- Where
- Inside your rooms
- What you supply
- One room, one slit lamp
- Investment
- No capital outlay
- Rhythm
- A fortnightly half day
We travel to practices and facilities across NSW.
All treatment equipment is brought in and taken away.
No device purchase, no lease, no extra clinical staff.
30 minute slots, running alongside your consulting.
Select your setting
The same clinic solves a different problem in every room it parks in.
Dry eye costs a surgeon accuracy, an optometrist chair time, an aged care facility a transport booking, and a beautician a client. The service is built to fit each one.
Protect the biometry, not just the comfort.
An unstable ocular surface moves keratometry, and that movement reappears weeks later as a refractive surprise and a difficult conversation. Optimising the surface before measurement is the cheapest accuracy you can buy, and it does not have to cost you chair time.
- Surface optimised before biometry, so keratometry repeats
- Fewer refractive surprises and more confidence offering premium IOLs
- Chronic, low response dry eye taken off your consulting list
- The patient stays inside your practice instead of being referred out
Keep the complex cases without buying the equipment.
Treatment resistant dry eye needs diagnostics, a treatment course and a follow-up protocol that a twenty minute appointment cannot carry. We run that course as an extension of your care and report back after every visit, so the patient never stops being yours.
- Advanced diagnostics and TearStim IRPL without capital investment
- A destination for patients who have already failed drops and lid hygiene
- A healthier surface before contact lens fitting and surgical co-management
- You remain the referring practitioner and receive every report
The eye appointment that needs no transport booking.
Dry eye is one of the most undertreated conditions in residential care. It is compounded by age, medications and chronic illness, and it is usually managed with a bottle of drops by staff who have no diagnostic equipment. We assess and treat on site.
- No resident transport and no external specialist appointments
- Fewer daily complaints of sore, watery or gritty eyes
- Better visual stability for reading, mobility and daily activity
- Clinical notes and a review plan left with the facility
The client whose eyes always react.
Streaming, stinging, red eyes during treatment are frequently meibomian gland dysfunction rather than a reaction to your product. Knowing the difference protects the client, and it protects your work from being blamed for something it did not cause.
- Know what to look for and exactly when to refer
- Fewer reactions attributed to your treatment or products
- Better tolerance of makeup, lash extensions and contact lenses
- A named clinician to refer to, not a search result
The treatment
Three mechanisms, not one. That is why it holds.
Most in-clinic dry eye treatment addresses obstruction alone. This protocol treats the inflammation and stimulates production in the chair, clears the obstruction, then sends the patient home with the routine that protects the result.
Mechanism one
IRPL with neural stimulation
Calibrated polychromatic light pulses applied to the periocular skin reduce inflammation along the lid margin and stimulate the nerve pathways supplying the glands. In response the glands resume normal secretion, which increases natural tear production rather than replacing it from a bottle. IRPL differs from cosmetic IPL in that the pulse sequence is regulated rather than free running.
Mechanism two
Meibomian gland expression
Manual expression of the upper and lower lids clears obstructed glands and improves the quality of the lipid layer, so the tears that are produced stop evaporating before they can work.
Mechanism three
At home lid hygiene and ocular care
Warm compress, lid massage and lid margin cleaning, taught in the chair and sent home in writing. In-clinic treatment opens the glands. The daily routine is what keeps them open between sessions and after the course finishes.
The device
TearStim, built on E-Eye IRPL technology by E-SWIN of Houdan, France, certified specifically for the treatment of meibomian gland dysfunction. Around 80 per cent of dry eye disease is evaporative, which is the form this device is built for.
- Course length 3 to 4 sessions
- Session schedule Every 10 to 14 days
- Time in the chair A few minutes per session
- Application 5 flashes around each eye
- Energy setting 9 to 13 J per cm2, by Fitzpatrick skin type
- Protection Opaque goggles and treatment gel
The diagnostics
Assessment is a comprehensive ocular examination rather than symptom history alone, so the dry eye is classified and graded before anything is treated, and progress is measured against a baseline instead of a recollection.
Findings and treatment recommendations are reported to the referring practitioner after completion of examination.
The pathway, start to finish
Six steps, and your practice is only involved in two of them.
The clinic is designed to slot into the way you already work. Reception checks patients in and out. Notes are dictated straight into your practice software, so there is no second system to learn.
Referral
You identify a suitable patient and refer internally. One patient is enough for the clinic day to run.
Assessment
Thirty minutes of comprehensive ocular examination. Tear break-up time, gland structure and function, lid margin examination and OSDI symptom scoring against a baseline.
Diagnosis and plan
The dry eye is classified and graded rather than described, and the patient is given a treatment plan they understand.
IRPL with neural stimulation, and expression
Light to the periocular skin with neural stimulation of tear production, followed by meibomian gland expression. Typically 3 to 4 sessions, every 10 to 14 days.
Home management
Warm compress, lid massage, lid margin cleaning and diet, taught in the chair and sent home in writing.
Report and review
Findings, treatment performed and ongoing recommendations reported to you after completion of examination. The patient returns to your care.
Why it works
The mechanism is published, and so are the numbers.
Two bodies of evidence sit behind this protocol, and they are not equal. The peer-reviewed trial data comes first. The manufacturer's post-market data is shown separately, and labelled, because it has not been through independent review.
Tier onePeer reviewed, independent
Prospective two-site clinical trial. Forty subjects with moderate to severe meibomian gland dysfunction received four sessions of IPL followed by gland expression, three weeks apart. Signs consistent with dry eye disease fell from 3.3 to 1.4 per patient, and gland score improved by 36 per cent. Dell, S.J., Gaster, R.N., Barbarino, S.C., Cunningham, D.N. and Lane, S.S. (2017) Clinical Ophthalmology, 11, pp. 817 to 827.
Tier twoManufacturer post-market data, not independently peer reviewed
Post-market clinical follow-up of dry eye analyses, 1,706 patients assessed and 818 treatment courses completed over one year across seven centres in six countries and three continents. Mean age 52 years, range 18 to 85. Comparable improvement across Schirmer at 75 per cent, TFSE at 77 per cent, NIBUT at 75 per cent and Eye Fitness Test at 73 per cent. Presented at ESCRS Vienna 2023, chief investigator L. Nobrega Cordeiro, MD. Collected and published by the device manufacturer, ESW Vision.
Further reading: TFOS DEWS II report (Craig et al., 2017), the International Workshop on Meibomian Gland Dysfunction management report (Geerling et al., 2011), Arita, Fukuoka and Morishige (2020) on IPL efficacy and tear film stability, and ElHusseiny et al. (2022) systematic review and meta-analysis. Full copies available to referring practitioners on request.
Who to refer
Four boxes. If all four are ticked, send them.
The strongest responders are patients with obstructive meibomian gland dysfunction, reduced break-up time, evaporative dry eye and chronic blepharitis. Adapted from TFOS DEWS II, current IPL and MGD clinical evidence, and the device compatibility checklist.
Patients attend with no makeup or facial cosmetics on the day of treatment, use sunscreen on treated skin afterwards, and pause other skin therapies for the duration of the course.
Referral outcome
Keep assessing
Tick each criterion the patient meets. If the picture is mixed or the aetiology is unclear, complete meibography, tear osmolarity, inflammatory markers or corneal staining before referring.
Absolute, do not refer until resolved
- Active ocular infection or blepharitis flare
- Active herpetic keratitis
- Corneal ulcer or epithelial defect
- Ocular surface neoplasia
- Photosensitivity disorders
- Ocular surgery within the last three months
- Uncontrolled severe inflammation
Relative, flag on the referral
- Pacemaker or implanted cardiac defibrillator
- Photosensitising medication
- History of allergic reaction to sunlight
- Abnormal skin lesions in the treatment area
- Recent sun exposure, sunbed use or self-tanning products
- Pregnancy or breastfeeding
For patients
If your eyes burn, water and blur by mid afternoon, drops are not the answer.
Most dry eye is not caused by a shortage of tears. It is caused by the tiny oil glands in your eyelids becoming blocked, so the tears you make evaporate before they can do their job. Treating that blockage is a different thing entirely from wetting the eye four times a day.
A feeling that something is in the eye that will not rinse out.
The eye floods to compensate for a tear film that keeps failing.
Blur that clears for a moment when you blink, then returns.
Long stretches of focus reduce blinking, and the film dries out.
Wearing time shortens year on year.
Especially in wind, air conditioning and late in the day.
Before you come in
Arrive with no makeup or cosmetic products on your face on the day of treatment. Tell us if you take any medication that makes you sensitive to sunlight, if you have a pacemaker, or if you have had a lot of sun, a sunbed or fake tan in the past month.
Your first appointment takes about thirty minutes and includes a full assessment before anything is treated.
What the treatment is like
Your eyes are covered with opaque goggles and a gel is applied to the skin around them. A short series of light pulses is applied around each eye, then the oil glands in the lids are gently expressed.
It takes a few minutes. Most people need three to four sessions spaced 10 to 14 days apart, and improvement builds across the course rather than arriving all at once.
Afterwards
- Mild redness or sensitivity may occur and usually settles within a few days
- Use sunscreen on the treated skin and avoid strong sun
- Warm compress and gentle lid massage once or twice daily
- Clean the lid margins with a dedicated eyelid cleanser
- No eye makeup, lash glue or extensions for 48 hours, and no lash extensions for 7 days
- Keep using any drops your ophthalmologist or optometrist has prescribed
- Avoid eyeliner on the inner lid margin long term, as it blocks the gland openings
The clinician
Julian Boumansour, Orthoptist
The clinic is delivered independently, within an orthoptist's scope of practice, with its own professional indemnity cover. Partnering practices take on no additional indemnity obligation beyond their usual clinical operations, and no additional clinical staff.
Every patient remains under the care of the referring practitioner. The dry eye clinic acts as an extension of your service, never a replacement for it.
- Australian Orthoptic Board Current registration
- Orthoptics Australia Member
- Professional indemnity insurance Held independently
- TearStim IRPL, gland expression and neural stimulation Scope of practice
- NSW region Service area
Start a conversation
Book a clinic day, or send one patient and see how it goes.
- Referrals and practice enquiries
- Use the form and we will come back to you within one business day.
- Consulting rooms
- Specialist Consulting Suites
Minchinbury Community Hospital
Corner Great Western Highway and Rupertswood Road
Minchinbury NSW 2770 - Patient appointments
- 02 9099 0539
Fax 02 9475 4790 - Service area
- Practices, facilities and salons across NSW