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Several other authors have previously published on the efficacy of meibomian gland probing with encouraging results. 50– 54 Wladis reported on a series of 40 patients with average OSDI of 78.11, all with ocular and facial rosacea, treated with a single session of intraductal meibomian gland probing. Mean OSDI decreased to 37.54 (p < 0.05) at one-month follow-up and 43.00 at six-month follow-up (p < 0.05). Nine out of the ten patients previously on oral doxycycline were able to discontinue use. 54 In a similar study by Sik Sarman et al. in 2016 of 58 eyes, which allowed for multiple treatments, mean OSDI score decreased from a mean of 79.7 at baseline to 22.9 at three months with an average of 1.7 sessions of probing. However, patients in this study were prescribed corticosteroids after the procedure and instructed to perform warm compresses and lid massage, which may have contributed to their superior results. 53 Ma and Lu compared intraductal meibomian gland probing with topical corticosteroids (0.1% fluorometholone) to use of fluorometholone alone in 49 patients. Patients who received intraductal meibomian gland probing had faster symptomatic relief (76% at one day post-operative) as well as significantly greater improvement in ocular symptom scores and meibum scoring at one week and one month follow-up as compared to the steroid-only group. The group that underwent probing also experienced a significantly greater increase in TBUT than the steroids-only group (8.2 +/− 2.1vs 7.0 +/− 3.0, p=0.029). Both groups continued prior conservative treatments. Other measured parameters such as Schirmer I score were not significantly different between the two groups. 51 RF: Data from our in-house NuLids I study was presented as a poster at ASCRS 2017. It showed statistically significant reductions in dry eye signs and symptoms; among these were an improved tear-film breakup time from 6 seconds to 10.8 seconds.
Meerovitch K, Torkildsen G, Lonsdale J, et al. Safety and efficacy of MIM-D3 ophthalmic solutions in a randomized, placebo-controlled Phase 2 clinical trial in patients with dry eye. Clin Ophthalmol. 2013;7:1275-85. Perfluorohexyloctane. NovaTears (Novaliq) is a one-component eye drop containing 100% perfluorohexyloctane. This unique lubricant is a water- and preservative-free lipophilic liquid. NovaTears stabilizes the lipid layer and can improve signs of meibomian gland dysfunction (MGD), as well as symptoms and signs of DED ( Figure 3). 42-44 NovaTears is currently available in Europe and Australia in multidose bottles and is in Phase II clinical trials in the United States. 45 LipiFlow has an excellent safety profile, and a single treatment can more effectively improve the symptoms of MGD than a three-month daily course of oral doxycycline without the 40% risk of side effects that doxycycline carries. 21,22 The most common findings post-treatment are mild conjunctival injection and mild petechial conjunctival or skin hemorrhages, which tend to resolve within a few weeks of LipiFlow use. BlephEx (RySurg; Palm Beach, Florida) BlephEx is a painless in-office procedure performed by the physician in which a handpiece spins a singleuse, disposable, medical-grade microsponge along the edge of the eyelids and lashes, removing scurf and debris and exfoliating the eyelids. The procedure typically lasts six to eight minutes and is well tolerated. It’s typically repeated at fourto six-month intervals. In 2016, Friedman et al. published the results of a pilot study sponsored by Allergan-owned Oculeve of 40 subjects who were instructed to use the ITN device four times daily for 180 days. They found that mean Schirmer scores were significantly higher following nasal stimulation with the device than prior to stimulation and that corneal, conjunctival staining and ocular symptom scores (as measured by OSDI) were significantly reduced from baseline at day 180. 64 Gumus et al. demonstrated that a single intranasal application of the ITN device increased tear meniscus height (measured via AS-OCT) by 28.8% in dry eye patients. 65 Degranulated to non-degranulated goblet cell density (GCD) ratios in dry eye patients increased to 4.71±4.48 when compared to baseline (0.74±0.62) and to extranasal (0.57±0.54) application (p-values <0.001). 65 In 2018, Sheppard et al. published results of two clinical trials of the ITN, both sponsored by Allergan; In the first, a single-day crossover study, patients underwent Schirmer testing before and after three test applications of the device: active intranasal, inactive intranasal (sham), and extranasal. Mean Schirmer scores were significantly greater with active intranasal (25.3±1.5mm) vs extranasal (9.5±1.2mm) and sham (9.2±1.1mm) applications (p <0.001). 66 In the second study, patients used the device 2–10 times daily for 180 days. At follow-up, stimulated Schirmer scores were significantly as compared to un-stimulated scores (17.3±1.3mm vs 7.9±0.7mm, p<0.0001). 66Although the reported mild to moderate adverse reactions of these DED medications are similar, responses to a drug, whether suboptimal or optimal, depend on the individual. 6 Borchman D. The optimum temperature for the heat therapy for meibomian gland dysfunction. Ocul Surf. 2019;17(2):360-4. Nulids helps reduce buildup on your eyelids. It makes a difference to the comfort of your eyes. Will it cure my dry eyes? Moon JW, Lee H-J, Shin KC, et al. Short-term effects of topical cyclosporine and viscoelastic on the ocular surfaces in patients with dry eye. Korean J Ophthalmol. 2007;21(4):189-94.
Maskin SL. Intraductal meibomian gland probing relieves symptoms of obstructive meibomian gland dysfunction. Cornea. 2010;29(10):1145-52. I’ve tried drops, gels, punctual plugs etc and nothing worked. This does take time to get used to the vibration so close your eyes but its well worth the effort. I’ve been using it every night for about two weeks and I’ve felt a difference. I don’t wake up and reach for the drops and during the work day and especially at night, the irritation and grittiness I always had isn’t as severe. My condition is from an autoimmune disease, so I’m sure there will be flare ups every now and then but in the short time of use its brought so much relief, I’m looking forward to seeing the long term results. Cindy M, Nulids user Fariselli C, Giannaccare G, Fresina M, Versura P. Trehalose/hyaluronate eyedrop effects on ocular surface inflammatory markers and mucin expression in dry eye patients. Clin Ophthalmol. 2018;12:1293-1300. IPL (Intense Pulsed Light). Intense pulsed light, or IPL, was originally developed for use in dermatology. Brief, powerful bursts of light at specific wavelengths (in this case, between 500 and 800 nm) cause changes in blood vessels near the surface of the skin, raise skin temperature and eliminate problematic flora on the skin and eyes, all of which may have a beneficial effect on meibomian gland dysfunction. (Many devices capable of producing this effect are on the market, but a popular one is the Quadra Q4 produced by DermaMed Solutions [Lenni, Pennsylvania].)Ophthalmology Management: For those who are unfamiliar, could you explain how the NuLids System works?
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