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Dry Eye Treatment

Dry eye disease (DED) is defined as a “multifactorial disease of the ocular surface characterized by a loss of tear film homeostasis and associated with ocular symptoms, involving tear film instability and hyperosmolarity, inflammation and damage to the ocular surface and neurosensory alterations an etiological role “. Accurate diagnosis and classification of dry eye is complicated by the heterogeneous nature of the disease and the variability of signs and symptoms.

3-D OSA ocular surface analyzer

The Ocular Surface Analyzer (OSA) is the new tool for the individual analysis of the tear film that allows a rapid and detailed structural investigation of the tear composition and the investigation of all layers, namely lipids, aqueous and mucin. OSA also helps identify the type of DED and determine which layers can be treated with a specific treatment, in relation to the type of deficiency. Three-dimensional (3D) meibomian gland imaging: The revolutionary introduction of 3D meibomian – 3D imaging of the gland offers the doctor two distinct benefits. Firstly, it allows you to confirm the presence of abnormal glands compared to that of a healthy person in a 3D format, and secondly, it provides a clear picture to share with the patient to help the possible cause of his discomfort.

Intense pulsed light therapy (IPL)

Intense pulsed light therapy (IPL) is a relatively new treatment for evaporative dry eye and rosacea. Using filters in the IPL handpiece, the light spectrum emitted by the flash lamp can be absorbed by oxyhemoglobin. The light is converted into heat-inductive ablation of the vascular structures. This process of photothermolysis is one of the proposed mechanisms of action of IPL for dry eye, in which the wavelengths selectively destroy blood vessels by targeting chromophores in the blood vessels. The destruction of telangiectasias along the eyelid prevents the access of inflammatory mediators to the Meibomian glands. Other possible mechanisms include a mild local heating effect to allow better meibum expression and the destruction of bacteria that cause inflammation at the meibomian gland.

The following parameters can be measured by OSA, and each parameter plays an important role in identifying the DED type

It is a technique that studies the surface reflection pattern and the dynamics of the tear film lipid layer, allowing to measure the stability of the tear film and the thickness of the lipid layer. If the tool shows a dull white pattern, it means there are no lipids; if it shows a white, rapid movement of the image, the lipid layer is present and in a borderline state; If the resulting image is full of colors, it means there are a lot of lipids.

The size of the tear meniscus formed at the edges of the eyelids provides useful information on the volume of tear fluid produced. The lacrimal meniscus can be examined for its height, regularity and shape. Assessment of the amount of tear film uses magnification tools; you can measure the height of the tear meniscus and evaluate its characteristics along the lower lid margin.

Measurement of BUT by a non-invasive technique eliminates the disruption of the tear film caused by the instillation of the fluorescein dye. The stability of the mucin layer and the entire tear film is measured by NIBUT using grids projected onto the cornea. You can manually or automatically judge when the tear disintegrates.

Describes the morphology of the glands to diagnose each meibomian gland. Further details fall out that would lead to lacrimal dysfunction. Meibography is the visualization of the glands by transillumination of the eyelid with infrared light. Meibomian gland dysfunction destabilizes tears, causing evaporative dry eye. The posterior lamella of the eyelid hosts a fleet of meibomian glands located between the eyelid conjunctiva and the tarsal plate. A normal meibomian gland is approximately linear and 3-4 mm long and extends across the posterior lid perpendicularly from the lid margin to the opposite tarsal margin.

This test helps detect blepharitis and demodex, which can be done on the outer surface of the eye and eyelids.

After you take the picture of the conjunctival blood vessels, you can compare them with the bulbar and limbal redness degree classification sheets.

Measurement of the pupil’s response to light with and without glare; Measurement mode: scotopic, mesopic and photopic.
Measurement of the pupil’s response to light with and without glare; Measurement mode: scotopic, mesopic and photopic.

The Advantages of IPL

  • Using strong pulsed light to treat MGD cases tends to alleviate dry eye symptoms.
  • The meibomian gland activity is increased, the tear film is balanced, and ocular surface inflammation is reduced after IPL therapy.
  • IPL improves tear film homeostasis and alleviated ocular symptoms in cases with refractory MGD, making it a potential treatment option for this disorder.
  • Meibum consistency, meibum expressibility, lid margin abnormality, ocular surface staining, tear film breakup period (TBUT), and the Ocular Surface Disease Index (OSDI) all improved significantly after IPL.

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