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First Author: C.Albou-Ganem FRANCE
Co Author(s): R. Amar
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Dry eye disease (DED) can occur as a primary disorder or as a component of other diseases. Its onset may be triggered or modified by exposure to a myriad of factors, both systemic and environmental. DED, primarily caused by meibomian gland dysfunction (MGD), results in contact lens discomfort and is a major contributor to contact lens drop out. This case study evidences a patient, who previously had to discontinue contact lens wear due to DED, but was able to comfortably resume contact lens wear following a 12-minute LipiFlow treatment
Clinique de la Vision
Case presentation: This 24-year old patient first presented with DED symptoms leading to discomfort severe enough to cause discontinuation of soft contact lens wear. Upon examination, the following was found: SPEED Score 17, MG function score of 2 bilaterally with a poor meibomian secretion quality of toothpaste consistency, Average ICU score (Interferrometric Color Unit, as measured with the Lipiview, Tearscience, Morrisville, NC) showed OD 52 and OS 37. Treatment Method: The patient received a 12-minute thermal pulsation treatment (LipiFlow, TearScience, Morrisville, NC). The treatment evacuates the meibomian gland contents by efficiently heating the meibomian glands from the inside of the eyelid, whilst gently evacuating the glands through a mechanical pumping and expressing motion applied to the outside of the eyelid.
Follow up at one month showed a drop in SPEED Score of 4 points to 13. This improvement was maintained at three months post-treatment. MG secretion quality improved to optimal clear liquid at three months with an MG function score of OD 9 and OS 12. Average ICU improved to OD 71 and OS 49 at three months, with a marked improvement of symptoms reported by the patient. The incomplete or Partial Blink (PB) Score was noted at three month using LipiView as OD 12/12 and OS 12/13. This feature was not available on the equipment on pre-treatment evaluation and has since been added. Whilst the LipiFlow treatment enables healthy MG secretions, chronic partial blinks may ultimately lead to gland obstruction. The partial blinks were illustrated to the patient using the frame-by-frame playback feature on the LipiView. The patient was educated on the relevance of her incomplete blinking habits and received blink training instruction to re-focus her attention on completion of the blink, which is essential for healthy tear rehabilitation. PB was still evident thus the patient education and blink training would need to be ongoing to further optimize their condition.
Following an extended period of discomfort and DED symptoms leading to discontinued contact lens wear, the patient featured in this case study, has found relief for her DED symptoms through a single 12-minute treatment. The improvement has been such that she has been able to return to contact lens wear successfully.