Dry Eye
Restasis works best in the long-term treatment of meibomian gland dysfunction (“MGD”). We find that when people are given Restasis while their eyes are still inflamed, this medicine causes ocular irritation and burning. Just as gasoline works great in the gas tank of car, but you cannot use gasoline to put out a car fire, Restasis does not work when the eye is “on fire” or having active inflammation. We pre-treat with topical steroids first and we find that this makes the Restasis well tolerated.
Restasis is excellent for long-term suppression of the inflammation causing dry eye and we normally start it 4-12 weeks after starting MGD therapy.
Xiidra is a newer option for the treatment of the chronic symptoms of MGD. We find that Xiidra has a more rapid effect than Restasis (2-4 weeks rather than 6-8 weeks) Xiidra is provided in vials and the recommended dose is one drop in the morning or afternoon, and 1 drop in the evening. Some people have a stinging and burning feeling in their eyes after using Xiidra and this feeling can be quite severe. We find that that this discomfort with instillation resolves after a few weeks. Some people also have blurry vision for a few minutes after using Xiidra or can get a “funny” taste in the mouth, and these also resolve after a few weeks of use. (Dr. Levinson uses Xiidra and had all of these symptoms when he started, but they resolved and the Xiidra helped his symptoms.)
Most of the commercially available Omega 3 including the FDA approved Lovaza, are prepared in an ethyl ester (EE) form. The EE form is very difficult for the body to absorb, and often remains undigested, and causes a lack of effect and “fish burp” and indigestion, and GI upset. We recommend Omega 3 in a triglyceride (TG) form. Please see our Omega 3 form.
We offer Meibomian gland imaging, which we find interesting to gauge the anatomy of the meibomian glands of the eyelids.
The “classic” test is called Schirmers testing, and this requires putting a thin piece of paper on the eyelid, touching the eye, for 5 minutes. We find this test to be uncomfortable, and unreliable.
We have tried other testing including InflammaDry and TearLab, which look at the osmolarity of the tear film. We found these tests to be unreliable predictors of dry eye symptoms and response to therapy.
We have found that the best “test” for dry eye symptoms is to listen carefully to our patients and ask “how are your eyes feeling?”
Any type of heat to the eyelid will help (as long as you are careful to not burn or scald the lids) However, we find that hot water in the shower is not hot enough. Rice in a sock and a hot potato work, but require long prep time. We find that heating masks, which are commercially available to provide the correct amount of heat, and require less than 30 seconds in the microwave, so the prep time is minimal. We like the DERM mask from Eyeeco.
Some of our patients find cleaning the eyelids to be very beneficial. We prefer lid foams, which can be used to gently remove lid debris (dried oils, and cellular material). However, we do not like lid scrub pads. These pads can be quite abrasive. As the problem in MGD is inflammation, we find that “scrubbing” irritated skin with a corrugated pad often exacerbates this issue. We have several lid foam products in our office we can show you. One of our favorites is OCuSoft lid foam.
These terms are interchangeable in my opinion, and they refer to the same condition – the inflammation of the eyelids which causes the meibomian glands to produce a dysfunctional oil.
You may see some articles discussing anterior and posterior blepharitis, and offering different treatments. However, in my opinion, these are essentially the same condition with the same treatment.
Your genes play a role. MGD is more common as time passes on the body, and is more common in women, than men. Menopause can exacerbate MGD. So can diet and environment.
Minimal. The cause of MGD is not bacterial; therefore antibiotics have a limited role. Doxycycline and Minocycline are often used in low doses, because they have an anti-inflammatory effect to oil glands (and are often used by dermatologists to treat acne and rosacea.) When we use oral Doxycycline or Minocycline, or a topical antibiotic of the same class, Azasite (topical azithromycin) we are using the anti-inflammatory effects of these medications, and not their antibiotic principles.
Yes. Autologous serum is an eye drop made from your own blood. The white part of blood, called serum, has many anti-inflammatory properties. We have been using autologous serum for years, and it is very effective in some patients with MGD and dry eye. Our autologous serum is compounded at Hunt Valley Compunding Pharmacy. Click here to read more about Novotears.
Yes. I suffer from MGD/ dry eyes and I have had multiple Lipiflow, and IPL treatments. I use heating masks, take Omega 3 every day and use Restasis. I’d be happy to speak with you in the office about your eyes and answer any questions you might have in person.
