What is Dry Eye Disease?
Dry Eye Disease is a common condition of the ocular surface and occurs when there is an imbalance of the components in the tear film. Common symptoms include persistent dryness, burning or stinging, itchy or scratchy sensation, excessive tearing, light sensitivity, and blurry vision that fluctuates. Dry Eye Disease is typically chronic and progressive, and in severe cases, can lead to irreversible scarring of the meibomian glands, cornea, and surrounding tissue.
One of the main causes of Dry Eye Disease is dysfunction of the meibomian glands, found in our upper and lower eyelids, which are responsible for producing the oily layer of the tear film. This oil helps prevent the water component of tears from evaporating too quickly, keeping the eyes lubricated and comfortable. When these glands become blocked or inflamed, they cannot release enough good-quality oil, leading to an unstable tear film and dry eye symptoms. This can lead to the inflammatory stage of Dry Eye Disease – abnormal micro blood vessels may begin to develop in the eyelids in response to the unstable tear film, or a hard bump consisting of hardened oil and inflammatory material in the eyelid may form. This is called a chalazion and often requires treatment for it to improve.
What are IPL and RF Treatments? What is Manual Gland Expression?
- Intense Pulsed Light (IPL) Therapy: IPL therapy is a non-invasive therapeutic treatment that uses light energy. Unlike lasers, which emit a single wavelength of light, IPL uses a broad spectrum of light that can be filtered to target specific wavelengths for various therapeutic purposes. As the light energy penetrates the skin, it triggers the body’s natural healing system.
It is effective in dry eye therapy as it:
- Removes abnormal micro blood vessels on the eyelids that grow in response to chronic dryness. In doing so, this decreases the inflammation in and around the eyes
- Destroys excess growth of the demodex mites buried in the eyelash follicles which cause blepharitis and worsen dry eye symptoms
- Rapidly reduces the inflammation in meibomian gland obstructions which leads to quicker resolution of chalazion without the need for surgery or medications and may reduce the frequency of future re-occurrences
- Reduces the appearance of any redness, sunspots, and acne scars in the areas around the eyes
While other IPL devices are frequently found in dermatology and cosmetic clinics for skin rejuvenation, Lumecca-I is only available in a few optometry clinics for the treatment of dry eye disease. Its unique feature is its small adaptor size, delivering the treatment precisely to the eyelid margin. Due to the high amount of light energy, this treatment may only be administered by a trained professional with knowledge of the ocular anatomy. All doctors at Richmond Hill Eye Clinic have received additional training to administer IPL safely to the eye region.
- Radiofrequency (RF) Therapy: RF is a Health Canada approved treatment for non-invasive treatment of mild to moderate facial wrinkles and is being used off-label for the treatment of dry eye. It utilizes high frequency electrical current, travelling between the two electrodes in the patented Forma-I probe, resulting in a precise and controlled heat generation. This results in a comfortable, gentle, and warming effect. There is no anesthesia or downtime associated with the Forma-I.
It is effective in dry eye therapy as it:
- Melts any solidified oil in obstructed glands more effectively than a warm compress, as the current precisely reaches the meibomian glands
- Improves the quality of your tear film by allowing the glands to resume normal and healthy oil production
- Softens the blockage in the meibomian gland which leads to quicker resolution of chalazion without the need for surgery or medications
- Stimulates collagen production, which improve gland function and reduces the appearance of fine line and wrinkles in the skin around the eyes
While other RF devices are frequently found in dermatology and cosmetic clinics for wrinkle reduction, Forma-I is only available in a few optometry clinics and may only be administered near the eye by a trained professional for the treatment of dry eye disease. Forma-I has precise real-time heat monitoring, which is important when using an RF device near the eye as the skin in the area is more thin compared to the rest of the face and body. All staff and doctors at Richmond Hill Eye Clinic have received professional training to administer RF safely to the eye region.
- Manual Gland Expression: This manual treatment is done after your IPL/RF treatment. Your optometrist will apply gentle pressure to the eyelids using a specialized tool to push out any blockages from the meibomian glands. Your optometrist will then perform lid debridement using a specialized tool to gently scrape along the edges of your eyelids.
It is effective in dry eye therapy as it:
- Pushes out any remaining blockages from the meibomian glands to allow the gland to stimulate the release of fresh and healthy meibum
- Physically removes any biofilm from bacteria and excess keratin obstructing the openings of the oil glands to reduce future blockages
- Allows your optometrist to monitor for changes in your meibomian gland health throughout your treatments
The recommended number of treatment sessions is 3-4 sessions completed every 3-4 weeks. 1-2 maintenance sessions per year may be recommended for the following years. For chalazion removal, 1 session may be adequate for acute or minor cases. 2 or more sessions may be needed for chronic or larger chalazion.