This article was originally published in a sponsored newsletter.

Last month, I discussed in general terms some of the instruments used for in-office treatment of meibomian gland dysfunction (MGD). Before I provide more detail about the protocols I use with each device in this issue, let’s briefly review how MGD leads to needing these procedures in the first place. When patients are affected by MGD, their meibum changes consistency from a clear baby oil-like liquid that normally inhibits tear film evaporation to a thickened, discolored and turbid substance that often completely blocks the meibomian glands and increases tear film evaporation. When evaporation exceeds the supply of tears, we get evaporative dry eye, and inflammation caused by continued evaporation then begets more inflammation. To deal with MGD, we need to reduce the inspissation of the meibomian glands and clear as much of the deficient meibum as we can.

When a patient has ocular rosacea combined with obstruction of the meibomian glands, I prescribe a treatment of four sessions of intense pulsed light (IPL) two weeks apart, followed by a thermal expression procedure. While IPL and thermal expression can be stand-alone procedures with good efficacy, I have found that the combination of the two is extremely effective and has high patient satisfaction.

Available thermal expression devices include:

• LipiFlow^TM by Johnson & Johnson- the first approved and fully automated device. This instrument was then followed by several other devices with various price tags and treatment fees.
• Alcon’s hand-held unit, iLux^®- simultaneously heats and manually expresses.
• TearCare^® (Sight Sciences)- utilizes intelligent SmartLids^® to heat the upper and lower lids through SmartHub^®, a temperature and heat controller, followed by manual expression with clearance forceps.
• Thermal 1-Touch^TM (Ocusoft)- offers unique treatment options, retreatment opportunities or both at a much lower price to patients. It utilizes a bilateral heating device with a rechargeable battery that heats upper and lower lids simultaneously for a specified time and is followed by manual expression with forceps. The device has the lowest acquisition cost of any of the thermal expression treatments and has no treatment costs associated with it. The Thermal 1-Touch^TM has allowed me to repeat treatments more often to help keep patients’ meibomian glands clear at an affordable cost.
• MGrx (OcuSci^®)- also has no “per treatment” cost, but the initial acquisition cost is higher than Thermal 1-Touch^TM.

Regardless of the type of thermal expression instrument utilized, I have found that consistency of repeated treatments and regular clearing of the meibomian glands yields the most success.

Douglas K. Devries, OD has a degree in financial management from the University of Nevada and graduated from Pacific University College of Optometry. He is co-founder and managing partner of Eye Care Associates of Nevada. He is an adjunct clinical professor of optometry at Pacific University and residency program director. He dedicates the majority of his clinical practice to ocular surface disease.