New Solutions for Dry Eye

For the more than 20 million Americans who suffer from chronic dry eye, blurred vision, irritation and redness of the eyes are daily burdens. For patients at Chu Vision Institute, intense pulsed light (IPL) therapy provides a simple solution for clearer, more comfortable vision.


We have been looking for a new treatment for chronic dry eye caused by meibomian gland dysfunction. As patients know, this can be a very frustrating condition. What’s so exciting about intense pulsed light therapy for dry eye, from the patient perspective, is that now they have a safe and effective alternative to the traditional medical therapies that have failed the patients.” — Y. Ralph Chu, M.D., Medical Director and founder of Chu Vision Institute and adjunct associate professor of ophthalmology at the University of Minnesota.


According to Y. Ralph Chu, M.D., Medical Director and founder of Chu Vision Institute and adjunct associate professor of ophthalmology at the University of Minnesota, chronic dry eye is one of the most common concerns patients present with at any ophthalmology practice. In the United States, about 6 million women and 3 million men have moderate or severe dry eye syndrome, and it is estimated that an additional 20 million to 30 million people have mild cases of dry eye syndrome. Symptoms include blurred vision, foreign body sensation and sensitivity to light. Because the symptoms can mimic other syndromes, chronic dry eye is often undiagnosed, which can lead to ocular complications such as cornea ulceration.


Understanding the Ocular Surface


As Dr. Chu explains, chronic dry eye was previously defined as a defect in the eye’s tear production. Now, the idea of quality of tears versus quantity of tears is finding a place in the condition’s diagnosis.


“Ophthalmologists have started classifying dry eye as ocular surface disease because we’ve learned that, really, dry eye is not just a lack of tears,” says Dr. Chu. “Many patients with adequate tear production also suffer from dry eye due to a poor quality tear film on the surface of the eye.”


A greater understanding of tears has led ophthalmologists to value the fluid — which is filled with proteins and electrolytes — as the underlying stabilizer of eye health that can minimize the symptoms of chronic dry eye. When the chemical makeup or production of tears becomes unbalanced, the disruption compromises the eye.


Serving as a key component to the tear balance, the meibomian glands secrete a fine layer of oil that keeps the water element of tears from evaporating. The glands, which are located at the base of the lashes on both the upper and lower eyelids, can become abnormal with age and certain conditions, such as ocular rosacea. In those cases, the secretions become thick and crystalline — like butter or toothpaste — when it should normally be smooth like olive oil. The change can initiate or worsen the symptoms of chronic dry eye.


In addition to understanding the role of tears and the supporting function of the meibomian glands, ophthalmologists clarified one of the fronts that can lead to an imbalance in tear quality.


“One of the key discoveries in the last several years is that we’ve learned dry eye is caused by inflammatory pathways,” says Dr. Chu. “Chronic, low-grade inflammation on the surface of the eye leads to damage to the surface, as well as the tissue that secretes the material that’s needed to keep the eye healthy.”


An Unexpected Side Effect


While RESTASIS, the only U.S. Food and Drug Administration-approved intraocular cyclosporine, is prescribed to reduce inflammation and prompt the natural production of tears, its integration into treatment plans did not solve the riddle of abnormal meibomian gland secretion. Around 2003, ophthalmologists began noticing that patients with chronic dry eye who received IPL therapy as a dermatologic treatment for rosacea were also experiencing a reduction in their dry eye symptoms.


Rolando Toyos, M.D., of Memphis, TN, was the first to quantify the relationship between IPL and chronic dry eye in several clinical studies. The final conclusion theorized that the treatment gently stimulated the meibomian gland, improving the quality of secretions and successfully decreasing the presence of telangiectasia.


Heating the Dryness Out


IPL therapy for dry eye is an effective outpatient treatment. Dr. Chu first cleans the face and places shields on both eyes to protect the lids and lashes. A cooling gel is applied to the eye area skin. Then, Dr. Chu passes the IPL handheld device across the skin, allowing the pulse of energy to heat the meibomian glands. The treatment also seals the delicate blood vessels at the lid.


“One of the pleasant side effects of this procedure is younger, healthier looking skin,” says Dr. Chu. “ It’s an element patients like that, besides improving their comfort and vision, can improve the look of their skin.”


The complete procedure typically lasts less than 15 minutes. Patients receive one treatment every month for four months. Typically, maintenance treatments are needed annually or semi-annually. Results can be seen after the initial treatment and can increase after each session.


To learn more about the Chu Vision Institute or to refer a patient, visit or call (952) 835-1235.


Original article by MD News



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