Globally, dry eye disease (DED) has a prevalence ranging between 5% and 50% in the adult population.1 Data from the National Health and Wellness Survey show that 6.8% of the United States adult population have been diagnosed with DED, and the prevalence increases with age and is higher in women than in men.1
The TFOS DEWS II report defines dry eye disease as a multifactorial disease of the ocular surface with loss of homeostasis of the tear film and ocular symptoms. The cause of DED can stem from a multitude of different factors such as ocular surface inflammation, tear film instability and hyperosmolarity, and neurosensory irregularities.2 In general, tear film instability strongly indicates DED and can be caused by changes in lipid layer function and the quality and quantity of tear fluid.
Loss of tear film stability and homeostasis can cause functional changes to the corneal epithelium, allowing for ocular inflammation to ensue and for patients’ dry eye symptoms to develop. Adverse environmental factors, chronic ocular surface irritation and inflammation, and nerve impairment can lead to further injury of the corneal epithelium causing dry eye signs and symptoms to worsen over time.3
Meibomian gland dysfunction (MGD) accounts for 80% of dry eye disease and it occurs when the meibomian glands become blocked or clogged by thick secretions, causing evaporative dry eye disease.4 MGD indicates that there is not enough of a lipid layer within the tear film being produced and as a result, the tear film evaporates at a rapid rate causing persistent tear film instability.
Mild MGD treatments can include at-home care such as preservative-free artificial tears and warm compresses. And for moderate to advanced levels of MGD, this will likely require an in-office approach and at-home maintenance for optimal results.5
The treatment of dry eye disease should be aimed at restoring and maintaining ocular surface homoeostasis, and radiofrequency is an advanced treatment modality that has given ideal results in reestablishing the ocular surface system and quickly reducing dry eye symptoms.
What is radiofrequency and how does it relieve dry eye disease?
Radiofrequency (RF) is a non-invasive in-office procedure that was first used in the dermatology and aesthetics setting to minimize the appearance of fine lines and wrinkles.6
RF devices are essentially bulk heating devices that safely deliver high-frequency oscillating electrical currents. When passing through skin tissue, there is an increase in oscillating current vibrations and these vibrations lead to friction and consequently heat production. The heat production promotes collagen contraction and growth within the superficial and deeper layers of the skin, and reduces tissue edema and skin laxity, resulting in an overall improved appearance of fine lines and wrinkles.7
Lower frequency radiofrequency can enter deeper into the skin compared to higher frequency RF.8 Ideal RF systems have a built-in thermal monitoring program with a real-time feedback loop to prevent excess heating of the targeted tissue to best regulate thermal exposure of the dermis. They also easily move across the skin surface and generate a uniform, consistent thermal energy in order to reduce discomfort, pain, and thermal burns.8
When radiofrequency is applied to the skin near the eyes, it has the ability to provide uniform heating at an optimal temperature to treat MGD.9 The RF energy is delivered to obstructed meibomian glands, where the higher energy heat melts the thick oil secretions obstructing the meibomian glands and decreases the harmful bacterial community, allowing for improved oil production, improving oil flow into the tears, and restabilizing the tear film.9
Improvements in signs and symptoms in patients treated with RF energy followed by manual gland expression were similar to patients treated with LipiFlow Thermal Pulsation System 3 months after treatment.9
What current radiofrequency technologies are available?
Cynosure’s TempSure Envi
Cynosure TempSure Envi capabilities:10
- Delivers RF energy to delicate areas of the ocular region.
- Therapeutic Logic Control (TLC) technology activates a timer when tissue has reached therapeutic temperature, allowing for uniform distribution of heat along treatment zones.
- Treatments are safe for all skin types.
- Other indications include hair epilation, telangiectasia, and milia.10
InMode Forma I
InMode Forma I capabilities:11
- Treat upper and lower eyelids, forehead, nasolabial folds, and neck.
- Thermal tissue remodeling technology treats deep layers of the skin by delivering uniform heating to the dermis.
- Temperature, impedance, and contact sensors are built into the handpiece in order to monitor epidermal temperature in real-time and maintain the treatment safely.
- Treatments are for individuals with all skin types and tones.11
What is the treatment process of radiofrequency?
The patient should be given the following instructions on how to prepare before their RF treatments:12
- Avoid too much sun exposure.
- Remove makeup from skin.
- Avoid exfoliating/peeling masks prior to treatments.
- Avoid aspirin or ibuprofen a week prior to treatments.
- Keep treatment areas clean and dry prior to appointment.12
The radiofrequency procedure generally takes 30-60 minutes to complete depending on the clinician and equipment. The eye care provider will gently massage the upper and lower eyelids with a gel for approximately 10-20 minutes. There is no risk of hair removal or adverse skin reactions, and pain and discomfort should not be felt during RF treatments.
There may be mild redness and swelling around the eyes for a few hours after the RF procedure, thus it is recommended to gently moisturize the area to soothe the skin and to avoid exposing the treated areas to heat until the skin has returned to its normal color and swelling has reduced.
Optimal results are typically noticed after 3-4 treatments that are commonly spread out over 2 to 4 weeks.12
RF energy has a long history in the dermatology and cosmetic realm. Now, RF is considered to be an advanced treatment and added tool in the MGD treatment space, and is especially well suited for those looking for rapid improvement in their dry eye symptoms.
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