Dry Eye Treatment and Therapy
It has been reported that 5-30% of people suffer from moderate to severe dry eye. Many more make lifestyle and contact lens choices because of mild issues with dry eye. Although commonly used, the term "dry eye" is too vague and can be misleading - especially for people who actually have a dryness problem by experience too many tears. A more precise term may be "tear film dysfunction" or "ocular surface disease". A recent professional committee report has rewritten the definition of "Dry Eye" to be:
“Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”
In short, undesirable changes to the tear film covering the surface of your eye can lead to many problems with eye comfort and vision that impair a person's ability to live fully.
When it comes to gritty, red, and intermittently blurry eyes, patients need help selecting the right option. There are many factors that go into selecting the right treatment that is both maintainable and is personalized to the severity of symptoms. As is often the case, you need to match the treatment to the disease severity. We have the expertise and time to make a treatment plan that meets your specific needs.
For a person with mild and infrequent problems, a well chosen artificial tear may be all the help that is needed. However, many people are unable to get adequate relief with artificial tears due to their temporary nature. It is thought that over 80% of people with "dry eye" actually have dysfunctional oil glands at the edge of their eyelids. These specific eyelid oil glands are called Meibomian Glands. Healthy Meibomian Glands are needed to maintain and/or rehabilitate the ocular surface. Unhealthy glands interfere with vision, reduce eye comfort, increase the risk for infection, and make it much harder to wear contact lenses. The problem comes when the glands become blocked with thick oil. If the blockage is not released the gland simply degenerates and disappears - a process known as "dropout". When the glands are gone they cannot be remade or recreated.
By treating these glands directly to remove obstructions while they are in mild disease stage, we can often achieve more meaningful and long lasting relief. Like any chronic disease, prevention and early treatment are preferable to dealing with late-stage complications. Treatment of Meibomian Glands is much like the dental care of your gums and teeth in that occasional in-office treatment combined with home care leads to the best outcomes.
For the remainder (~20%) of people with "dry eye", agents that increase natural tear production may be in order. These include prescription eye drops, nutritional changes, and use of warm compresses. In advanced cases, care must be taken to preserve the remaining surface and prevent permanent vision loss.
For eye drops, we generally recommend lipid (oil)-based drops that are either preservative-free or have very gentle preservatives. The lipid component helps stabilize the tear film better than a standard artificial tear. With preservatives, why add an unneeded chemical to an eye that is already have trouble? We do have have two prescription eye drops available to treat dry eye - Restasis and its newer competitor Xiidra. Both drops can help reduce inflammation to help improve tear function.
For nutrition, multiple studies have shown than high-quality, omega-3 supplements help people with dry eye feel better. It often takes a couple months of supplements with about 1000-2000 of EPA and DHA mg/daily to achieve improvements. It may be possible to see even faster improvements if the omega-3s are combined with other antioxidants. We can specifically tailor your ideal Omega-3 level with a simple blood test so you know exactly what diet and/or supplement changes are needed.
For warm compresses, the intent is to get warm moist heat directly to the eyelids. There are multiple methods to achieve this goal. The classic technique is a homemade warm compress with a wash cloth and very warm water. While this can be effective, it takes a lot of work to do it right and it can make a mess. As an alternative, there are sleep mask-like compresses that can simply be warmed in the microwave and be used for 5-10 minutes. These are more effective than the homemade version, yet still require regular use and don't exactly target the Meibomian Glands. We offer an in-office treatment that does precisely target the glands, takes about 10 minutes, and is expected to last at least a year.
What to Expect during a Dry Eye Evaluation
To evaluate the surface of your eyes, we need to check the stability and integrity of your tears. A direct inspection is done with standard light and magnification of the slit-lamp biomicroscope. Then certain benign dyes (fluorescein and lissamine green) may be added to the tear film to highlight areas that are not working correctly. The eyelid glands will then be inspected and by be expressed with gentle pressure to examine their contents. We can also quantify your tear production with a quick test. Those methods plus your history of symptoms should be enough to determine a treatment plan that will work for you. These evaluations may be part of, or independent from, your regular comprehensive eye examination.