It was only a few years ago when optometrists and ophthalmologists almost universally agreed that symptomatic dry eye patients primarily represented deficient tear production and were treated with artificial tears and Restasis.  More recently, the evidence is mounting drawing increasing attention toward problems resulting from the meibomian glands lining the eyelids and producing an abnormal or deranged lipid component that is both qualitatively and quantitatively abnormal.

Patients typically have 3 questions after being diagnosed with this abnormality which involves a meticulous examination of the eyelid glands, their express-ability, expressed material, and anatomical and architectural changes of the eyelid.  These questions are:

Can you help me understand my dry eye problem?

How did we get to this point?

Where to do I go from here and what can I expect as a result of treatment.

 

For my LipiFlow patients, my response centers around the following message:

Unfortunately, you are symptomatic from a combination of inflammation and dryness affecting the surface of your eye.

At the most fundamental level, your problem is a consequence of stasis and obstruction of the specialized oil-producing glands that line the eyelid called Meibomian glands.  This process referred to as stasis is a slowing down of the normal production and expression of the lipid produced by the eyelid  glands and this leads to obstruction and gland blockage resulting in a tear film that is both lipid deficient and unstable.  The resulting dryness in combination with inflammation impacts the ocular surface as well as the oil producing glands that line the eyelid.

This is a chronic condition and in many cases takes decades to develop but fortunately, we have a new treatment at Duke that is safe and effective in targeting the most fundament aspects of the problem – namely stasis, obstruction, and the resulting symptomatic inflammation.

I wish I could predict more precisely the degree and duration of improvement each patient might experience and we continue to look for a cure for this process but until we find that cure, we have the LipiFlow treatment that “sets the clock back” on a process that began several years previously.