What is Dry Eye?

“Dry Eye” is a broad term used to describe problems with the tear layer that covers the eyes. Another (and probably more accurate) term to describe the condition is “Ocular Surface Disease.”

To understand dry eyes, it is important to first understand how the tears work and how they are produced.

The majority of the tear film is composed of water – this is called the “aqueous layer.” The watery tears are produced by the lacrimal gland, located deep behind the upper eyelid.

Covering the aqueous layer is the “lipid layer.” This layer, made of oil, covers the aqueous layer and prevents it from evaporating. The oil tears are made by eyelid glands called Meibomian glands.

The innermost tear layer is the “mucin layer,” which allows tears to adhere to the eye.

These three distinct layers work together to create a smoothly distributed and stable covering of the eyes.

What are the symptoms of dry eyes?

Dry eye symptoms can vary, and they often create some confusion about their actual cause. The most common symptoms include burning, stinging, and gritty feeling eyes. These symptoms are often more common during prolonged staring activities like reading or computer use, or after exposure to wind or moving air created by fans.

Another very common symptom of dry eyes is excessive tearing. When the eyes become dry and irritated, it often triggers reflex watering of the eyes. These are not the quality and lasting tears that maintain comfortable eyes – they are thin, watery, “reflex” tears. They are the “emergency” tears that flow after the eyes have become dry and aggravated. Once this response has been triggered, it can sometimes last hours.

Often, dry eyes simply feel like there is something in the eye. Doctors call this “foreign body sensation.” No amount of rubbing or flushing the eyes seems to alleviate the awareness that something is in the eye.
Blurry vision – when the tear film on the eyes is inadequate, vision can fluctuate significantly. Blurred vision after reading for longer periods of time is often caused by dry eyes.

And finally, sometimes the eyes just feel dry. Lubricating drops are often used to supplement the lack of moisture in the eyes, but the problem never goes away.

What Causes Dry Eye?

It is very common that people suffering from dry eye disease have never been told why it is happening. There are many reasons for this, but most often it is because only a basic level of evaluation and treatment is being offered by most doctors. Dry eye management requires extensive training and experience, as well as advanced diagnostic and treatment instrumentation. Without these tools, a thorough and accurate assessment cannot be performed, and treatments cannot address the root cause of the problem. That is why it is so important to meet with a dry eye specialist to determine the cause of the problem and the best treatment plan. We are dry eye specialists.

A dry eye consultation will determine what is causing your dry eyes, and which treatments will address that cause.

Common Causes of Chronic Dry Eyes

  1. The eyelids do not produce enough oily tears. This is called “meibomian gland disease,” and it accounts for over 85% of dry eye disease. Without the oily tear layer covering the tear film, the watery tears have no protection against evaporation. Doctors call this “evaporative dry eyes.” Poor meibomian gland function has many causes, which include:
    • Rosacea (ocular rosacea)
    • Decreased blinking – prolonged computer use or other visual tasks
    • Demodex (skin mites infesting the eyelashes)
    • Blepharitis (bacterial infection of the eyelid edges)
  2. The lacrimal glands do not produce adequate watery (aqueous) tears – this is called aqueous deficiency, and it accounts for only a tenth of dry eye disease. Aqueous deficiency can result from:
    Systemic autoimmune disease – Sjögren’s syndrome, lupus, scleroderma, and rheumatoid arthritis.
    Medications: Antihypertensives, antihistamines, and antidepressants

Diagnosing Dry Eye

The process of diagnosing ocular surface disease starts with a thorough discussion of medical history, symptoms you are experiencing, and your medications. From there, advanced diagnostic testing, performed in our office, provides the information needed to determine the cause of problem. These tests include:

TearLab osmolarity: Chronic evaporation of the water in the tears leaves a higher concentration of the remaining tear salts and other components behind. Tear salt concentration is measured to know if excessive tear evaporation is occurring.

LipiView meibography: Most cases of chronic dry eyes are caused by eyelid problems, specifically, meibomian gland dysfunciton. Meibography is a unique type of imaging that scans the eyelid gland structure to determine if significant eyelid disease (meibomian gland loss) exists.

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Dry Eye Treatments:

IPL

Intense pulsed light (IPL) is a technology used by medical practitioners to perform various skin treatments for aesthetic and therapeutic purposes, including hair removal, photorejuvenation (e.g. the treatment of skin pigmentation, sun damage, and thread veins) as well as to alleviate dermatologic diseases such as Rosacea. IPL is used in optometry and ophthalmology as well, to treat evaporative dry eye disease due to meibomian gland dysfunction. An innovative and painless procedure, IPL has provided relief for many patients and helped improve their quality of life.

IPL is a safe and effective treatment for dry eye and aesthetic conditions of the face. IPL works by emitting specific wavelengths of light into the skin that treat the following conditions:

  • Dry Eye – IPL treats meibomian gland dysfunction (MGD), the leading cause of dry eye, by reducing the inflammation of the face and eyelids that cause MGD.
  • Rosacea – IPL reduces redness and flushing of the face by reducing the dilated blood vessels in the skin and by killing harmful skin bacteria that contribute to rosacea (and dry eye).
  • Spider Veins – IPL reduces the small dilated overgrown veins in the skin (spider veins).
  • Hemiangiomas – IPL reduces red spots on the skin from benign blood vessel overgrowth.
  • Brown Aging Spots – IPL reduces pigmented spots in the skin by damaging melanin in the brown spots. The body then absorbs and removes these brown spots.
  • Dark Under-Eye Circles – IPL reduces the overgrown small blood vessels and pigment that cause under-eye circles and also smoothes the skin of the eyelids.
  • Small Wrinkles – IPL stimulates collagen production which reduces small wrinkles in the skin.
  • Hair Reduction – IPL reduces the number of hair follicles in your skin to reduce unwanted hair growth.
  • Photofacial – Rejuvenates skin for smoother, younger looking skin

LipiFLow

LipiFlow thermal pulsation is a treatment device specifically designed for effectively removing blockages from the meibomian glands, allowing them to properly function and produce the oils that make up the top protective lipid layer of the tear film. Supported by 37 patents and used around the world by leading eye care professionals, LipiFlow is the the standard of care for MGD with studies demonstrating its safe and effective results. LipiFlow was designed to minimize patient discomfort during a 12 minute in-office treatment that most patients describe as a gently massaging of the eye lids.

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Dry Eye Treatment Diagram

Intraductal Probing

A more advanced treatment option, intraductal probing (IDP) is performed when the meibomian gland openings are blocked by tissue adherence – in other words, when the glands have sealed their openings shut.

Blephex

Blephex is a device that “scrubs” the bacterial biofilm (like dental plaque) off your eyelid edges

Topical Medications

Eyedrops like Restasis and Xiidra are commonly prescribed the treat chronic dry eyes. In truth, only about 20% of chronic dry eye sufferers actually benefit from these medications. These medications are effective for inflammatory conditions stemming from Sjogrens syndrome, Lupus, Rheumatoid arthritis and other autoimmune conditions, however, they are not effective in treating meibomian gland disease – the most common type of dry eyes in which the tears evaporate too quickly.

Oral Medicaitons

Inflammatory skin conditions (Rosacea) can sometimes be better controlled with low-dose Doxycycline. Treatments usually last for 90 days or longer.

Punctal Occclusion

Plugging the tear drain ducts in the eyelids can increase the volume of tears in the eyes. This treatment is typically considered when rehabilitative treatments fail.

Protective Contact Lenses

For very advanced dry eyes, when all standard therapies fail, large-diameter contact lenses called “scleral lenses” are used to provide protection to the eyes. These lenses require a doctor with extensive contact lens fitting experience.

Eyelid Heat Compresses

Using a heat compress (microwave heaed compress or the more effective electric heating device) helps to maintain normal funciton of the meibomain glands.

Neurostimulation

The TrueTear neural stimulating device works by stimulating all tear glands (aqueous, mucin, and meibomian) to produce more tears.