Professor Chris Lievens
By Helen Carter
Optometrists may be able to regenerate meibomian glands that have truncated in dry eye patients by using new treatments to bring the glands back to life, dry eye expert Professor Chris Lievens told SRC.
Professor Lievens said it had been thought that once the meibomian glands truncated, they were forever dysfunctional but he and others who treated patients with severe dry eye had started to see glands grow back and restored to functional use.
‘What’s exciting is that once the gland is truncated, with treatment we’ve seen glands grow back over time to the margin and using imaging technology, seen glands regenerate that we thought were gone,’ he said.
‘Meibomian glands produce oil except if they are not functioning properly. Of those with dry eye, 86 per cent have evaporative dry eye so we need to target this group and help them regenerate their meibomian glands so they can produce healthy oils on their own.’
Professor Lievens is at the Southern College of Optometry and chief of staff at The Eye Center in Memphis, Tennessee.
He urged optometrists to give patients hand-outs on blinking exercises as this also improves dry eye symptoms.
‘Patients need to feel their eyelids close completely because if they don’t close, lipids will not be expressed. People who do lid-blinking exercises become far better blinkers and symptoms improve.
‘We have many advances to treat dry eye now like never before. While 72 per cent of people with dry eye use only artificial tears as treatment, 82 per cent using tears demand something better,’ he said.
Professor Lievens treats patients who have been to many eye care practitioners and have almost given up hope of resolving their problems. He said lid disease, ocular allergy and blepharitis were included under the dry eye heading.
‘Dry eye is a multifactorial disease requiring multifactorial treatment and this is the key to our success,’ he said.
‘To help change their life talk to your dry eye patients about their diet, living conditions, where they sit and work, their hobbies and oral supplements such as fish oil and Omega-3s.’
He urged optometrists to look for and treat Demodex folliculorum, eyelash mites that overpopulate lashes and are a factor in blepharitis and dry eye, contributing to symptoms.
‘Upwards of 80 per cent of people with blepharitis have eyelash mites. Eighty-four per cent of people aged 60 and close to 100 per cent of those over age 70 have them,’ he said.
‘If optometrists do an epilation manoeuvre and rotate a lash for 15 seconds, a lot of times the mites’ tails will poke out. You can pull out the lash and take a photo on an iPhone to show the patient as this strongly motivates them to comply with treatment.
‘We show patients what is growing in their eyelids under a microscope and get 100 per cent compliance rate with our instructions,’ Professor Lievens said.
He says he has had great success using the Blephex sponge brush to clean and buff eye lashes and eyelids, and suggests using Blephex first then Lipiflow, which massages, heats and evacuates meibomian glands to produce normal lipids.
‘One Lipiflow treatment results in tremendous improvement in symptoms and the ocular surface. It is repeated every 12 to 18 months,’ Professor Lievens said.
He says tear supplements are not a cure but provide valuable symptom relief while undergoing treatments.