Treatment of ocular surface inflammation and dryness by warming the lids and applying gentle massage has been prescribed for
years with variable results. Even when the technique is applied correctly and patients are actually able to devote enough
time to it, some patients gain little more than temporary relief.
In some cases, when patients are using lid hygiene and warm compresses in addition to 5 or 6 other topical and oral treatments,
this part of the routine can become the most frustrating piece to comply with. In addition to vision fluctuation, foreign
body sensation and pain, patients also often become psychologically and emotionally strained in severe cases.
Easing the treatment regime
A novel device from TearScience allows this part of the treatment regime for patients with meibomian gland dysfunction (MGD)
to be performed using a comfortable 12 minute procedure in the office. The LipiFlow device allows gentle warming to 41–43
°C applied to the palpebral surface of the upper and lower lids directly over the meibomian glands as it simultaneously applies
pressure to the outer eyelids (Figure 1). This combination achieves focal heating and expression in a very efficient manner.
Figure 1: A schematic of the LipiFlow system.
Development of this device coincides with a paradigm shift in treatment focus to meibomian gland obstruction and dysfunction
as a key, limiting step leading to compromise of the ocular surface in the majority of cases of dysfunctional tear syndrome
(DTS). Just as with any other new device, we approach implementation of these devices carefully and after they've been supported
by clinical data demonstrating efficacy and safety.
In the journal Cornea,1 Steve Lane and colleagues compared LipiFlow to iHeat warm compress systems in a crossover, multicentre clinical trial in
one hundred and thirtynine patients. At two weeks of treatment, the iHeat arm (n = 70) crossed over to LipiFlow (n = 69) treatment.
After studying meibomian gland (MG) assessment, tear break up time (TBUT), and dry eye symptoms, LipiFlow treatment demonstrated
statistically significant superiority at 2 and 4 weeks. Moreover, the crossover group showed a significant improvement two
weeks post treatment with LipiFlow.