October 31, 2014
The ocular surface and tear film can no longer be ignored, nor should they be. We have long been aware of the problems of chronic dry eye and the damage that can occur to the ocular surface. Complications can range from chronic irritation and blurry vision to infections and corneal melts. In addition, with the growing number of refractive procedures and premium IOL surgeries, it is becoming increasingly obvious how important the tear film is to vision and, therefore, how paramount it is to treat dysfunctional tear syndrome in order to obtain excellent visual outcomes. In the past, treating dry eye and tear film abnormalities has been frustrating for both the patient and physician with limited options and minimal success. However, there are innovative treatments on the horizon to address these abnormalities.
The teaching has been to separate dry eye syndrome into aqueous deficiency and evaporative tear syndrome. Evaporative tear syndrome could further be subdivided into goblet cell deficiency (as seen in conjunctival scarring), blepharitis/meibomian gland dysfunction (MGD) and lid function abnormalities (such as lagophthalmos and incomplete or partial blink). MGD makes up the majority of evaporative tear syndrome cases. The standard treatments for MGD, such as warm compresses, lid hygiene, topical and oral antibiotics, and topical anti-inflammatory agents, have been well established and are beyond the scope of this article. Now the debate has begun over whether any or all of the “procedural treatments,” such as intense pulsed light therapy, LipiFlow and meibomian gland probing, should be incorporated into the treatment regimen. I will make the argument for adopting LipiFlow into your practice.