Dry Eye Therapy

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Dry Eye therapy

Dry eye is a multi-factorial condition that may have no early symptoms, but typically consists of any or all of the following symptoms: gritty or foreign body sensation, red eyes that are often worse by the end of day, fluctuating vision, tired and/or watery eyes. It is the most common presenting complaint and is considered a chronic, inflammatory condition that requires both monitoring and maintenance therapy. With increased screen time there is an uptick in the prevalence of dry eye disease and is increasingly affecting younger patients. There are a number of treatment options:

pharmaceutical tear modulators (Restasis and Xiidra)
artificial tears (preserved and undpreserved)
autologous serum drops
scleral lens fittings
medical procedures such as punctal plugs
the fitting of amniotic contact lenses in moderate to severe cases
eyelid cleansing or debridement
warm compresses
eye whiteners (LUMIFY)
nutritional supplements such as Omega-3s
and light/heat treatment of the meibomian glands to relieve symptoms and minimize ocular tissue damage.

Omega-3 is often prescribed in cases of frequent chalazions, meibomian gland dysfunction and its anti-inflammatory properties. Vitamin D is also often added as it is found to help tear quality and its deficiency may be linked to people suffering from dry eye.

Dry eye is often associated with an overgrowth of bacteria, excessive biofilm presence, and blocked meibomian glands. Daily lid hygiene may be prescribed to alleviate symptoms or sources of your dry eye.

Warm compresses are often prescribed for chalazions, meibomian gland dysfunction, and tired eyes. We do not recommend they be used for treating allergies or eye infections, in these cases, cold compresses can be helpful to reduce symptoms of itching, and eye discomfort, in combination with other more targeted treatments.

Watch the video below regarding punctal plugs for the treatment of dry eye.

Blepharitis is another eye condition that can exacerbate dry eye sensation. Wikipedia offers the following definition: “Blepharitis is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The overall etiology is a result of bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.”

Tear Science

The tear film is comprised of 3 layers: mucin, aqueous and oil (meibum) that protects the surface of the eye. When the tear film is disturbed from its optimal composition, it results in the symptoms already mentioned. The most common cause of dry eye is evaporative dry eye due to meibomian gland dysfunction (MGD).

Tear Film Osmolarity and Dry Eye

When either the quantity or quality of secreted tears is compromised (known as either aqueous deficient or evaporative dry eye disease), a more concentrated tear film results (i.e., increased osmolarity). This elevated concentration places stress on the ocular surface tissues, namely the corneal epithelium and the bulbar conjunctiva.

The I-Pen is a quick and safe electronic device used to measure your tear film osmolarity, or the concentration of dissolved salts in your tears.

Knowing your tear film osmolarity is useful in cases of dry eye symptoms, in the diagnosis of certain ocular surface disorders which affect tear film osmolarity and for all pre/post-surgical patients (i.e., those undergoing LASIK or cataract surgery), and for monitoring the progress of dry eye therapy over time.

This is a quick and painless test to aid in diagnosis and management of dry eye and the ocular surface.

Understanding the tear film can help us determine the underlying cause and what needs to be supplemented or addressed.

These are some of the common contributing factors that can lead to chronic dry eye disease:

Auto-immune disorders such as rheumatoid arthritis, Sjogren’s syndrome, thyroid disease, and lupus
Medicines such as beta-blockers, antihistamines, diuretics, Accutane, glaucoma, and anxiety medications
Refractive eye surgery such as LASIK or cataract surgery
Contact lens use
Large eye openings known as the interpalpebral fissure
bacterial infestation of the eyelids known as blepharitis (see below and one of its treatments)

We offer periciliary eyelid scaling or blepharoexfoliation to remove bacteria, crust, and debris from the eyelash base and lid margins, thereby clearing the meibomian glands to improve important oil secretions. Meibomian gland dysfunction is the most common cause of dry eye.

The blepharo-exfoliating process is done with a safe, hand-held device that spins a surgical-grade, moistened, sterile micro-sponge along the eyelash roots and lid margins. This 10 minute procedure removes years of biofilm buildup to help improve eyelid hygiene, increase oil secretions important to the tear film, leading to improved eye health and comfort. In a retrospective study, patients that underwent treatment had a 56% improvement in symptoms, 39% improvement in dry eye signs, and more than three second improvement in tear film stability.

Other contributing factors that can aggravate dry eye symptoms include: dry climates, smoke, wind, low indoor humidity, allergies, decreased blink rate (often seen with computer viewing), menopause, advanced age, entropian and ectropian (inward and outward misdirection of the eyelids, respectively), and prolonged computer work.

Dry Eye/Computer Vision Syndrome

Long periods staring at a computer or smartphone screen contribute to dry eyes from a lack of blinking, as previously mentioned. Computer vision syndrome, or CVS, can consist of any of the following symptoms while working on a digital device or computer screen: tired, sore eyes, burning or gritty sensation, blurred or strained vision, and watery eyes. Proper screen ergonomics, prescription lenses, and ocular lubricants are some of the tools we have available to alleviate symptoms. A good rule to follow is known as the 20-20-20 rule. For every 20 minutes in front of a digital screen, take a 20-second break while looking at something 20 feet (i.e. far) away.

Take our dry eye questionnaire and submit prior to your eye exam by clicking here.

Punctal Plugs, also known as punctal occluders, are small, bio-compatible devices that are painlessly inserted into the tear duct to slow tear drainage. This ultimately increases the volume of tears persisting on the ocular surface, with the added moisture helping to relieve dry eyes. This procedure is widely performed, safe, and easy to apply in about 2 minutes. Our plugs are collagen-based and slowly dissolve over a six-month period.

In treating dry eye with punctal occlusion, there is often a measured improvement achieved in tear breakup time (TBUT), reduced corneal staining, and improved visual acuity due to increased tear stability. Punctal occlusion has been reported to be very effective for the treatment of dry eye in relieving symptoms while enabling patients to reduce their dependency on lubricants.