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Make sure to follow this treatment and repeat daily for best results.
A combination of both heat and moisture will help melt and release the oils in the meibomian glands so that the oil will coat the surface of the eye and keep the natural tears from evaporating. This can be done using:
Forcefully squeeze your eyes repeatedly or gently massage the eyelids while the compress is over the eyes. This will help squeeze the gland to secrete and express the liquefied oils.
LipiFlow® would give you an excellent head-start and you can do the maintenance more effectively. It does steps 1 and 2 very effectively.
After the warm compress and squeezing, use TheraLid Eyelid Cleanser or Systane® Lid Wipes and close your eyes and apply foam to the edges of your eyelid (base of eyelashes) to wash away the debris that the warm compress has released. Rinse thoroughly.
If TheraLid or Systane® Lid Wipes are not available, you can try diluted baby shampoo. Apply 2 drops of baby shampoo to a wet washcloth. Rub until it lathers then close your eyes and apply to eyelid margins. Rinse thoroughly. Baby shampoo can leave behind residue, so it’s not our first choice.
Omega-3 supplements help fight inflammation in the glands as well as help tear secretion. Some omega-3 supplements we recommend are:
Click here to read more about why omega-3 fats are so important for your eyes.
If you do the four steps above well, you might find yourself not needing artificial tears as you’ll be producing your own. This is much better and helps the survival of your precious meibomian glands as the gland will die if not taken care of properly and consistently. Please save your meibomian glands!
Dr. Youssef recommends Refresh Optive Advanced® Lubricant Eye Drops OR Systane® BALANCE. If you find yourself using the drops frequently (more than 4 times per day), use preservative-free drops to avoid toxicity.
DO NOT USE VISINE® OR MURINE® tears!
Autologous serum drops are eyedrops made from blood serum. Studies have shown they reduce dry eyes and other ocular surface disease symptoms improving overall quality of life. They contain diluted concentrations of vitamins and growth factors that are important for the health of the surface of the eye.
The study included 53 patients who received autologous serum eye drops and other treatments for ocular surface disease including topical cyclosporine, artificial tears, punctal cautery, ointments and flaxseed oil. A questionnaire was used to gauge patients’ satisfaction. Autologous serum eye drops, topical cyclosporine and artificial tears yielded the greatest satisfaction scores. Topical antibiotics and steroids were more effective than autologous serum for patients with significant lid margin disease. Patients reported the greatest improvement in function from autologous serum eye drops compared with other treatments.
Despite the efficacy of autologous serum eye drops at reducing dry eye symptoms, they’re not commonly used because they’re difficult to obtain. For safety, the patient’s blood must be tested for infectious diseases like hepatitis B and C and HIV. However, at PVSC, we improved access to this important line of treatment of dry eye symptoms.
The fee for this process is $190.00 for 12 week supply of drops.
To collect the blood for serum preparation, you need to be well hydrated by drinking 1L of water within the hour before the collection by the nurse.
About 6 tube for a total of 50ml of blood is collected from the patient using a butterfly needle, small, flexible devices used to access superficial veins for blood draw or intravenous injections.
In the PVSC lab, the blood sample is inserted into a centrifuge and spun very quickly in order to separate the serum from the blood platelets. for about 10 minutes to separate blood components. Once the serum has been separated, it’s diluted to 40% using BSS producing 12 vials of eyedrops for 12 weeks of use.
The drops will be ready for pickup the day after the collection of the blood.
Patients must bring a small cooler to keep the drops in ice until they can be put in the freezer/fridge at home.
To avoid bottle contamination avoid touching the dropper to touch the conjunctiva, eyeball, eyelid, or eyelashes. If contact is made, the bottle is considered contaminated and should be thrown away.
Be sure to firmly screw the top of the bottle back in place immediately after use. Store unused bottles in freezer (-10°C) and open bottles in refrigerator between applications (4°C). Discard active bottle after 1 week to reduce risk of contamination.
Use one drop 6-10 times a day or more if needed. Start by using the higher concentration first, then go to the lower concentration.
Meibomian glands are small glands in the eyelids responsible for producing the oily layer of tears that prevents tear evaporation and maintains the stability of the tear film. When these glands become blocked or inflamed and simply don’t work well, there’s a decrease in the quality and quantity of the oil produced leading to dry eye symptoms. Meibomian gland probing and expression (MGPE) is a method to alleviate the symptoms of meibomian gland dysfunction (MGD) and help the glands function properly.
This painless procedure is performed at PVSC with local anesthetic to numb the eyelid area to reduce discomfort. First, Dr. Youssef will probe with a thin, flexible instrument which is inserted into the meibomian gland openings at the base of the eyelids to remove obstructions or blockages in the ducts allowing the oil to flow. After probing, gland expression is performed in which gentle pressure is applied to the eyelids to encourage secretion of oil. A topical antibiotic/steroid may be prescribed to reduce inflammation after manual expression. Warm compresses or a heated pad may be applied to the eyelids before or after the probing and expression to help soften the thickened/hardened oil within the ducts.
It takes 20 minutes and is safe to drive home after treatment. Most patients have immediate relief of dry eye symptoms after probing and all patients have relief by 4 weeks after probing. Make sure you are following post-procedure care instructions on lid hygiene (warm compresses, lid scrubs, etc.) as it’s essential in maintaining meibomian gland function and alleviating dry eye symptoms long term.
BlephaClean is an in-office procedure performed at PVSC in which a revolving handpiece is used to carefully spin a cotton tip along the edge of your eyelids and lashes, removing scurf and debris and exfoliating your eyelids. It’s a painless vibration sensation but a freezing drop is usually placed in each eye prior to treatment for increased comfort. The procedure lasts about 5 minutes and, for Demodex infestations, is usually repeated every week for 3 weeks using tea-tree oil (TTO) to control the infestation.
Triple procedure is a combination of BlephaClean and MGPE to manage MGD:
BlephaClean removes the debris from the lashes and cleans the lid margin. This will prepare your lid for step 2.
Remove obstructions or blockages in the ducts and allow the better flow of their secretions. This will prepare your lid for step 3.
Apply gentle pressure to the eyelid to remove the very thick/hardened oil that is full of bacteria and debris that cause inflammation.
A punctal plug is a small device that’s inserted into the tear duct in the upper or lower eyelid. By blocking the duct, liquid can’t drain from the eye so the eye stays moist helping to relieve dry eye symptoms.
Temporary plugs are made of collagen and dissolve over time. They’re used mostly after surgery to keep the eye moist or as a trial to determine if a punctal plug is effective in relieving dry eye before inserting permanent ones. Permanent plugs are made out of silicone and are longer lasting, designed to stay in the eye for years until removed if necessary.
Artificial tears are usually still required after punctal plug insertion.
The risks of punctal plugs are fairly small and include eye irritation, excessive tearing, and, in rare cases, infection.
Omega-3 seems like a cure-all for almost anything – better heart health, reducing inflammation, providing more lustrous hair and skin, and even promoting better mood. But what about dry eye?
In a 2011 study to investigate the effects of omega-3 supplementation on patients with dry eye, researchers gave patients various doses of fish oil for 3 months. They tested subjective symptoms and ran multiple tests and at the end of the study, 70% of patients became asymptomatic. The testing showed no effect on omega-3s on the oil composition but seemed to indicate that omega-3 supplementation use increased tear secretion.
Omega-3 and omega-6s are fatty acids, which are long chains of carbon, oxygen, and hydrogen atoms. There are many difference types of fatty acids, each classified by how long the chain is and how they’re bonded within the molecule.
Omega-3 and omega-6 fatty acids are thought to be essential for us as humans because our bodies can’t make them naturally and so we need to eat them in our diets. Unfortunately, the Western diet is very deficient in omega-3 and full of omega-6. This imbalance results in a number of health issues and is in part to blame for the rising incidence of cardiovascular disease, inflammatory disease, mental and psychiatric disorders and suboptimal neurodevelopment. In comparison to populations that eat fish on a regular basis (like with the Mediterranean diet), they have consistently been shown to be healthier than those that don’t.
The forms of omega-3 that are thought to have the most health benefits are eicosapentaneoic acid (EPA) and docosahexaenoic acid (DHA), both of which are found exclusively in seafood. It’s possible for our bodies to make EPA and DHA from another form of omega-3 called alpha-linolenic acid (ALA), however, research has shown that the conversion of ALA to EPA and DHA is extremely limited. So although ALA is found in plant foods like flax, hemp, pumpkin seeds, and walnuts, no one can rely only on plant sources for DHA and EPA (especially those with nutrient deficiencies because conversion ALA to DHA requires zinc, iron, and pyridoxine).
So don’t buy flax oil in the hopes that it will omega-3 intake. Instead, eat more fish or take daily fish oil supplements, making sure they are high-quality, pharmaceutical-grade supplements that absorbs more quickly in the body.