The EyeBag® and its place on the world health stage
The EyeBag® is inexpensive (compared to other physical treatments) and can be used daily to control dry eye symptoms.
The EyeBag is the simplest, most cost-effective physical treatment for Meibomian gland dysfunction.
Other physical treatments include LipiFlow, MiBoFlo, and intense pulsed light therapy also known as IPL.
The LipiFlow system is not available as an NHS treatment in the United Kingdom but is more widely available in the United States of America. LipiFlow treatment involves a device that is attached to the eyelids and warms the inside and outside of the lids to 42.5°C whilst at the same time having a mechanical pulsed physical expression of the meibomian glands. This expresses the accumulated the meibomian gland material. LipiFlow seems to be effective but the duration of treatment is quite variable and unpredictable. It is usually an expensive procedure which is only available to self-paying private patients in the UK.
The MiBoFlo device is currently not supported by peer-reviewed research. It is a silver-tipped eyelid warming device which is applied directly to the eyelids in the clinical practice or consulting room. This treatment is not available on the NHS.
Many different drops are available to treat dry eye, most of which are lubricant drops usually described as artificial tears. In United Kingdom, these are mostly prescribed as medical devices and there are nearly 80 such eye drops available. There are different categories of dry eye drop / lubricant artificial tears and these are described in detail in the DEWS II Report Management and Therapy Section.
Cyclosporin (spelled Ciclosporin in the USA)
Cyclosporin has been available as an immunomodulating therapy for many conditions over a long period of time. Initially used in transplant medicine to minimise the likelihood of transplant rejection, its immunomodulating functions have subsequently been widely used in autoimmune diseases such as uveitis and some dermatological conditions. It has been available as an ophthalmic preparation to treat severe dry eye for a number of years, but the vehicles and preparations used to deliver it to the ocular surface have not been very satisfactory. The most useful formulation has for many years been a veterinary preparation known as Optimmune which is typically used for dogs which suffer dry eye. This use is widespread in veterinary medicine particularly in the United Kingdom where West Highland terriers are particularly susceptible to a Sjögren-like dry eye condition. The opt immune veterinary preparation of Cyclosporin eye ointment has been used (off label and in fact off species) in the United Kingdom where it can be prescribed for human patients provided the patient understands and consents to the situation. Recently, a Japanese pharmaceutical company called Santen has launched a cationic formulation of topical Ciclosporin which, marketed under the trade name Ikervis, is licensed for the treatment of keratitis associated with severe dry eye in the UK.
Lifitegrast is a pharmacological preparation used to treat dry eye marketed by Shire Pharmaceuticals. Shire market Lifitegrast in the USA under the trade name Xiidra but is not presently available in the European Union or the UK, although Shire are applying to the EMA (European Medicines Agency) for a licence to market this treatment for dry eye throughout the European Union and economic area.
Diquafosol is another pharmacological agent used to treat dry eye. It has been extensively used in Japan. It is not presently available in the United Kingdom or in the European Union. The use of Diquafosol is supported by peer-reviewed evidence and again details can be found in the TFOS DEWS II Report.
IPL is the abbreviation for Intense Pulsed Light therapy. IPL treatment delivers high-intensity flashes of non-laser light to specific parts of the body. IPL was first introduced to the medical community around 1992. Initially, IPL treatment was used to treat cosmetic indications, for unwanted hair, skin rejuvenation, pigmented spots and vascular lesions. IPL has subsequently been more widely used to treat skin conditions affecting the face such as Rosacea and Acne vulgaris. There have only been a few anecdotal reports of cases of melanoma occurring after IPL treatment in the quarter of a century since this treatment was first used on human patients. Over the last few years, IPL treatment for dry eye has gained popularity but is not available through the UK National Health Service.