Dry Eye Disease
Symptoms of Dry Eye Disease
Blurry vision/ fluctuating vision
Redness
Burning sensation
Dry Feeling in Eyes
Itching
Light Sensitivity
Excessive Tearing/Watery Eyes
Tired Eyes/ Eye Fatigue
Stringy mucous discharge in or around the eyes
Contact Lens Discomfort
Scratchy Feeling of sand in the eye
Causes of Dry Eye
There are many causes of Dry Eye Disease:
- Aging : As we age and hormones change (especially during menopause and during pregnancy) our eyes become drier.
- Medications: Certain medications can cause dray eye such as blood pressure medications, antidepressants and antihistamines to name a few.
- Computer use: Using a computer or tablet or smart phone can cause dry eye, especially in children and adolescents.
- Environmental causes: Exposure to dry air, heat and wind can contribute to dry eye disease. If you work or live in an area with poor air quality, high pollutants, or air conditioning/ fans you may also suffer from dry eye.
- Autoimmune disorders: Certain systemic conditions can cause dry eye such as Rheumatoid arthritis, Lupus and Sjorgren’s Syndrome, thyroid disorders and diabetes to name a few.
- Meibomian Gland Dysfunction (MGD): A condition where the glands in the eyelid are not secreting enough lipid (oil) to cover the aqueous layer (water layer) of the tear film. The meibum is important because it gives the tear film stability and protects against microbial agents. Meibomian gland dysfunction can lead to ocular and eyelid discomfort and an evaporative dry eye.
- Blepharitis This is an inflammation of the eyelids. The margins of the eyelid become red and inflamed. This is a chronic condition that is difficult to treat. Some causes of blepharitis include Rosacea, blocked eyelid glands (MGD- see above),eyelash mites known as Demodex, seborrheic dermatitis (dandruff of the scalp and eyebrows).
Meibomian Gland Dysfunction
Meibomian Gland Dysfunction
Meibomian Gland Dysfunction
Demodex (eyelid mites)
Meibomian Gland Dysfunction
Meibomian Gland Dysfunction
Blepharitis
Meibomian Gland Dysfunction
Blepharitis
How is dry eye diagnosed?
Evaluation for dry eye
During your exam for dry eye the doctor will ask you a series of questions and take a through history of your symptoms. It is important not to take any eye drops at least 2 hours prior to your appointment because they may interfere with the results of dry eye testing. One of the tests the doctor will perform includes tear osmolarity testing. During this painless in office test, the doctor will take a sample of your tears. Increased osmoarity or hyperosmolarity indicated a decreased production of the water and oil layer in the tear film. After the testing, the doctor will have a number indicating where you are starting prior to treatment and can scale your dry eye as mild, moderate or severe. During the course of treatment this test can be repeated and used as a gauge to see how you are responding to your treatment plan.
Inflammadry Testing
This is a simple in office test that allows the doctor to take a sample of your tears and check for MMP-9, a marker for inflammation. Often patients with dry eye will have elevated MMP-9 levels. The test results are ready in 10 minutes and can be repeated over the course of your treatment to evaluate your response to therapy.
Vital Dye Staining
By placing different dyes in your eyes the doctor can evaluate the severity of your dry eye. The dyes are attracted to damaged cells on the surface of the eye and “highlight” the parts of your eye that are compromised due to dry eye disease. The dye also stains your tear film so the doctor can check to see how long your tears stay on the surface of your eye and also evaluate volume of your tears.
Schirmer Testing
By first placing an anesthetic drop in the eyes, the doctor will then place Shirmer test strips in your eyes for 5 minutes. This test is performed to measure your tear production.
Dry Eye Treatment
Artificial Tears
Anyone who has made their way down the dry eye drop section of the pharmacy knows there are many choices when it comes to artificial tears. Some tears come in single use vials and some tears are preserved in the bottle but preservative free when they are dropped in the eye. There are tears that provide short term relief and others that may provided a longer period of relief. Artificial tears can temporarily relieve your dry eye symptoms but unfortunately they do not solve the problem. If you are using artificial tears more than four times a day, then speak to your doctor about other options to treat your dry eye.
Warm Compresses
We recommend warm compresses applied to the eyelids twice per day for 10 minutes. We sell The Eye Doctor eye compresses which your put in the microwave for 10 seconds then onto your eyelids after making sure the temperature is not too hot. These compresses are anti microbial and hold the heat on your eyelids longer than a warm wash cloth.
Omega 3 Supplementation
We recommend Dry Eye 3 (DE 3) by Physician Recommended Nutriceuticals. Not all Omega 3’s are equal. Studies show that consumption of 2240 mg of EPA & DHA in the re-esterfied triglyceride form (rTG) are better absorbed and therefore more efficacious. Omega 3’s in the rTG form help the meibomian glands in the eyelids to secrete a healthier oil and act as a natural anti inflammatory.
Medications for Dry Eye
When artificial tears are not enough, your doctor may prescribe a medicated eye drop for your eyes. The medicated eye drops help to stop inflammation and increase your own tear production. There is also a medicated nasal spray that helps improve tear production.
Punctal Occlusion
During this painless in office procedure the doctor will insert a temporary plug into your lower eye lid tear drainage system, your upper eye lid tear drainage system or both. Similar to putting a drain stopper in a sink drain to keep the water from draining, these punctal plugs block the drainage of the tears you are making, keeping them on the surface of your eye and providing relief. Some punctal plugs dissolve after a few days, some last for a few months, some are non dissolvable. This procedure is billed to your medical insurance .
Amniotic Membrane
This treatment option uses the part of the placenta and has natural biological properties (stem cells) that help the surface of the eye to heal. These membranes are use to treat dry eye, keratitis (an inflammation of the cornea), corneal scars, chemical burns, corneal defects and other ocular inflammatory disease. The membrane is placed on the patient’s eye from 1-3 days then removed by the doctor. This procedure is done on one eye at a time and is billed to your medical insurance.
Other Treatment Options
Other treatment options include precisely treating the meibomian glands with a thermal heating pad. Another treatment option is intense pulse light therapy. Both of these procedures are non invasive and provide great results. These procedures are not currently done in our office, but we can refer you to a doctor who preforms these procedures. These procedures are not covered by insurance.