Long term effective treatment for Dry Eye symptoms has eluded many who have come to rely on short term relief from drops, various at-home symptom relief remedies or other prescribed medications. For many, managing symptoms is a frustrating process. The key to effective Dry Eye treatment is to understand the underlying cause of the symptoms.

Dry Eye is generally caused by an imbalance in the tear film that acts as a shield on the surface of our eyes. There are two primary contributors to tear film imbalance. The first is decreased tear production. In recent years, we have learned that true reduced tear production is rare. What we know now is that the problem almost always originates with blockage of the tiny Meibomian Glands in our eyelids. These glands produce essential oils that form the top layer of the tear film and are the core protective element that is essential to long-term visual comfort. 86% of all dry eye symptoms are caused by oil deficiency in the tears.

When the Meibomian glands are blocked or the glands have been compromised, the eye becomes exposed. This leads to dry eye signs and symptoms. This is known as MGD or Meibomian Gland Dysfunction. MGD is easy to diagnose and manage. The treatment of MGD is essential for the long term management of dry eye.


Fortunately, most Dry Eye patients boast healthy tear production as many have a common symptom of Dry Eye, excessive tearing. As tear production is generally not the root cause of Dry Eye, Dr. Chester Quan or Dr. Christina Chang will check for gland blockages and the structure of your Meibomian Glands in your eyelids. Drs. Quan and Chang uses a camera, called Lipiview to evaluate the Meibomian Glands.

Gland blockages can occur over time from debris that is caught in the eyelids, digital device and computer usage and, for women, just putting on make-up over the course of many years. While Miebomian Gland Dysfunction, or MGD, is most often detected in adults over 40, the condition does not discriminate based on age and is often seen in kids and young adults as well. That is why checking for MGD should be a part of your regular eye exam. MGD, if caught early, is the best way to avoid chronic dry eye symptoms. More importantly, you can prevent the potential for substantial permanent gland loss.

Normal Gland Structure

Gland Shortening And Loss

Significant Gland Loss

Severe Gland Loss


Dry Eye Syndrome and chronic Dry Eye symptoms can have significant impact on daily lifestyles and can impede on simple activities such as reading, working on a computer, enjoying the outdoors or watching a TV. Those same daily activities that are impeded by Dry Eye symptoms are also the same activities that can be contributing causes to Dry Eye.

For example, looking at computers or digital devices for long periods of time can contribute to decreased blink rates. Blinking is essential to activating the oil-producing Meibomian Glands and spreading those oils across the surface of the eye. When blink rates decrease, it impacts long term functionality of the glands and can lead to MGD or even irreversible damage if MGD is not detected and treated early. Other contributing factors that cause Dry Eye symptoms to flare up are dry climates, smoke, indoor air circulation, and wind. Some of us are just lucky with Dry Eye being a product of the aging process.


In addition to environmental factors that contribute to Chronic Dry Eye symptoms, there are various diseases, medications or medical procedures that can cause Dry Eye symptoms. If you are experiencing any of the below medical conditions or receiving any of these treatments, you should discuss with your eye doctor to get to the root cause of your Dry Eye symptoms. The following are common conditions or treatments that can lead to chronic Dry Eye Symptoms:

  • Rheumatoid Arthritis, Sjogren’s syndrome, thyroid disease and lupus
  • Medicines such as beta-blockers, antihistamines, diuretics and anxiety medications
  • Refractive surgery such as LASIK surgery
  • Various prescription and non-prescription medications
  • Swollen, red irritated eye lids, commonly referred to as Blepharitis
  • Out-turning of the eye lids (ectropion) and in-turning of the eye lids (entropion)
  • Contact lens use for long periods of time


The tear film is a complex structure of mucin, tears and oil that protects the surface of the eyes. When the tear film is compromised, it results in a variety of symptoms, most of which have been associated with Dry Eye and MGD (Meibomian Gland Dysfunction). Understanding the tear film is key to seeing the clear differences between tear deficiency issues and MGD, especially since MGD is more common and has greater long term impact on Dry Eye symptoms.

Mucin Layer

The Sticky Foundation

The mucin (mucous) layer at the bottom of the tear film provides a “sticky” foundation and acts as a barrier to the eye surface.

Aqueous Layer

The Watery Center

The aqueous layer is the “juicy” center that is comprised of tears produced by the lacrimal glands.

Lipid Layer

The Oily Top

Finally, the top “oily” lipid layer of the tear film is made up of lipids or oils produced from the meibomian glands. When MGD is present, our glands do not consistently produce the oil necessary for a stable tear film and the aqueous layer will evaporate.

LipiFlow Treatment May Be For You

For many patients, LipiFlow treatment means relief. In a recent clinical study, 79% of patients reported improvement of their overall dry eye symptoms within 4 weeks (ranging from 10% – 100%) following a single LipiFlow treatment.

So What Is LipiFlow?

The LipiFlow Thermal Pulsation System is the only FDA-approved device for treating Evaporative Dry Eye caused by Meibomian Gland Dysfunction (MGD). The treatment opens and clears blocked meibomian glands. This allows the glands to resume their natural production of lipids (oils) which helps reestablish the tear film. This improved tear film is what helps dry eye sufferers feel and see better.

How Does LipiFlow Work?

LipiFlow uses thermal pulsation which allows precisely controlled heat to reach the inner eyelid where the meibomian glands reside, while also performing mild, intermittent directional pressure. Together, the precise heat and gentle pressure help unblock and clear the meibomian glands on both the upper and lower eyelids.

The procedure utilizes a sophisticated single-use device with built-in sensors to ensure a safe, sterile treatment.

The treatment time is 12 minutes and is performed in our office. It is comfortable and patients actually compare it to a spa-like experience.

What To Expect After LipiFlow Treatment?

There is no down-time or recovery period after the procedure. Vision may be slightly fuzzy for a few minutes as your tear film recovers. Although some patients notice improvement in symptoms right away, this is not the norm. A more likely outcome will be improvement within 4-8 weeks as the ocular surface normalizes. Another study showed that 90% of patients had significant symptom relief (a 50% improvement) by their 8 week follow-up. It has also been shown that further improvement can be seen at 6 months. Although it is hopeful that everyone will see improvement, some patients with severe disease may not. With severe disease, the goal of treatment will be to stop its progression.

How can I know that this is right for me?

You can schedule what we call a Dry Eye Evaluation with Dr. Quan or Dr. Chang. During that visit, Dr. Quan or Dr. Chang will utilize tests and specialized equipment to examine your meibomian glands, tear layer, and eyelid structure as well as your cornea and eyeball itself.

After this evaluation, a treatment plan will be outlined that may, or may not, include LipiFlow treatment. Every patient is unique, and you will be presented with the best treatment options for you.

If you have questions, or want to schedule an appointment, call: (415)753-5338.