e., the inside) of the lid, rather than on the dermal side. Heat is applied close to the glands and therefore is not lost to the eyelid skin and anterior tarsus as it is in traditional, externally applied heat. To accomplish this, a specially designed scleral shell-type device is positioned behind the eyelid. The shell, of course, vaults and insulates the cornea.

Once the eyelid is warmed to 42.5 degrees Celsius, inflatable silicone bladders that surround the upper and lower eyelids fill and deflate in a synchronized rhythm to effectively massage the meibomian glands that are positioned against the warming shell.

The binocular warming and pulsating compression treatment lasts 12 minutes. It expresses melted gland plugs from the glands, clearing the central meibomian gland ducts to channel and deliver freshly produced meibum to the lid margin.

Lane et al (2012) found that LipiFlow treatment was significantly more effective compared to warm compresses for alleviating clinical symptoms and improving meibomian gland secretion scores. Furthermore, reduction of symptoms (as measured by the Ocular Surface Disease Index and the Standard Patient Evaluation of Eye Dryness questionnaires) and improved tear breakup times after a single LipiFlow treatment were sustained for nine months in one study (Greiner, April 2012), and for up to one year in another (Greiner, Nov. 2012).

My LipiFlow Experience

I underwent a unilateral LipiFlow treatment (Figure 1) without topical anesthetic. The shell was not uncomfortable, and I found the warmth soothing. The pulsation felt like gentle tugging on my eyelashes. I experienced no adverse effects after the treatment.

As I write this, it has been one week since my LipiFlow procedure. TearScience notes that it takes some patients two to four weeks to experience symptom improvement. Although I am generally asymptomatic as far as dry eye symptoms go, my treated eye feels “softer” and the glide of my treated eyelid feels “smoother.”

Worth Checking Out

TearScience literature advises that factors such as meibomian gland atrophy may limit improvement in gland function and symptomatic relief. However, for some patients even small gains can positively impact their quality of life. I encourage you to investigate the viability of this technology either in your practice or by referral to a specialty practice. Either way, you will have offered evaporative dry eye patients the most sophisticated technology available for addressing their symptoms. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #211.

Dr. Mastrota is secretary of the Ocular Surface Society of Optometry and center director at the New York office of Omni Eye Services. She is a stock shareholder of TearLab Corporation and a consultant or advisor to OcuSoft, B+L, Allergan, Alcon, Sarcode Bioscience, and Nicox. Contact her at katherinemastrota@msn.com.