Tear labratory |
Dry Eye

Tear substitutes in the form of eye drops, gels or sprays supplement the missing or poor quality components of the natural tear fluid.

The most commonly used ingredients are hyaluronic acid, methyl cellulose or poly­vinyl­pyrro­lidone. They are available with and with­out preservatives. Many com­panies offer a wide variety of pre­pa­ra­tions and com­bi­na­tions.

In addition to the supplementation of the natural tear fluid by tear sub­sti­tutes, the cleaning of the eyelids is of crucial impor­tance. Combined with a light massage, dry secretions and thus germs are removed and the meibomian glands are activated with their ex­cre­tory ducts.

If a large part of the meibomian glands are blocked, a sufficient proportion of lipids in the tear fluid is mis­sing. Thus, the tear can not be efficiently pre­ven­ted from eva­po­ra­ting too quickly, the tear fluid ruptures and the ocular surface dries out. In addition, the ab­sence of treatment of a congested mei­bo­mian gland can lead to death of the con­cerned glands, whereat this con­di­tion would not be reversible anymore.

LipiFlow is a new procedure that can be used to treat the root cause of eva­po­ra­tive dry eye: meibomian gland dys­func­tion - MGD.

LipiFlow warms the inside of the eyelid in the area of the meibomian glands. At the same time it provides a gentle mas­sage on the outside of the eyelids to eli­mi­nate the con­ges­tion of the eyelids and to facilitate the release of lipids. By ope­ning and cleaning the glands, the natural production of the lipids needed for a heal­thy tear fluid sets in. This precise, cli­ni­cal­ly proven procedure can be performed with us.

The effect

After a few weeks, most patients feel a sig­ni­ficant relief of their symptoms. In a clinical study, the LipiFlow sys­tem shows a marked improvement in lipid secretion of the lid glands. Four weeks after treatment with Lipi­Flow, 79% of patients report an im­prove­ment in the symptoms of dry eye.

The teardrop fluid that wets the ocular surface flows down the lacrimal tubules and the la­cri­mal sac into the nose. Closing of the tear tu­bules prevents drainage of the tear fluid. Especially with a small amount of tears rapid drying of the eye surface can be reduced very effectively. The closure of the lacrimal points with so-called TP plugs can be compared to a drain plug.

How are the plugs (TP-plugs) implanted?

The TP plugs are made from a soft, flexible silicone similar to the contact lens material. They are inserted into the lacrimal point under the micro­scope with a special in­stru­ment. The front piece folds open like an um­brella, then spreads into the canal and pre­vents it from slipping back out. The TP plugs come in different sizes - adapted to the width of the tear spot.

Will the complaints be over after the insertion of the plugs?

In many cases of reduced tear pro­duc­tion, discomfort can be lessened. However, some­times tear substitutes are still indicated - but at significantly longer intervals.

A generator (E-Eye) is used to generate poly­chromatic pulsed light, i.e., per­fect­ly cali­bra­ted and homo­ge­neous light pulse fre­quen­cies. The distance, energy, and spectrum of the pulse sequences are precisely measured so that the Meibomian glands are sti­mu­lated and their function can be normalized.

The aim is for the glands to resume secretion through this sti­mu­lation, for the tear film to regain its normal structure, and thus for the symptoms associated with dry eyes to be reduced.

This treatment is non-invasive, comple­tely painless, and harm­less to the eyeball. It takes only a few mi­nutes, during which the patient rests comfortably in a treatment chair.

A noticeable improvement can only be ex­pec­ted after the three prescribed sessions.

In addition to the specific previously men­tioned treatment op­tions, the "simple" options of lid-edge care should, of course, not be forgotten. They can be done by most people, independently and at home:

• Warming of the lid
• Massage of the lid
• Cleaning of the lid

Since 2017 we have been using another option to stimulate the meibomian glands to improve the lipid layer of the tear film: "e-eye".

Of course we will also advise you on this.

In the case of a watery eye, in addition to the quality of the tear film, it is necessary to check

• the position of the eyelid and whether the edge of the eyelid is in contact with the eyeball,
• whether the tear duct is protruding or closed, or
• whether the tear ducts are narrowed or closed.

This will determine the surgical options.

Example:
If the tear ducts are protruding but the eyelid is close to the eyeball and the tear ducts are clear, the tear duct can be surgically widened on the inside: “tear duct wedge excision.”