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BLOG: Microblepharoexfoliation provides added benefit for blepharitis
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New approaches to treating ocular surface disease are arriving at a dizzying pace. Both diagnostic and treatment modalities leave many of us wondering which ones offer real value, especially when out-of-pocket payments from patients can be considerable.
In this issue of OSN, our cover story explores intense pulsed light (IPL) treatment for meibomian gland dysfunction (MGD). This dermatologic treatment has shown promise for MGD in clinical studies.
Microblepharoexfoliation (MBE) is another treatment approach that has shown considerable promise in my practice’s ocular surface disease referral clinic. MBE involves thorough removal of biologic debris on the surface of the lids and lashes by using a high-speed rotary sponge soaked lid cleanser. The procedure, performed by a doctor or a trained technician, removes scurf and uncaps meibomian glands better than any patient could do alone. It can be performed with or without proparacaine, and most patients feel just a tickling sensation and no discomfort during or after the procedure.
BlephEx, a company founded by ophthalmologist James Rynerson, sells a rotary tool and disposable sponges to perform this procedure, along with disposable brushes that come four to a packet — one for each eyelid.
We charge patients $200 per treatment (both eyes included), which generally must be repeated every 4 to 6 months. Between treatments, patients are instructed to continue their own eyelid hygiene maneuvers using any of the available commercial cleansers or lid cleaning wipes.
There’s no question that MBE fills a gap in treatment that is missing from other regimens, IPL, thermal pulsation (LipiFlow, TearScience) and gland probing/expression. Patients fairly quickly experience relief, and we have found this approach to be additive in benefit to these other therapies. I’ve not seen any method for cleaning the eyelids as well as MBE, and I’ve become convinced that this treatment deserves a place in our standard regimen for blepharitis.
When a new treatment comes along for any condition, we should approach it with healthy skepticism, as I did at first with MBE. In my practice, though, this treatment has proven to be a great value for patients, improving their quality of life with a most difficult-to-treat disease.
Disclosure: Hovanesian reports he is a consultant to BlephEx.