Treatment and Management: In-office Therapies
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Advanced Therapies:
Following your consultation, your eye doctor will develop a Customized Treatment Plan to target the root cause of the dry eye and help relieve some of the dry eye symptoms you may be experiencing. Dry Eye is a chronic condition, but it can be controlled with some or all of the following treatment options:
LipiFlow® is an advanced thermal-mechanical device designed to treat Meibomian Gland Dysfunction (MGD) and Evaporative Dry Eye. It works by gently heating the eyelids and applying a light massage to the Meibomian glands, effectively clearing blockages and restoring gland function. The patented device uses Vectored Thermal Pulsation technology to apply heat and massage the inner eyelids, removing any obstructions within the glands.
LipiFlow® is a 12 minute in-office treatment that targets the root cause of your dry eyes rather than just treating symptoms. This Health Canada approved treatment has been shown to alleviate dry eye symptoms for a year.
IPL therapy is an in-office treatment that uses pulses of light to liquefy hardened oil that can plug the meibomian gland, clearing it and stabilizing the tear film. IPL also kills bacteria and mites, and decreases inflammation by closing abnormal blood vessels. By targeting these vessels, IPL generates heat that triggers the body’s natural healing process, helping to remove abnormal blood vessels and reduce inflammation. IPL therapy is considered the gold standard treatment to address the root cause of Meibomian Gland Dysfunction (MGD), Blepharitis, and Ocular Rosacea.
Signs and symptoms improve after just 1 to 2 treatments and continue to improve throughout the therapy course. Initial therapy typically involves 3-4 sessions spaced 2-4 weeks apart. IPL is followed by manual meibomian gland expression. Maintenance therapy depends on the duration, severity, and frequency of symptoms and is usually recommended every 6-12 months.
We combine IPL therapy with LipiFlow® treatment to target both inflammation and blockages in the Meibomian glands, offering a comprehensive solution for dry eye and MGD.
IPL is known to not only improve dry eye symptoms but also increases collagen production, enhancing the overall appearance of the skin.
Meibomian Gland Expression involves applying pressure to the eyelids to release oils from the glands. Eye specialists use small forceps or paddle-like instruments, such as the Mastrota paddle, to apply pressure to the lower and upper eyelids. Successful expression of meibum from the glands helps to improve the quality of oil production and reduces dry eye symptoms. Your eye doctor can determine if additional procedures are needed and can teach you how to perform meibomian gland massage at home for long-term management.
ZEST is a gentle and effective cleansing treatment for the eyelids and base of eyelashes. This in-office based treatment is ideal for removing bacteria, biofilm, Demodex mites, dandruff, debris, and oil using a uniquely formulated gel with refined extract of okra. The Zocular formulation additionally has restorative and anti-inflammatory properties that calm and soothes eyelid inflammation which alleviates signs of redness and irritation.
We recommend ZEST for patients with Blepharitis and/or Meibomian Gland Dysfunction (MGD) as well as pre-surgically for those preparing for cataract surgery.
Patients often notice significant improvements just after one treatment and is recommended maintenance treatments every 4-6 months.
Punctal plugs are tiny devices inserted into the tear ducts to slow tear drainage, keeping the eye surface moist and comfortable. They relieve symptoms of dry, itchy, and burning eyes. There are two types: temporary plugs, made of materials like collagen that dissolve within days to a week, often used post-refractive surgery or semi-permanent plugs, made of durable medical plastic like silicone, lasting 3-6 months.
This treatment is ideal for chronic dry eye, aqueous deficient dry eye, and post-refractive surgery patients, especially once inflammation is managed.
elid Malposition Surgery
Lid malposition surgery addresses conditions like entropion and ectropion. Entropion involves the inward rotation of the eyelid margin, causing lashes to misdirect. Ectropion, on the other hand, is the outward rotation of the lid margin. Both conditions can affect the upper and lower eyelids, leading to poor lid closure, incomplete blinks, and exposure of the cornea. This results in inadequate tear film distribution and chronic ocular surface irritation, significantly impacting quality of life with symptoms like blurred vision, excessive tearing, pain, and foreign body sensation. Surgery is often necessary to correct these malpositions, improving symptoms of dry eye and ocular irritation.
Chalazion Excision
A chalazion is a small, non-infectious lump that forms in the upper or lower eyelid due to the blockage of the meibomian gland, which produces fluid to lubricate the eye. Chalazions typically resolve on their own over a few months. Treatment options include warm compresses, gentle eyelid massages, and over-the-counter remedies. However, surgical removal may be necessary for several reasons including if the chalazion does not resolve, if the chalazion becomes infected, size of chalazion impacts ocular comfort or vision.
Punctoplasty
Punctoplasty is a surgical procedure to treat punctal stenosis, a condition where the external opening of the tear duct (punctum) narrows or becomes occluded, often causing excessive tearing and eye irritation. Symptoms include overflow of tears, increased moisture in the eyes, and redness or irritation from constant tissue use. Initial management may involve punctal dilation for diagnostic purposes, but most patients require surgery to create an adequate opening, maintain punctal position, improve tear drainage, and preserve lacrimal pump function.
Punctal Cautery
Punctal cauterization is a surgical procedure that permanently closes the external opening of the tear ducts (punctum). The goal of this technique is to effectively increase tear film volume and retention, treating ocular surface disease. While retaining tears through punctal cautery can worsen symptoms in cases of poor quality meibum or other inflammatory conditions, if aqueous deficiency persists, prioritizing cauterization and avoiding excessive reopening of the tear ducts may be more crucial than ensuring drainage.
Amniotic membranes are used as biologic bandages to protect and support the healing of the corneal surface. They treat various conditions, including keratitis, chemical burns, corneal erosions, and chronic epithelial defects related to dry eye. Treatment is often times combined with autologous serum eye drop.s While not a cure for chronic dry eye, amniotic membranes help create a healthier corneal surface for ongoing treatment.
Scleral lenses are an option for treating dry eye, especially in patients who haven’t responded to conservative treatments. These large-diameter rigid gas permeable (RGP) lenses vault over the cornea and extend to the sclera, creating a fluid reservoir that hydrates the ocular surface and improves optical quality