Dry eye is a late manifestation in a continuum of disease starting with blepharitis, according to a hypothesis posed by James M. Rynerson, MD, and Henry D. Perry, MD, in a paper published in Clinical Ophthalmology.
The authors proposed the use of a new term to describe the chronic disease: dry eye blepharitis syndrome.
“It’s all the same disease process. It’s simple. We get biofilms, they lead to inflammation, and then the inflammation affects the different structures in the lid. It’s the simplest eye disease to understand, yet we’re trying to make it the most complex,” Rynerson told Ocular Surgery News.
Contact lens wear
Cleaning the lid margins and reducing the biofilm relieve dry eye symptoms and other disorders, such as contact lens intolerance, in which traditional treatment has been to change lens brand to something more water or oxygen permeable, Rynerson said.
“It is groundbreaking in eye medicine that we can have an impact on these patients who think they would have to give up their contact lenses,” Rynerson said, citing a University of New South Wales study in which 10 of 17 symptomatic contact lens wearers became asymptomatic after blepharitis treatment with BlephEx.
“These patients can go right back into their contact lenses. Just get rid of the biofilm. That was the key,” he said.
BlephEx is a hand-held instrument with a spinning medical grade micro-sponge soaked in cleaning solution that removes biofilm from a patient’s lid margins and reduces inflammation, according to Rynerson, who is president and CEO of BlephEx LLC.
“Once you remove the biofilm, the source of inflammation goes away, and patients begin to feel so much better immediately,” Rynerson said. “Once bacteria start producing a biofilm, they never stop. They start producing it just after birth; as soon as the lid margin is colonized with bacteria, they start producing biofilm.”
Tear breakup time
Rynerson pointed to two additional studies showing BlephEx significantly increased tear breakup time, improved meibomian gland function and reduced inflammation. One, conducted by Daniel Mulder, OD, and colleagues at the University of the Incarnate Word, Rosenberg School of Optometry, San Antonio, Texas, evaluated 20 patients with meibomian gland dysfunction at baseline and again 4 weeks after BlephEx treatment.
“The study shows a 60% increase in tear breakup time. If you measure the tear breakup time, you’re measuring the lipid layer, the oil in the tear film. If you’re measuring the oil in the tear film, that means that you’re indirectly measuring the health of the meibomian glands. Those are the lipid-producing glands,” Rynerson said.
Similar results were seen in a multicenter analysis of patients treated with BlephEx, he said. There was a 66% increase in tear breakup time in 90 patients followed up at an average of 3.8 weeks.
“If just one treatment can improve tear breakup time by 60% to 66%, how is that tear film going to look after the second treatment? After the eighth treatment? After they’ve been getting 4 to 5 years of regular every 4- to 6-month treatments, we are going to have normal tear films in these people with this regular treatment of keeping our lids clean. By keeping our lid margins clean and inflammation-free, we can keep our own tear glands working. That’s where we must go. If dentistry can do it, why can’t eye medicine do it?” Rynerson asked. – by Robert Linnehan
- Rynerson JM, et al. Clin Ophthalmol. 2016;doi:10.2147/OPTH.S114674.
- For more information:
- James M. Rynerson, MD, can be reached at 119 S.E. Parkway Court, #250, Franklin, TN 37064; email: firstname.lastname@example.org.
Disclosure: Rynerson reports he is the inventor of the BlephEx technology and is the president and CEO of BlephEx LLC.