Dry Eye Clinic
Dr. Abdalrahman Alabsi
Dry Eye Diagnosis and Treatment Technologies
TearCheck — Comprehensive Dry Eye Diagnostic Device
TearCheck analyzes dry eye in a smart, reliable, and effective way, allowing a comprehensive assessment of eye comfort and dry eye severity – from the patient's symptoms to analysis of the tear layers and imaging of the eyelid oil glands. This makes it possible to identify the causes quickly and clearly and to track improvement.
Smart dry eye analysis tests:
Eye Fitness Test: Questionnaire assessing dry eye symptoms and eye comfort.
TFSE® / NIBUT: Tear stability / tear break-up time: the test evaluates the tears over 10 seconds to assess tear stability and measure how quickly the tear film evaporates and breaks up, without touching the eye.
OSIE®: Ocular surface inflammation assessment: a temporary dye (fluorescein drop) adheres to areas of the ocular surface with changes related to dry eye inflammation.
Tear Meniscus: Tear meniscus height: the tear level above the lower eyelid margin is measured.
Abortive Blinking / Eyelid Tonicity: Incomplete blinking / eyelid function: all blinks over 60 seconds are recorded to automatically detect incomplete blinking.
D-BUT: Dynamic tear break-up time: an additional test that measures tear film break-up time using a temporary dye drop (fluorescein).
Eye Redness: Eye redness grading: images of the conjunctiva are captured to assess redness caused by the inflammation of dry eye and to track improvement.
Demodex: Blepharitis (Demodex) assessment: a magnified image of the eyelid margin and lash base is captured, making it possible to see signs of eyelid margin inflammation and the presence of Demodex (a microscopic mite that lives at the roots of the lashes and causes inflammation of the eyelid margins).
Meibography IR: Eyelid oil gland imaging (meibography): precise 2D and 3D imaging of the tear-secreting oil glands of the eyelids (meibomian glands) to assess their condition, the degree to which they are affected, and any blockage of the glands and their ducts.
E-eye IRPL – Intense Regulated Pulsed Light
E-eye IRPL is a second-generation IPL device designed to treat evaporative dry eye caused by a deficient lipid (oil) layer of the tear film due to meibomian gland dysfunction (MGD), which accounts for about 86% of dry eye cases.
How it works: it is more than a standard IPL treatment. The device generates fully calibrated, regularly sequenced polychromatic light pulses, with energy, spectrum, wavelength, and duration precisely controlled to stimulate the nerves connected to the meibomian glands, activating them and improving their function. This improves secretion of the lipid layer and the quality and stability of the tear film. The treatment is painless and safe for the eyes.
Indications for E-eye IRPL:
Dry eye syndrome.
Meibomian gland dysfunction (MGD) – dysfunction of the tear-secreting oil glands.
Chalazia (oil-gland cysts) of the eyelids.
Blepharitis (eyelid inflammation).
Rosacea and rosacea-associated dry eye.
Session steps (takes only a few minutes):
Sunscreen is removed from the face if it was applied within two hours of the session.
The patient sits comfortably in the treatment chair.
A white protective eye mask is placed over the patient's eyes.
Any pigmented spots or moles in the treatment area are covered with a white patch.
A special treatment gel is applied to the cheeks and temples.
The light intensity is set according to skin tone, and the patient should feel a tolerable warmth from the light during the session.
Five light flashes are applied below each eye: four flashes along the lower area starting from the nasal side, then one flash at the temple to activate the oil glands of the upper eyelid.
The same procedure is repeated below the other eye.
The gel is wiped off and the treatment is complete; sunscreen or other products may then be applied.
Treatment protocol:
The protocol consists of 3 main sessions (plus an optional fourth session) as follows:
Day 1 (session 1): improvement for at least one week.
Two weeks later, day 15 (session 2): improvement for at least two weeks.
One month later, day 45 (session 3): improvement lasting from 6 months up to 3 years, depending on dry eye severity and response to treatment.
One month later, day 75 (session 4 – optional, case by case): improvement lasting from 6 months up to 3 years, depending on dry eye severity and response to treatment.
Combining IPL (E-eye IRPL) sessions with a LipiFlow session, or with other devices that help melt the oils and open the oil-gland ducts, is one of the most advanced and effective protocols for moderate to severe meibomian gland obstruction (MGD) and evaporative dry eye, because each device offers a different, complementary treatment (synergistic effect). It is recommended to start with LipiFlow or another oil-melting device before, or together with, the first intense pulsed light (IPL) session, with manual expression of the eyelids when needed after the sessions to clear blockages and accumulated thick secretions.
* The eyes are re-examined and the dry eye severity is reassessed 6 months after the first session, to determine whether repeat sessions, a maintenance session, or longer follow-up are needed.
Additional proven effects of IPL:
Deep thermal effect on tissues and oil glands.
Photomodulation of mitochondria and increased collagen production.
Reduced inflammation along the eyelid margins.
Regeneration of connective tissue.
Lightening of dark circles around the eyes.
LipiFlow — Vectored Thermal Pulsation System
A medical device that helps melt the stagnant secretions of the eyelid oil glands and clear the oil-gland ducts blocked by meibomian gland dysfunction (MGD), which affects about 86% of dry eye patients.
How LipiFlow works:
Vectored Thermal Pulsation (VTP) technology applies automated, precise heat and pressure to both eyelids simultaneously (bilaterally) across the entire eyelid for 12 minutes. A therapeutic temperature of up to 42.5 °C is applied directly to the inner surface of the eyelid, acting directly on the oil glands until the end of the session, while the eyelid, ocular surface, and cornea are protected. At the same time, pressure is generated in pulsed sequences with peristaltic waves from proximal to distal to help clear blockages and stagnant material from the glands.
Indications for LipiFlow:
Dry eye syndrome.
Meibomian gland dysfunction (MGD) – dysfunction of the tear-secreting oil glands.
Chalazia (oil-gland cysts) of the eyelids.
Blepharitis (eyelid inflammation).
Rosacea-associated dry eye.
Session steps (the session takes only 12 minutes):
The patient lies comfortably on the treatment bed.
The eyelids are checked to be clean and any makeup on or near the lid margin is removed, then a topical anesthetic drop is applied to the eye.
The Activator is fitted – a sterile, single-use unit whose silicone part surrounds the upper and lower eyelids.
As the session starts, the temperature rises gradually to 42.5 °C and stays there until the end of the session.
During the session, pulsed pressure sequences with peristaltic waves from proximal to distal are generated, decreasing and increasing throughout the session.
At the end of the session the Activator is removed and the treatment is complete.
Treatment protocol:
One session a year: about 70% of patients with mild to moderate blockage need only one session a year, and its effect may last even longer.
One session every 3–6 months for the remaining ~30%: either advanced cases or patients with risk factors for faster re-blockage, such as those who are using or have used Roaccutane (isotretinoin) for acne.
Combining IPL (E-eye IRPL) sessions with a LipiFlow session is one of the most advanced and effective protocols for moderate to severe meibomian gland obstruction (MGD) and evaporative dry eye, because each device offers a different, complementary treatment (synergistic effect). It is recommended to start with LipiFlow or another oil-melting device before, or together with, the first intense pulsed light (IPL) session, with manual expression of the eyelids when needed after the sessions to clear blockages and accumulated thick secretions.
Blephasteam — Moist Heat Eyelid Warming Device
Blephasteam provides safe and effective warming of the eyelids to help restore the flow of oils from the meibomian glands. Its constant humidity and heat melt the oily secretions that block the meibomian glands and their ducts in meibomian gland dysfunction (MGD), making it easier to remove these secretions with eyelid massage and expression. Blephasteam creates an environment that naturally enhances the quality and stability of the tear film by supporting the thickness of the tear lipid layer, improving ocular surface health and the patient's daily comfort.
How it works: the device generates moist heat from evaporating water while maintaining a constant temperature of 42 °C throughout the 10-minute session.
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Indications:
Dry eye syndrome.
Meibomian gland dysfunction (MGD).
Chalazia (oil-gland cysts) of the eyelids.
Blepharitis (eyelid inflammation).
Rosacea-associated dry eye.
Session steps (the session takes only 10 minutes):
The patient sits comfortably in the chair.
The device is prepared to generate moist heat, which takes about one minute.
The device is fitted snugly on the face, keeping the head from tilting downward.
The session lasts 10 minutes, during which moist heat is maintained.
The eyes may be open or closed during the session.
At the end of the session the device is removed, and manual massage or manual expression in the clinic is recommended.
Treatment recommendations:
Blephasteam can be used daily together with circular manual massage of the eyelids toward the lashes. It can also be used in the clinic to help melt oily secretions in the eyelids, with manual expression of the eyelids when needed after the session to clear blockages and accumulated thick secretions.
Combining a Blephasteam session with IPL (E-eye IRPL) sessions provides a synergistic treatment using two different therapeutic technologies.
A diagnostic tool that helps measure the production of the aqueous (watery) layer of the tears. It is used mainly in cases of dry eye.
The test is based on the principle of capillary action through a graduated blotting strip, which allows the aqueous layer of the tears to travel along the test strip.
When the Schirmer test is performed without a topical anesthetic, basic and reflex tear secretion are measured together. When it is performed with a topical anesthetic, it measures basic tear secretion only.
The test uses filter-paper strips measuring 5 mm wide and 35 mm long. The patient may keep the eyes closed during the 5-minute test or continue blinking. After 5 minutes, the doctor removes the strips and measures the length of the wetted part of the strip.
The Schirmer test result is determined by measuring the length of the wetted area of the strips within 5 minutes.
Types of Schirmer test:
The Schirmer test without topical anesthesia and with topical anesthesia.
The version without topical anesthesia evaluates basic tear secretion from the main lacrimal gland, in addition to reflex tear secretion produced by the trigeminal nerve, which is stimulated by the irritation of the test strip. The Schirmer test with anesthetic drops is performed to measure only the basic aqueous tear secretion of the lacrimal gland.
Schirmer test results:
The length of the wetted area on the Schirmer strip (without anesthesia) indicates the degree of dryness at the level of the aqueous layer. Schirmer test results are interpreted as follows:
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0 to 5 mm: severe dry eye.
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5 to 10 mm: moderate dry eye.
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10 to 15 mm: mild dry eye or possible dry eye.
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More than 15 mm: normal tear function.
A rapid diagnostic tool that measures the inflammatory marker (MMP-9) associated with dry eye disease.
The InflammaDry test is a rapid diagnostic test for the qualitative detection of elevated levels of the MMP-9 protein in the tears of patients suspected of having dry eye disease.
Test components:
The test contains three main parts:
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Test Cassette.
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Sample Collector.
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Buffer Vial.
Test procedure (clinical procedure):
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Sample collection: the sample collector is gently dabbed at several points along the lower eyelid (palpebral conjunctiva), then allowed to rest on the palpebral conjunctiva for 5 additional seconds to make sure it is saturated with tear fluid.
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Assembly: the sample collector is inserted into the sample transfer window of the test cassette.
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Secure closure: the device is pressed firmly until a “double click” is heard, to make sure it is properly closed.
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Buffer step: the absorbent tip is immersed in the buffer vial for at least 20 seconds.
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Running the test: the absorbent tip is removed, the protective cap is replaced, and the test is laid flat on a horizontal surface for 10 minutes.
Interpreting the results:
The result is read 10 minutes after the test starts running, and is interpreted as follows:
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Positive: a blue line appears in the Control zone together with a red line in the Result zone. This indicates the presence of MMP-9 protein at a concentration of 40 ng/mL or higher.
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Negative: only a blue line appears in the Control zone, which means the MMP-9 concentration is below 40 ng/mL.
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Invalid: if the blue line (control line) does not appear, the test is considered invalid and must be repeated with a new device.
Medical note:
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The InflammaDry test must be performed before using any anesthetic drops or topical dyes on the eye, to ensure an accurate result.
References
1. Wolffsohn JS, Benítez-Del-Castillo JM, Loya-Garcia D, et al. TFOS DEWS III: Diagnostic Methodology. Am J Ophthalmol. 2025;279:387-450. doi:10.1016/j.ajo.2025.05.033
2. De Luca A, Ferraro A, De Gregorio C, et al. Promising High-Tech Devices in Dry Eye Disease Diagnosis. Life (Basel). 2023;13(7):1425. doi:10.3390/life13071425
3. Toyos R, Desai NR, Toyos M, et al. Intense pulsed light improves signs and symptoms of dry eye disease due to meibomian gland dysfunction: A randomized controlled study. PLoS One. 2022;17(6):e0270268. doi:10.1371/journal.pone.0270268
4. Pucker AD, Yim TW, Rueff E, et al. LipiFlow for the treatment of dry eye disease. Cochrane Database Syst Rev. 2024;2(2):CD015448. doi:10.1002/14651858.CD015448.pub2
5. Olafsson J, Lai X, Landsend ECS, et al. TheraPearl Eye Mask and Blephasteam for the treatment of meibomian gland dysfunction: a randomized, comparative clinical trial. Sci Rep. 2021;11(1):22386. doi:10.1038/s41598-021-01899-8
6. Cho P, Yap M. Schirmer test. I. A review. Optom Vis Sci. 1993;70(2):152-6. doi:10.1097/00006324-199302000-00011
7. Sambursky R, Davitt WF 3rd, Latkany R, et al. Sensitivity and specificity of a point-of-care matrix metalloproteinase 9 immunoassay for diagnosing inflammation related to dry eye. JAMA Ophthalmol. 2013;131(1):24-8. doi:10.1001/jamaophthalmol.2013.561
8. Jones L, Craig JP, Markoulli M, et al. TFOS DEWS III: Management and Therapy. Am J Ophthalmol. 2025;279:289-386. doi:10.1016/j.ajo.2025.05.039
