Holland EJ, Whitley WO, Sall K, et al. Lifitegrast clinical efficacy for treatment of signs and symptoms of dry eye disease across three randomized controlled trials. Curr Med Res Opin. 2016 Jul 22:1-7. Dr. Akpek notes that like IPL, BlephEx works best in more severe dry-eye cases. “BlephEx is a handheld device that removes inflammatory biofilm,” she explains. “It’s good for anterior or posterior blepharitis. I almost always use this to exfoliate the lid margin skin and better expose the gland orifices before performing other procedures.” For more information, visit rysurg.com. Schaumberg DA, Nichols JJ, Papas EB, et al. The International Workshop on Meibomian Gland Dysfunction: report of the Subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci. 2011;52(4):1994-2005. Therapeutic expression can be performed with your fingers or cotton tip applicators, but instruments such as a Mastrota Paddle (Ocusoft) and the Maskin Meibum Expressor (Katena) can ensure a more effective and efficient procedure. For maximum efficacy, the following three-phase approach is recommended: compress, debride, express. Starting with a compress or heating device will significantly liquefy the meibum, making it possible to express the gland content by applying less force to the eyelid.

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. ProKera™ is available as a device that can be placed on a patient’s eye in the office and has a ring that holds the amniotic membrane transplant (AMT) in place. The original ProKera™ is indicated for moderate to severe indications, including neurotrophic PED, severe infectious keratitis, post-PRK haze, and Salzmann nodular degeneration; however, Bio-tissue recently started offering the ProKera™ SLIM and ProKera™ PLUS. The ProKera™ SLIM is indicated for mild to moderate conditions, while the ProKera™ PLUS is recommended for severe indications that require longer treatment.The NuLids II study, presented as a poster at ASCRS 2018, showed even more compelling data. It demonstrated an 81% increase in meibomian glands yielding liquid secretions, a 65% increase in tear-film breakup time and a twofold reduction in OSDI scores compared to pre-trial baseline. Further, 95% of subjects found NuLids to be easy and comfortable to use and were either satisfied or very satisfied following treatment.

These formulation breakthroughs, in conjunction with the invalidation of patents for Restasis, have opened the door for more, and even generic, CsA options.

Like plaque on your eyelids, it clears bacteria and biofilm on the outside of your eyelids and eyelashes. Should I use Nulids before or after warm compresses?

While Lipiflow is a first-of-its-kind device to treat MGD-associated DED, several new treatment approaches are on the way that also hold promise for providing relief.McNamara NA, Ge S, Lee SM, et al. Reduced levels of tear lacritin are associated with corneal neuropathy in patients with the ocular component of Sjögren’s Syndrome. Invest Ophthalmol Vis Sci. 2016;57(13):5237-43. McDonald MB, Fumuso PW. Trehalose: A novel treatment for dry eye. Ocular Surgery News US Edition. July 10, 2018.