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Subspecialties Cornea / Ocular Surface, Health Economics and Policy

The Importance of Ocular Hygiene

Dry eye is a very common problem in my practice. Patients usually come through my door with a different complaint, but it turns out that they suffer from an ocular surface problem, meibomian gland dysfunction, or evaporative tear disease. I could identify some form of this condition in almost all of my patients.

Some have a very mild form of OSD and are asymptomatic, and in others it is more advanced, but I believe in all patients it needs to be treated at a young age, so that they do not think that they got the condition overnight, as many currently do – it happens over many years, in a similar way to tooth decay. It is important that clinicians assess lid health regularly.

Just like taking care of our teeth throughout our lives and going to the dentist twice a year – it is equally important for my dry eye patients to take care of their ocular hygiene.

Patients who come to me with dry eye mostly use over-the-counter artificial tear drops. There are some good prescription eye-drop options available, but usually drops alone don’t solve the problem entirely. Patients have the option of applying a warm compress to their eyes at home – in the form of a warm wet towel or a microwaved heat mask – but this is time consuming.

We also know that heat is not necessarily effective in those conditions: it is important to maintain the temperature for a specific time to make sure the meibum is melted.

For these reasons, I was quite keen to try the TearCare device from Sight Sciences. I have used it over the past few months, participating in clinical research trials, as well as offering it to patients in my private practice. It is a great tool for managing the evaporative form of dry eye, which involves meibomian gland dysfunction, and I’ve been suggesting it to patients as a first-line treatment.

Patients really appreciate the fact that they are not required to apply prescription medication every day, and they tend to see a very quick improvement. I make it clear that using TearCare is not a cure, but a continuous process. Just like taking care of our teeth throughout our lives and going to the dentist twice a year – it is equally important for my dry eye patients to take care of their ocular hygiene.

The device is really easy to use, both for the physician, and for the patient. It allows me to target the glands, and if I can see that one gland is more plugged than the other, I can manually target it with extracting forceps.

I am usually the first person telling my patients about ocular surface disease, or dry eye, even though so many of them would have benefitted from being treated earlier. I feel that it is now vitally important to raise public awareness of this issue. There are many great technologies available to treat this condition – and new ones will continue being developed – but very few patients know about meibomian gland and dry eye treatments, and I would really like this to change.

Dry Eye Scene – a selection of devices designed to alleviate dry eye symptoms

iLux from Alcon is a meibomian gland dysfunction (MGD) treatment system, which was introduced to the market in February 2019. The iLux device features a Smart Tip patient interface, which applies light-based heat and compression under direct visualization. 

LipiFlow by Johnson and Johnson Vision is a system used for thermal pulsation treatment. It assists in clearing gland blockages by heating and massaging the inner and outer lid. Patients receive in-office treatments that last 12 minutes, with activators placed under and over the eye lids, avoiding contact with the ocular surface.

NULids is a medical device system designed for home use. It features a soft, daily disposable brush that massages the eye lids for 15 seconds per eye, once a day.

E>Eye from ESW Vision aims to alleviate dry eye symptoms by generating a polychromatic light. It is used by an eye care professional, who places a metal eyewear protection on the patient’s head, and applies a series of five flashes under the lower eyelid. 

Allergan’s TrueTear intranasal tear neurostimulator aims to increase tear production using tiny pulses of energy. The device is aimed at adult patients with severe dry eye symptoms. It wirelessly connects to a phone app, which tracks the device use and intensity levels.

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About the Author
Jennifer Loh

Jennifer Loh is the founder of Loh Ophthalmology Associates in Coral Gables, Florida, and a member of the executive committee of the Refractive Surgery Alliance Society.

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