Introduction  

LipiFlow is a procedure to remove blocked or clogged oils to treat meibomian gland dysfunction (MGD). The glands produce oils that make up the tear film's lipid layer. When the glands are blocked, they cannot secrete enough oil essential for preventing the eye's surface from drying out. MGD is a condition that often results in dry eye syndrome.

LipiFlow can treat all cases of dry eye disease, that is, mild, moderate, and severe. It is a safe, drug-free, and effective procedure that minimizes patient discomfort such that it is described as more of a gentle eyelid massage. The procedure uses both heat and physical massage to liquefy the meibomian gland contents and express them to restore the lipid layer's function. Studies demonstrate that LipiFlow is becoming the standard treatment method for MGD. It also works where other treatment options such as artificial tears, punctal plugs, and so on have failed.

This in-office procedure lasts about 12 minutes and uses a device that consists of two parts. One part has a tiny piece resembling a large scleral contact lens. The second part is placed on the eyelids outside the eye and is connected to the shield where it opens the gland’s openings and expresses the now heated warm and liquid oil. The device helps prevent any heat or pressure from being transferred to the eyeball. The design of the device also ensures the eye's structure is protected since the machine does not get into contact with the cornea. However, this procedure is not suitable for everyone, so there is a need for a thorough diagnosis before a patient undergoes LipiFlow. At least six lower eyelid glands should be opened to a certain degree for a patient to undergo the procedure. Besides, patients with incomplete blinks are not good candidates because LipiFlow may not be successful.
 

Also Known As

Thermal pulsation
 

Before the Procedure

The patient undergoes a lipiview tear film analysis and formal eyelid examination. The doctor will explain the procedure, benefits, and risks to enable an informed decision.
 

Procedure

  • The patient can lie down or sit comfortably on a reclined chair
     
  • One or two topical mild anesthetic drops are instilled in the eyes to grant the patient comfort before the device is fitted under the eyelid
     
  • The physician fits the device’s eyepiece with an eyelid warmer under the lids. An in-built eye shield protects the eyeball during treatment
     
  • The patient is required to close the eyes around the eyelid device
     
  • The physician activates the device where the patient feels minor lid pressure and warmth on the eyelids
     
  • The patient undergoes varied modes of eyelid pressure, which include slow increasing pressure and pulsation during the whole duration of the treatment

 

Risks & Complications

There is usually little or no pain and discomfort during the entire procedure. However, some patients may complain of excess pain during treatment necessitating the physician to make the necessary adjustments. S/he may reduce the pressure or pause for some time. Nevertheless, most patients say they feel like they are undergoing a very relaxing eyelid massage. Potential side effects may include:

  • Dryness
     
  • Discharge
     
  • Sensitivity to light
     
  • Increased corneal staining
     
  • Inflammation of the meibomian glands
     
  • Moderate conjunctival vascular injection
     
  • Gland blockage may worsen although minimally
     
  • Minimal improvement in dry eye disease and MGD
     
  • The need for eye medications to control future flare-ups
     
  • Transient blurry vision for a few minutes following the treatment
     
  • Burning sensation which can resolve in about four weeks without treatment
     
  • The treatment may fail where the glands remain the same as before LipiFlow treatment
     
  • Some people will require repeat treatment as early as six months or even three years following the initial treatment

 

Aftercare & Recovery

Patients can go home soon after treatment as no downtime or recovery is required.
 

Outcome

Studies indicate that LipiFlow performed in the right patients has high chances of success. Immediately after treatment, approximately seven glands are unblocked while up to nine get unblocked in about one year. Significant symptom alleviation is noted alongside improved meibomian gland functioning, tear break-up time, partial blink rate, and lipid layer thickness in approximately four to 12 weeks following treatment. The procedure is effective in approximately 80% of the patients. Some studies indicated that one session of LipiFlow is more effective in decreasing dry eye disease symptoms than three months of medication.