Our tears have a big job to do. To nourish and protect the front of the eye, the tear layer needs to exist as an unbroken layer of fluid. When the tears evaporate too quickly, or when they don’t cover the front of the eye completely, blurred vision as well as pain and irritation can result. To appreciate the source of dry eye symptoms, we have to first consider the anatomy of the tears layer by layer. The first layer in the tear film is the “mucin” layer which allows the rest of the tears to adhere to the front of the eye. The middle layer of the tears is the largest layer and is called the “aqueous” layer. The outermost layer of the tears is the oil or “lipid” layer. The lipid layer is important because it prevents the aqueous layer from evaporating off the eye. Recent research has shown that problems associated with the lipid layer have big consequences for the health and comfort of the eyes.
Anatomy of the Tearfilm – The Mucin layer holds the other layers to the eye. The Aqueous layer is the bulk of the tears, and provides moisture and nutrient exchange to the cornea. The Lipid layer floats on the surface of the tears and prevents evaporation of the aqueous layer.
It has been found that up to 86% of dry eye is due to a chronic inflammatory condition known as Meibomian Gland Dysfunction, or MGD. Meibomian glands are located in the upper and lower lids and produce the crucial oil layer that prevents the rest of the tear film from evaporating. When MGD affects the ability of these glands to produce oil, chronic dry eye can result. Early detection of MGD is important because by the time MGD causes symptoms, permanent structural damage to the Meibomian glands has likely already occurred.
Our eye doctors check the functionality of the Meibomian glands at your annual comprehensive eye and vision examination. Meibomian gland function is checked directly under the biomicroscope. To determine if the Meibomian glands are functioning properly, we check the glands for their ability to secrete oil, and that the oil that they do secrete is of the proper consistency. This procedure causes little or no discomfort.
The Meibomian glands are also imaged directly using a system called “LipiScan.” These diagnostic images are easily taken, and allow our doctors to view the structure of the Meibomian glands. When the Meibomian glands become twisted or shortened, they demonstrate dysfunction typical of MGD. When the glands are lost entirely (gland atrophy), they are lost for good and cannot be recovered. For those patients with shortened or distorted Meibomian glands, prompt treatment is important to prevent un-necessary gland loss and the symptoms that arise from MGD.
Healthy Meibomian glands as seen with the LipiScan imaging system
Meibomian gland loss as a result of chronic, inflammatory disease (MGD)
There are a wide variety of treatment options available for dry eye and MGD. Determining the cause of each individual patient’s dry eye is important so that the proper treatment can be initiated. If MGD is the cause of eye dryness (as is often the case), the most lasting and effective treatment is LipiFlow®. LipiFlow® is a 12-minute treatment performed at Vista Eye Care which is designed to remove blockages from the Meibomian glands, allowing them to properly function and produce the oils that make up the top protective lipid layer of the tear film. LipiFlow® activators are single-use sterile devices that safely and comfortably deliver a combination of heat to the inner lids and simultaneous therapeutic motion to the outer lids, removing blockages from the Meibomian glands. The Activators are contoured to avoid contact with the cornea, protecting the delicate structures of the eye. Maximum results are usually experienced 6-8 weeks after treatment.
LipiFlow® Activators are precisely designed to provide necessary inner and outer lid contact, to properly apply heat and massage and clear the Meibomian glands. The entire treatment takes approximately 12 minutes and on average causes minimal discomfort. The clinical science behind MGD as the primary cause of dry eye and its effective treatment with LipiFlow® is supported by extensive scientific research. Removal of the gland blockages is essential to improve gland function and reduce the progression of MGD.
LipiFlow Activators in use on a patient with MGD
If you suffer from eye dryness, or if your LipiScan imaging revealed Meibomian Gland Dysfunction, you may be a great candidate for LipiFlow®. Please call our office today at (303) 450-2020, or use the button below to schedule you examination online.
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Amid the rapid rise of myopia around the world the AOA has issued a clinical report citing optometry’s leading role in diagnosis, management and treatment of the public health threat. https://www.aoa.org/news/clinical-eye-care/public-health/doctors-of-optometry-leaders-in-fight-against-myopias-threat