Advancements in Modern Dry Eye Treatments & Recently FDA Approved Drop Therapies

At Beverly Hills Optometry, we proudly offer the latest advancements in office-based procedures and newly FDA approved therapies for managing dry eye disease, MGD, blepharitis, chalazion and more. Below are highlights:

Office-Based Therapies:

• Microblepharoexfoliation: Early biofilm may seal off the gland orifices and gradually fill the gland, mixing with meibum and leading to chronic lid disease and discomfort. Lid debridement can remove biofilm and debris and uncap the openings of the oil glands. There are two options: BlephEx & ZEST technique. A recent study demonstrated that one ZEST session improved contact lens-related discomfort, doubled contact lens wear time, decreased usage of rewetting drops and reduced MMP-9 levels.

• Thermal expression options: These thermal modalities heat the meibum and melt the stagnant oils, allowing for proper expression and clearance. For patients with obstructive MGD, consider combining lid debridement with thermal expression to maximize the therapeutic efficacy. Applying lid debridement pre/post-thermal expression removes surface biofilm and allows for easier outflow of meibum. A number of office-based devices are available, including LipiFlow (Johnson & Johnson Vision), TearCare (Sight Sciences), iLux (Alcon), Radiofrequency NuEra Tight (Lumenis), and more.

• Intense pulsed light: OptiLight IPL (Lumenis) is the first and only FDA approved light therapy device for managing dry eye and MGD. This treatment addresses telangiectasia, lid swelling and inflammation. Through the science of photobiomodulation, IPL selectively targets abnormal blood vessels that leak inflammatory meditators, heats and liquifies meibum, eradicates Demodex and suppresses MMP-9 inflammatory levels. Over 40 studies have shown that IPL (often combined with gland expression) provides significant improvement in objective and subjective findings. As a bonus, post-IPL patients may also notice skin rejuvenation effects such as reduction in sunspots, minimization of vascular lesions and stimulation in collagen growth, leading to improvement in fine lines and wrinkles.

• Meibomian Gland Probing: serves as an office-based procedure to treat the leading of dry eye disease, Meibomian Gland Dysfunction (MGD). MGD occurs when the Meibomian glands (or oil glands) within the eyelids become blocked or dysfunctional, leading to dry eyes, inflammation, and other symptoms. There are commonly two types of unhealthy obstruction: dynamic and fixed. Dynamic obstructions, cloudy or toothpaste-like, may be unblocked with thermal expression devices (above). On the other hand, fixed, focal, firm, and unyielding obstructions require a different technique called Meibomian Gland Probing (MGP). MGP involves using a specialized tool to gently relieve fibrotic tissue that causes damage to the glands. After removal of the fibrotic (or scar) tissue, the gland structures and function commonly improve as well as patient relief.

Recently FDA Approved Drug Therapies for Ocular Surface Disease (2023)

• XDEMVY (Lotilaner) is a topical ophthalmic eye drop approved for patients with demodex blepharitis. Directions: Instill 1 drop into affected eye(s) twice daily (for 6 weeks) to eradicate demodex mites (by selectively inhibiting GABA-Cl channels) and help improves patient symptoms. In about 10% patients, the most common side effects included stinging and burning; in less than 2% of patients, other ocular adverse events were chalazion/hordeolum (stye), and punctate keratitis. 

• MIEBO is a first-in-class ophthalmic drug (100% perfluorohexyloctane) developed to treat dry eye disease (DED) associated with Meibomian gland dysfunction (MGD). NOV03 prevents excessive tear evaporation and restores tear film balance for up to 6 hours. Directions: Instill one drop into affected eye(s) 4x/day. There are equivalent over-the-counter options in Europe, where it has been safely used.

• Vevye (CyclaSol) is the first and only water-free cyclosporine solution indicated for the treatment of signs and symptoms of dry eye disease. Vevye is a fast acting and well tolerable dry eye drug therapy, demonstrating efficacy after only 4 weeks. As a water-free product, there is no associated pH and no osmolarity. Directions: Instill 1 drop into affected eye(s) twice daily.

There are other office-based therapies and medications in the pipeline.