New Dry Eye Treatment: The LipiFlow Device

At some point very soon, I know I need to dedicate a significant number of posts to Dry Eye Syndrome.  (It is in all caps, because this is a condition that significantly affects the quality of life of as many as 7 to 17% of the population depending on which studies you are looking at!).  People with Dry Eye experience redness, irritation, discomfort, blurred vision, sharp pain, watering, crusting, or dryness.  It is typically worsened with computer use, contact lens wear, and the use of ceiling fans and air conditioners.  Treatment ranges from over the counter drops to expensive prescriptions and ointments to lubricate the ocular surface.

This patient's meibomian glands are obviously clogged, causing a blockage of tear film secretion!

One of the leading causes of dryness is called Meibomian Gland Dysfunction, where the tear glands located along the top and bottom eyelid fail to properly release their oily tear film layer onto the eye, causing the tears to quickly evaporate and leave the surface dry.  To treat MGD, we often prescribe warm compresses with massage to open the gland orifice and force the tear secretion through the gland onto the eye.  Fish oil supplements and oral doxycycline can also help with the functioning of these sebaceous glands.  I will go into more detail concerning these treatments in the future, but this post is dedicated to the new treatment for MGD:  the LipiFlow device!

The LipiFlow device

A local company in Morrisville, NC called TearScience recently received FDA approval for this device to treat moderate to severe MGD.  As you can see from the image above, the major component of the device is a mechanical "cup" that is applied to your eyelids.  This machine heats the lids from the inside, then uses timed pulsations to express the clogged secretions from the meibomian glands.  The entire procedure lasts about 12 minutes, and there is very minimal discomfort reported by patients at this time.  The cup that sits over the eye is quite large, but it does not touch against the cornea (the clear dome of the eye), and as such, must be large enough to only touch the outer portions of the eye.  Yes, you read that right.  The suction cup-esque part of the device pictured above touches the inside of your eye.  Sounds uncomfortable, but you will be given a numbing drop before the device is inserted.

As you can see from this diagram, one part of the device is under the lids providing heat to the glands, and the other is external to provide pulsation to "milk" the glands

Things to know:
1) This procedure is very new, but results are showing that some patients are getting relief from their dry eye symptoms lasting anywhere from 3 months to more than a year!  For many patients life without artificial tear drops, or with significantly less drops, is well worse 12 minutes of pressure being applied to the lids.
2) Because this procedure is so new, only a very few clinics are offering it.  There is also no CPT code available, so this means in practical terms that no insurances will cover the procedure at this time.  Expect cost to be significant.  In my area, Duke Ophthalmology has access to the device, and the cost is around $1500.
3) The science isn't available yet as to how effective this machine is long term, or what the magnitude of objective improvements are in the level of dryness, such as tear film break up time and tear film osmolarity. The theories behind this device are the same that optometrists recommend to patients every day when they prescribe warm compresses with lid massage to improve meibomian gland secretion.  If you are interested in more information, please feel free to post here.  In the North Carolina area, there is a doctor at Duke who is accepting patients for this procedure for those that are interested!