Dry Eye Center
Tears are important because they keep the eye’s surface clear and smooth, allowing for good vision. Each time a person blinks, a film of tears spreads over their eyes. Normal eyes constantly create tears to keep the eyes moist. When this does not happen, dry eyes occur.
Dry eye is treatable. Community Eye Center offers many treatment options for dry eye.
Dry Eye Disease affects millions in the U.S. alone. Symptoms of dry eye can include:
- Dryness
- Irritation
- Redness
- Soreness
- Watery eyes
- Blurred vision, especially with reading or computer work
- Feeling of sand or grit in the eyes
- Sensitivity to light
- Stringy discharge in the eyes
Things that can contribute to dry eye can be one or a combination of the following:
- Age
- Medications (such as allergy medications, antidepressants, hormone therapy, birth control, menopause treatments, medication for anxiety and others)
- Certain medical conditions and autoimmune disorders
- Hormonal changes/Menopause
- Environment (wind, smoke, or dry climate)
- Allergies
- Computer screen time
- Laser eye surgery
Dry Eye Types
Dry Eye Disease is one of the most common eye problems, affecting people of all ages in all areas of the world. It affects millions of people in the U. S. alone and is particularly common in those over the age of 50, especially women. Dry Eye Disease has the potential to cause significant pain, discomfort, blurred vision, and permanent damage to the eye. It is a chronic and progressive disorder requiring proper evaluation and treatment.
Dry eye results from changes to the normal tear film that bathes the front surface of the eye. This film has 3 basic layers:
- Lipid (oil) layer – the outermost layer of the tears. This is a thin layer of oil, secreted by the Meibomian glands, located in the eyelids. This oil serves to slow evaporation of tear, thus stabilizing the tear film. A deficiency of oil quality or quantity results from a condition called Meibomian gland dysfunction.
- Aqueous (water) layer – the middle, and thickest layer of the tears. This layer contains oxygen, nutrients, and various immune components, and is produced by the main and accessory lacrimal glands.
- Mucin layer – the innermost layer of the tear film. Mucin coats the eye’s surface, allowing the tears to spread evenly across the surface. It is secreted by goblet cells on the surface of the eye and can be affected by disorders such as chemical burns, Stevens-Johnson syndrome, and nutritional deficiencies.
Research has shown that there are two basic types of dry eye disease:
- Aqueous-deficient dry eye – the tear-producing glands do not produce enough tears.
- Evaporative dry eye – poor quality tear oil layer results in unusually-rapid tear evaporation.
Many people have a combination of both types and studies have suggested that perhaps 60-70% of dry eye patients have at least some degree of evaporative dry eye. Regardless of the type, the symptoms are similar and well-known to those who suffer from this disorder-dryness, irritation, light sensitivity, a feeling of sand and or foreign matter in the eyes, blurred or fluctuating vision, especially with reading or computer work, and significant limitations to their lifestyles and activities.
Treatment of dry eye disease has traditionally involved the use of various artificial tear drops and ointments. While these can help supplement your natural tears, they do not effectively treat the underlying cause of the disorder. In some cases, punctual occlusion, which closes off the tear drainage system, may help to improve tear volume and reduce symptoms.
Recently, new technology has become available to effectively treat Meibomian gland dysfunction (MGD), the root cause of evaporative dry eye. Community Eye Center is pleased to offer the FDA-approved Lipiflow® treatment for MGD. This novel thermal pulsation technology acts to help improve, or even normalize Meibomian gland oil production, unblocking plugged oil glands with a gentle 12-minute in-office treatment.
Dry Eye Testing And Treatment
Dry Eye Testing
There are several ways to test for dry eye. At Community Eye Center, the doctors utilize a variety of testing methods, so that they may treat each patient according to their type of dry eye. Based on your exam, your doctor may use one of the following dry eye testing methods:
- LipiView – This instrument captures video images with a high-tech interferometer, enabling the doctor to measure the amount and quality of the lipid (oil) layer of the tear film. In addition, the instrument records the completeness of the patient’s blinks. This information, along with other test results, is used to determine the best treatment strategy.
- TearLab Osmolarity – This test measures the salt content of tears, using a tiny sample of tears collected from the eyelid margin. Tear osmolarity has been shown to be consistently elevated in dry eye disease and is used both to diagnose dry eye and to track the success of treatment.
- Schirmer Testing – This is a measure of the volume (amount) of tears produced by the eyes in normal circumstances. Certain conditions can cause a significant decrease in tear production, with resultant aqueous-deficient dry eye disease. The test uses tiny strips of paper placed along the eyelid margin to measure the number of tears produced in 5 minutes.
- Fluorescein Staining – This is done with a tiny amount of fluorescein dye dissolved in your tears. Fluorescein will highlight areas of surface irritation resulting from dry eye disease.
- Lissamine Green Staining – This highlights cells that are devitalized (unhealthy) from dry eye disease.
Dry Eye Treatment
Treatment of Dry Eye Disease has traditionally involved the use of artificial tear drops and ointments, along with avoidance of wind, dusty environments, ceiling fans and the like. Today, treatment is tailored to the type of dry eye and can include a variety of medications, materials, new technology and tear supplements. Most dry eye patients will benefit from the use of supplemental artificial tears, and many different drops, gels, and ointments are available. Some are water-based, some oil-based, some thicker than others; specific recommendations are again based on the type of dry eye being treated. In any case, these products, while helpful, do not treat the dry eye disease, and are typically used along with other treatments.
- Prescription Eyedrops – Because inflammation occurs frequently in dry eye disease, topical anti-inflammatory eyedrops are commonly used, topical steroid medications for short-term use, and in some cases long-term treatment using Restasis. When necessary, antibiotic or antiallergy drops can also be utilized.
- Punctal Plugs – These are used to close off the tear drainage ducts, thus increasing the number of tears present on the surface of the eye. They are made of collagen or silicone, are inserted into the tear duct in the office, and can be removed if necessary. In some cases, permanent closure of the tear duct using cautery is performed, often after first using a temporary punctal plug. Nutritional Supplements – There is some evidence that certain omega-3 and omega-6 supplement combinations can help to reduce irritation from dry eye disease.
- Lipiflow® – This 12-minute in-office treatment is a true breakthrough in the treatment of evaporative dry eye, believed to account for the majority of dry eye disease. Using controlled warmth and gentle eyelid massage, Lipiflow works to open clogged Meibomian (oil) glands, restoring more normal oil gland function, and stabilizing the tear film. Community Eye Center is pleased to offer our patients this groundbreaking new technology, providing an effective treatment for the cause of evaporative dry eye.
Dry eye disease is usually a chronic and progressive condition, and can significantly impair a person’s vision, comfort, and ability to read, do computer work, and function normally. It has often been a source of much discomfort and frustration. Today, through the use of cutting-edge technology and modern scientific knowledge, we have the ability to treat this problem far more successfully.
Dry Eye & Meibomian Gland Dysfunction (MGD)
You need not think about your eyes all of the time. Community Eye Center offers treatment options for Dry Eye which can reduce or eliminate the need for drops, compresses and other burdensome, time-consuming attempts to relieve symptoms.
Nearly 90% of patients with dry eye have Meibomian Gland Dysfunction (MGD), also called Evaporated Dry Eye. This is a condition in which there is a blockage or some other abnormality of the meibomian glands; when this happens, these glands do not secrete enough lipid (oil) into the tears. Meibomian Gland Dysfunction is a treatable condition which can be diagnosed and treated using LipiView® and LipiFlow®.
To diagnose MGD, our doctors will evaluate the patient to determine if he or she is suffering from dry eye disease. During the patient’s evaluation, he or she will receive a comprehensive exam from our doctors and will answer a brief questionnaire. This questionnaire will help our doctors understand how the patient’s eyes feel from day-to-day.
If the doctor’s assessment shows that the patient is suffering from dry eye symptoms that are beyond mild and/or the eyes show signs symptoms of deterioration, our doctors will use LipiView® to evaluate the lipid (oil) layer on the patient’s eyes. LipiView® is a revolutionary technological imaging process that takes detailed images of the eye’s tear film to determine whether or not the patient is suffering from Evaporative Dry Eye caused by Meibomian Gland Dysfunction (MGD).
Once a diagnosis of MGD is confirmed, our doctors may prescribe the use of LipiFlow Thermal Pulsation System for opening and clearing blocked glands. This allows the body to resume the natural production of lipids (oils) needed for the tear film.
LipiView®, LipiFlow® and Meibomian Gland Dysfunction FAQ
Yes, chronic or severe dry eyes will only worsen with time. Some symptoms of deterioration can include:
- Increased evaporation of tears
- Unstable tear film
- Damage to the surface of the eye
- Discomfort
- Inflammation and cell damage
- Fluctuation and decrease in vision
This non-invasive process takes less and 5 minutes and is much like a comprehensive eye exam.
The LipiFlow® Activator (a disposable eyepiece) which is placed on the eye. Once it is on the eye, you will recline in the treatment chair and experience the 12-minute procedure. A combination of directed heat and pulsatile pressure will help relieve the blockage for the Meibomian glands. Opening these blocked glands will aid your body in resuming natural production of tear film oil.
For those suffering from moderate or severe dry eye, life can seem like a constant struggle to alleviate symptoms. Eye drops and warm compresses are a regular ritual. LipiFlow® has revolutionized dry eye management for these afflicted individuals.
- The LipiFlow® system is the first and only treatment for dry eyes that addresses the cause of Evaporated Dry Eye. Other treatments – warm compresses and drops – merely provide temporary symptomatic relief.
- It can provide ongoing relief by improving the gland function, allowing them to produce the oils needed for a healthy tear film. Other treatments options may require daily, and sometimes even hourly attention to keep symptoms of dry eye under control.
- It provides a practical way to manage dry eye disease or dry eye syndrome by providing relief and helping to stop dry eye deterioration and worsening symptoms.
On average, patients report little to no pain during the LipiFlow® treatment.
