Adjunct devices are frequently used, mainly for two applications: treatment of eyelid margin anomalies and insufficient tear volume.

 

The eyelid margins are very important structures in dry eye. They correspond to the junction between the skin around the eye and the eye mucus that covers the eye and the inner eyelids, further they contain the opening of the meibomian glands and the root of the eye lashes. The meibomian glands, which produce the tear lipids, often become contaminated by environmental pollutants but also by make up; this lead to gland blockage (meibomiatis) and ultimately gland atrophy. The eyelashes, which are situated just in anterior to the meibomian glands at times become contaminated by bacteria and or make up resulting in chronic, low grade inflammation (blepharitis).  Treatment that may incorporate heat compresses, medicated wipes or antibacterial foam is devised for each individual patient as best suited.

 

An insufficient tear volume may be in part remedied by the blockage of the puncti (the orifices of tear excretion) by small plastic plugs (punctal plugs). The use of punctal plugs is the preferred dry eye management approach for some practitioners. At MICHEL GUILLON punctal plug's are used less frequently and only when the tear volume has been measured and found to be abnormally low. Punctal plugs by producing stagnating tears create at times a worsening of the anterior eye inflammation; the approach follows therefore always involves the use of temporary plugs prior to permanent plugging and frequent monitoring visits.