The most common form of evaporative dry eye is caused by disease of the eyelids, mainly Meibomian Gland Disease or MGD.
The treatments available for MGD in order of severity are:
- Lid hygiene.
- Warm compresses.
- Omega 3 supplements.
- Blephasteam Goggles.
- Manuka honey eye drops.
- Antibiotic eye ointments.
- Blephex Lid treatment.
- Intense Pulsed Light therapy. (E-Eye)
- Maskin Probing.
All of the above treatments are available at the practice except Maskin probing.
Lid hygiene primarily involves cleaning of the eyelids to remove crustiness, dried skin cells and bacteria. There are special cleaning products available for this, including Lid Care and Steri-Lid. Warm compresses are used to heat the meibomian glands in the eyelid to promote the output of meibum (the oily layer of the tear film), and can be performed with a medi-heat pack or Blephasteam goggles. The goggles pre-heat a wet paper film saturated in saline and are worn for 10 minutes.
MGD and dry eye can also be treated therapeutically with Manuka honey drops (Opti-Mel), and antibiotic ointments. Omega-3 supplements also help to normalise the meibum.
This is a new instrument that is used to manually remove the crustiness caused by a build-up of dry and dead skin cells on the lids that are caused as a result of MGD. In a lot of cases, this is presumed to be caused by the mite Demodex, which normally lives on the skin, but eventually over-populates on the lid margins, in particular the eyelashes. The mite burrows down in the lash follicle and releases waste material and toxins onto the lid surface. This creates the chronic inflammation and infection seen in lid disease. The lashes become “cuffed” and coated with a thick crusty coating that has to be debrided.
Image below : Cleaning the eyelid margin with Blephex Instrument
The Blephex instrument, combined with a solution of Tee Tree oil (which kills the mite) is an ideal way of removing the debris. It is painless, with the main sensation being a “tickling” whilst the probe cleans the lid. Follow-up care requires the use of Blephadex lid cleanser every second day until resolution.
Image below : Before & After Blephex Treatment
This is the only available instrument that can measure the Osmolarity of the tears. This is highly associated with dry eye. A highly sensitive (and expensive) probe is placed at the outer edge of the lids and collects a small sample of tears. The computer then determines the tear osmolarity, which then helps with decision as to which tear supplements may have a more beneficial effect.
E-EYE Intense Pulsed Light Therapy.
IPL has been used in the beauty industry for many years to treat various skin conditions. It has also been proven to help in the treatment of chronic blepharitis and evaporative dry eye, although the exact underlying cause of the effect is not fully understood at this stage.
A thick layer of gel is applied to the lower lid, and special stainless steel goggles placed over the eyes. The instrument then releases an intense bright red light flash through the lids, with 4 separate flashes along the lower lid being the standard treatment. This is then repeated at 1 week, 2 weeks and 1 month, or 4 separate visits. More may be required. This procedure has a high patient satisfaction rate.