Dry Eye diagnostics (includes evaluation of meibomian glands for MGD)
- Meibography
- Lipid Layer Thickness by interferometry
- Meibomian Gland Evaluation and Expression score
- MMP-9 Tear Assay
- Tear Osmolarity
- Fluorescein and Vital Dye staining
- Tear Break Up Time
- Schirmer Testing
- SPEED questionnaire
- Omega 3 Index – blood test
- Early Sjogren markers – blood test
- Corneal Topography
Dry Eye and MGD Treatments
- Tear Substitutes, drops, gels
- Lid warming eye masks
- Tea Tree Oil based lid cleanser
- Omega 3 – triglyceride form
- Prescription Cyclosporine drops (Restasis, Cequa, and Klarity-C)
- Prescription Xiidra drops
- Regener-Eyes drops
- Debridement of lid margin
- Lipiflow – vectored eyelid thermal pulsation
- Intense Pulsed Light (IPL)
- Blephex
- Punctal Occlusion with punctal plugs
- Autologous Serum Eye Drops (ASED)
- Protopic ointment
- Doxycycline
- Azithromycin drops
What is Dry Eye?
Dry Eye is a term used to describe a host of ocular conditions that create irritation, burning, grittiness, tearing, and redness of the eyes. Dry Eye is multifactorial and may be secondary to decreased tear production, corneal exposure, or too rapid an evaporation of tears due to a poor lipid layer (an oil layer that coats a healthy tear film). Once the type of Dry Eye is elucidated there are multiple ways to treat the condition including artificial tears, prescription eye drops, oral supplements, lid hygiene routines, and in-office procedures such as Lipiflow and IPL. As a dry eye center of excellence, Dr. Sherman, and Dr. Raviv have extensive experience with dry eye diagnosis and treatment.
Lipiflow
A major factor in dry eye disease are occluded oil glands present in the lid – the meibomian glands. Meibomian gland disease (MGD) needs to be properly identified and controlled in order to relieve dry eye symptoms and improve tear function. This can be accomplished with at home treatments such as lid cleaning with special tea tree oil containing cleansers along with daily heating with microwaveable eye masks.
The most advanced treatment involves an in-office thermal pulsation device (LipiFlow), which simultaneously heats all four eyelids and thoroughly clears out all of the meibomian glands. Dozens of published papers and our clinical experience find that (in conjunction with other dry eye therapy) patients usually find up to a year or more of relief from symptoms following LipiFlow.
Intense Pulsed Light (IPL)
IPL or Intense Pulsed Light is the latest treatment available for dry eye and meibomian gland disease (MGD). IPL has been used for two decades by dermatologists for the treatment of age spots and vascular (blood vessel related) conditions such as rosacea. Many of those patients experienced an improvement in their dry eye. Now IPL has been optimized specifically for long lasting dry eye relief and has emerged as one of the most successful treatments for dry eye and MGD. Performed in our office in a pain free, no down time manner, IPL (often combined with Lipiflow) is one the most effective in office treatments for long term control of dry eye.
Blephex
Blepharitis is a common eyelid condition that can lead to symptoms ranging from burning, itching, flaking, eyelid discharge, eyelid redness, and the occurrence of frequent “pink eye” like flare ups. The eyelids, which act as the critical windshield wipers of the tear film, are complex structures that can frequently get inflamed and develop bacterial overgrowth. Maintaining a health eyelid margin involves usually involves at home applications of heat, lid wipes, and cleansing. Sometimes this treatment is not enough and difficult to maintain daily.
With Blephex, our staff is able to perform a very efficient, thorough, and lasting cleaning of the eyelid margin with lasting effect. Medically known as MicroBlepharoExfoliation, this 15 minute in office treatment allows for a rapid restoration of the healthy lid surface. Typically, Blephex is repeated at a scheduled interval of 3-4 months, providing for lasting relief. Commonly Blephex is combined with Lipiflow.