Gulani m.o.i.s.t. ™ Therapy for Dry Eyes
Meibomian Gland Recanalization
There are a plethora of over the counter relief drops and remedies for Dry Eye but it is essential that you have a thorough exam with an expert to have a treatment strategy best tailored for your condition. This is also vital to rule out any local surgeries as a cause ie. Lasik or associated systemic disease of which this could be the first indicator ie. Sjogren’s syndrome, certain arthritis, thyroid disorders, drug side effects, etc.
Dr. Gulani teaches DRY EYE management in his instructional courses for eye surgeons globally and provides an in-depth diagnostic evaluation along with a full spectrum of care from medical/pharmaceutical to advanced surgical applications including amniotic membrane surgeries with stem cell transplants for patients with this condition. He approaches Dry Eye as a Specific entity with a Specific cause which warrants a Specific treatment. Using this dedicated methodology, he has successfully helped people suffering from all levels of dry eyes who travel to our institute from all over the world.
He explains that the tear film is actually about 7microns thick and is made up of three layers:
- The Innermost, Mucin Layer (produced by the Conjunctival Goblet cells on the surface of the eye) and this layer makes the tear film “Stick” to the eyeball.
- The Middle, Aqueous Layer (produced by the Lacrimal glands which are located on the upper and outer side of your eye socket). This is the real Tear Film if you may and contains all of the chemicals and nutrients that are needed for the ocular health and safety.
- The Outermost, Lipid layer (produced by the Meibomian glands which are arranged along the eyelid margins vertically in rows like “Tooth Paste Tubes” with their “Mouths” opening at the lid margin close to the eye lashes. This layer actually provides surface tension to the tear film and hence maintains its vertical distribution on the eye despite gravity.
Dr. Gulani classifies Dry eyes at various levels for eye care practitioners based on severity, symptomatology and vision impact.
Essentially though he explains that there are two basic kinds:
I. Quantitative (Decreased Quantity)
- Decreased production
- Increased Loss
II. Qualitative (Decreased quality / altered chemical content of either one or all three layers despite good quantity)
The tear film is actually dependant on the nerve sensation of the cornea (that is why people have Dry eyes following a certain kind of Lasik surgery where the nerves get cut during surgery) and inflammatory cycles related to allergy, infections etc.
Finally, the tear film leaves the eye via tear ducts (in each lid) and goes into the nose on a normal basis (remember how some eye drops taste nasty).
The above explanation is Dr. Gulani’s way of simplifying the dry eye concept for all his patients and then he gets to work further investigating the root cause of dry eye and planning an effective treatment regimen.
So lets say someone has a decreased production but good quality of tears, they can have temporary or permanent intra-canalicular punctual plugs inserted into their tear ducts and thereby “Retain” whatever little tears they produce (a Plumbing issue- Block the drain since the tap is producing less water so the water remains in the sink for a longer time). This can further be augmented by tear producing eye drops like Restasis or Xiidra.
If the quantity produced is good but the loss is excessive (Evaporative Dry eyes) then he addresses that abnormal layer effectively with appropriate eye drops, medications and techniques. For example, if the Lipid layer is affected because of the Meibomian glands being blocked by repeated inflammation and allergy, he can detect this problem and actually re-open these glands with a brief, in-office procedure using new technologies he keeps innovating and honing over decades of experience.
Meibomian (“my-boh-mee-an”) glands are 20 – 40 toothpaste tube (slightly crooked though) shaped glands, lined along eye lashes in our eye lids which secrete the oil layer of our tear film to prevent evaporation of our tears too quickly by creating surface tension (making a film of water stay vertical despite gravity).
Blockage, disease or inflammation of these glands results in Meibomian Gland Dysfunction (MGD). You can imagine then that afaulty oil layer can allow our tears to evaporate quickly and cause dry eyes (Evaporative kind of dry eye) and in many cases is associated with lid inflammation (Blepharitis)
Most common causes of MGD include, repeated or incorrectly managed lid inflammations including allergies, gender as in more prevalent in females, advancing age, ethnic background as in Asians have a higher propensity. Wearing eye makeup is another contributing cause of MGD. Eyeliner and other makeup can clog the openings of meibomian glands especially if you don’t thoroughly clean your eyelids and remove all traces of eye makeup before sleep. Wearing contact lenses for especially long durations also is a risk factor.
Medical situations can also increase the chances of this infliction and history of arthritis, Sjogrens, Thyroid dysfunction, diabetes etc are important and need control for overall success.
With 3 decades of experience in working with dry eye patients from around the world, Dr. Gulani’s clinical acumen along with cutting edge diagnostic technologies including one of the first Oculus Keratographs in the country can detect all levels of dry eyes from quantitative to qualitative whereby he then designs an individual plan of attack for that dry eye patient.
Besides an array of technologies like LipiView, LipiFlow, iLux, Tearcare, Blephex and IPL to treat dry eyes, Dr. Gulani’s personal experience in using customized, differential Meibomian Gland recanalization technique done in-office in less than 5 minutes with a blunt probe and proprietary numbing gel made in a pharmacy in California has resulted in near 100% success.
This followed by an individually time-planned warm compression of the eyelids and medication protocol of eye drops results in melting and expressing the thickened oil and also changing it chemically to the more user friendly version.
Oral supplements like Omeg-3 supplements, Flaxseed oil etc and also tear enhancing eye dorps like Xiidra and ReStasis can also be used along with PH balanced artificial tears
In mor serious cases of dry eyes with associated pathologies and complications, Dr.Gulani can raise the bar to perform “No-Stitch” human placenta surgery, transplants etc.
Thus we can see how approaching the dry eye complaint in a systematic manner can actually make sense of the situation, rule out any associated diseases and effectively plan for a customized solution for each individual eye.
Gulani m.o.i.s.t ™ therapy therein identifies the exact kind of dry eye to then custom-design a treatment plan for that individual patient in single or combined and even staged protocols for successful outcomes.