One group of patients that we help at Perspective Optometry are those with Sjögren’s syndrome. Sjögren’s patients often present with dry eye disease and many of them do not respond well to conventional treatments. That was a prominent consideration when Perspective Optometry decided to bring in Lipiflow treatment to serve Sjögren’s patients in Metro Vancouver.
Sjögren’s Syndrome is an autoimmune disease that affects they body as a whole, including the eyes. Sjögren’s patients experience dysfunction in their exocrine glands, mainly the salivary (which are in the mouth) and lacrimal glands (which are in the eyes), resulting in dry mouth and dry eye syndrome due to glands that secrete less than they should. Sjögren’s is a major cause of aqueous tear-deficient dry eye because of the underproduction of the lacrimal glands. Healthy tears are comprised of the aqueous and lipid layers and deficiencies in one or both layers can dry out your eyes. Patients with Sjögren’s are often treated by trying to replace the deficient aqueous component of tears using artificial tear substitutes or immunomodulators, such as cyclosporine (often sold under the brand Restasis).
However, in addition to aqueous tear deficiency, Sjögren’s patients often have meibomian gland dysfunction (MGD). The meibomian glands, found on the interior of the eye lid, secrete the oily or lipid component of healthy tears. When meibomian glands are not functioning properly, tear film evaporates too fast, causing dry eye disease. The scientific literature suggests that the meibomian glands of patients with Sjögren’s syndrome are more seriously impaired than the glands of dry eye patients who do not have Sjogren’s. This combination of aqueous tear deficiency and meibomian gland dysfunction in Sjögren’s patients might explain why they do not respond as well to articial tears or other treatments that only address the aqueous deficiency.
This is where Lipiflow might help Sjögren’s patients. According to a recent study published in the journal Clinical Ophalmology , Sjögren’s patients may benefit from treatments like cyclosporine that addresses aqueous tear film deficiency combined with treatments like LipifFlow that addresse Meibomian gland dysfunction. The study concluded that LipiFlow treatment in MGD patients who were Sjögren’s Syndrome-positive for novel biomarkers of Sjögren’s demonstrated improvement in signs and symptoms of dry eye.
What is LipiFlow?
The study contains a useful description of the LipiFlow treatment for those who are unfamiliar with it (although, our optometrist’s explanation at a visit might be easier to understand!):
The LipiFlow treatment is indicated in patients with chronic cystic conditions of the eyelids, including MGD. The LipiFlow treatment is contraindicated in patients with coexisting ocular conditions in either eye, which might have posed an increased risk of procedure-related injury (eg, active ocular infection or inflammation in either eye); history of ocular surgery or trauma within the last 3 months; ocular surface abnormality potentially compromising corneal integrity in either eye (eg, prior chemical burn, recurrent corneal erosion or corneal epithelial defect); eyelid abnormalities affecting lid function in either eye.
The LipiFlow consists of a disposable ocular component and a nondisposable control system. The disposable component comprises an insulated lid warmer with an eye cup. The lid warmer includes a scleral shell designed to rest on the sclera and vault the cornea. The concave side of the scleral lens is composed of an insulating material, which, in addition to the air gap created by the corneal vault, shields the cornea and ocular surface from exposure to the heat. The convex side of the scleral lens contains an embedded precision heater that heats the palpebral conjunctiva overlying the upper and lower lid meibomian glands. The eye cup contains an inflatable air bladder that rests over the closed eyelids once the scleral lens has been inserted.
The 12-minute therapeutic procedure includes an initial heating phase followed by pulsating pressure, which serves to evacuate any heated softened material from the glands. The bladder inflates and deflates in such a way so as to massage the eyelids from the terminal end of the meibomian gland in the direction of the meibomian gland orifices.Clin Ophthalmol. 2017; 11: 701–706.
Source:Clin Ophthalmol. 2017; 11: 701–706.
Here is a diagram from LipiFLow.ca showing how LipiFlow works: