Dry Eye Center
What are the symptoms of dry eye?
Dry eye symptoms can vary from person to person. Some of these symptoms happen regularly, and others occur intermittently. Most people’s symptoms are different, and can vary depending on whether they’re indoors or outdoors. Dry eye disease occurs when your eyes are affected at least once per day. Believe it or not, watery eyes or excessive tearing can by a symptom of dry eyes. If the normal tear quality is reduced, the body creates over-production of watery tears.
What is dry eye disease?
Dry eye disease affects the surface of the eye and results in a loss of the normal balance of things that keep your eyes comfortable and clear. Tears spread across the cornea or the surface of the eye with every blink. The amount and quality of one’s tear are essential for one’s eyes. At the surface of the eyes, there are many parts that work together in harmony. The parts that must work together are muscles, nerves, glands, tear ducts, connective tissue. They all play a vital role in keeping the eyes moist.
Dry eye disease occurs usually when one of these factors is out of balance. This actually causes imbalance to the other factors, perpetuating the cycle of dry eye disease.
The risk of developing dry eye disease increases with age. Women are more likely to develop the condition compared with men. However, dry eye disease is becoming increasingly common in younger people with more device use like smartphones, laptops and tablets . Increasing device and smartphone use has made dry eyes more prominent than ever before. According to research, over 16 million Americans have dry eyes. Those who develop dry eye disease can experience problems with daily activities like reading, watching television, using the computer and mobile phones, dealing with work, and driving.
What role do our tears have in dry eye disease?
Tears have three layers: the outer lipid layer, the middle aqueous layer, and the inner mucin layer. Each layer serves a purpose.
- The inner layer is made up of mucus that coats the surface of the eye. The mucin layer binds tears to the eye. The cornea is naturally hydrophobic, so the mucous layer helps to connect watery layer above. The mucous layer is also responsible for spreading the water layer evenly over the surface of the eye.
- The middle layer which is also the thickest layer is mostly composed of an aqueous or watery layer. This layer which is more like a saline solution contains vitamins and minerals that keep the eye nourished. The watery layer is what makes up most of the tears. It is also responsible for maintaining the eye lubricated and washing away unwanted particles.
- The outermost layer of the tear is an oil or lipid based layer. It seals the tear film, keeping the surface of the tear smooth and preventing the other layers from evaporating. In other words, the oily layer keeps your tears from drying up too quickly
Dry eyes can occur when there is a loss of natural balance (either from external or internal problems) with any of these layers.
Tears play an essential role in protecting and keeping your eyes healthy. There are three types of tears: basal tears, reflex tears, and emotional tears:
- Basal tears serve as the principal protection of the eyes
- Reflex tears are responsible for flushing away harmful things from the eyes like dust, fumes and other harmful irritants.
- Emotional tears are tears formed in response to great emotion like sadness, joy, anger or fear.
The right amount and quality of tears keep the eyes nourished and lubricated. Every time you blink, a protective film of basal tears spread over the surface of your eye. Tears help with:
- Natural lubrication to reduce friction from blinking.
- Wash away unwanted stuff from the eyes
- Keeping the surface of the eye clear
- Natural proteins help fight germs or things that cause eye infection.
What are the causes of dry eyes?
There are two leading causes of dry eyes and often there is overlap between these two main causes of dry eyes.
- Evaporative Dry Eye or Meibomian Gland Dysfunction that is classified by a rapid evaporation of tears caused by a deficiency in the oil layer.
- Aqueous Deficient Dry Eye that is classified by a reduction in the quantity of tears produced by the lacrimal glands
Several factors can affect tear production or the condition of the eye in general. Dry eyes can result from many factors, including but not limited to:
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Incomplete Blink
When we concentrate on a smartphone, tablet, or detailed task, we do not blink as often as we should. Proper blinking spreads our tears and helps our lids secrete oil from our Meibomian glands
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Age
The amount and quality of tear the eyes produce decrease with age. Dry eyes increases in prevalence for people aged 55 and above.
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Gender
Due to hormonal changes, pregnancy, use of contraceptives, and menopause, women have a higher chance of developing dry eyes.
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Cosmetics & Skincare Products
You may find ingredients that are toxic and cause dry eyes in cosmetic and skin care products. Products exist that are hypoallergenic, organic, or vegan.
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Eyelid problems
Conditions such as ectropion (out-turning of the lids), entropion (in-turning of the lids) can produce more exposure or friction and cause the normal tear film to break up faster.
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Recent surgical procedures
Refractive eye surgery like LASIK can cause decreased tear production. This is due to a permanent change to the front surface of the eye. For some people, dry eye symptoms related to eye procedures can be temporary. Others can have persistent symptoms.
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Medications
Most medicines have side effects, and some of these can affect tear production. Medications such as blood pressure medications, antidepressants, sleeping pills, heartburn tablets, drugs for acne, birth control, hormone replacement, allergy, cold and Parkinson’s disease can reduce tear production.
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Health conditions
Autoimmune diseases like Rheumatoid Arthritis, Sjögren’s Syndrome, Scleroderma, Lupus, and Thyroid disease can directly affect the glands responsible for tear production. These conditions can cause imbalances in the three main layers of the tear: mucus, oil, and water. Vitamin A deficiency can also decrease tear production.
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Indoor and outdoor environmental conditions
Your eyes (and tears) are the most exposed parts of your body. Exposure to a dry environment, whether indoor or outdoor, can affect the eyes. People who live in places with dry climates are more prone to having dry eyes. Exposure to wind, smoke, and fumes can also aggravate your eyes. Dry indoor environments include air-conditioned rooms, hospitals, airplanes, and workplaces.
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Daily activities
Reading, staring at a smartphone or computer, driving and other similar activities require concentration leading people to blink less often which in turn causes increased tear evaporation.
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Lifestyle
Contact lenses can also irritate the surface of the eye and contribute to dry eyes. Other activities like cigarette smoking, alcohol consumption and not getting enough sleep can also affect the dryness of your eyes.
How might dry eyes effect you?
Short term effects of dry eye disease include constant eye irritation, blurry vision, regularly tired eyes and difficulty in wearing contact lenses.
- Dry eyes can start out as uncomfortable and annoying, but more than that it can cause permanent vision impairment if not taken care of and managed well.
- Dry eyes can also impact the way you usually live your life. People may face lifestyle restrictions. Simple daily activities like reading, working and driving can become difficult.
- Dry eyes can also get in the way of productivity in work and non-work related activities. Dry eyes can even impact quality of life.
Therefore diagnosing and treating dry eye disease during its early stages is essential.
How does Concourse Optometry Diagnose Dry Eyes?
A person must go under tests and imaging to determine what’s causing their dry eyes. Each case can be different and may require custom treatment.
A comprehensive eye exam notes a patient’s complete health history and lifestyle that maybe the underlying cause of the dry eyes. It also involves a dry eye survey (OSDI) and examination of the eyelids and the surface of the eye. If the dry eye is severe enough a specialized medical dry eye evaluation will be scheduled.
A medical dry eye evaluation will assess the tear volume, how quickly the tears break up on the front surface of the eye, and image your Meibomian glands with our Antares imaging system. This analysis helps us determine if your dry eye disease is from aqueous deficiency (lack of tear volume/production), Meibomian gland dysfunction MGD (lack of the oily layer of the tear film), or a combination of both. Once the diagnosis is made a customized treatment plan will be presented to you. Since a majority of dry eye disease is from Meibomian gland dysfunction, our analysis will let you know what stage of loss you have and treatment options for maximizing current gland function and preventative measures for gland preservation.
How does Concourse Optometry treat dry eyes?
Dry eye disease is often managed, rather than cured. However, research and technology have given us significant improvements. Importantly, these can make a big difference to your quality of life.
After your dry eye evaluation we will guide you through the appropriate treatment plan.
Self Care to Prevent Dry Eye
Blink more often
Avoid staring at computers and phones for an extended period. Make a conscious effort to rest your eyes in regular intervals, such as every twenty minutes. The rest is especially important when your daily activities require you to use smartphones and devices. Blinking exercises can really help, especially after you use a warm compress.
Don’t over wear your contact lenses
Always keep them clean and never forget to take them out at night. Daily disposable lenses allow for a fresh coating every day.
Reduce Cigarette Smoking
Cigarettes contain hundreds of toxic chemicals that inflame and damage your eyes. Industrial chemicals, smoke and fumes can also affect your eyes.
Apply warm compresses to your eyes
Brands like ThermaMedex are hygienic due to sterile packing and single use disposable modality. Gentle lid massage to follow, our in office procedures are designed to to clear any blocked oil glands
Diet And Supplements For Dry Eye Prevention
Water
Keeping your hydration levels up can help improve the comfort of your eyes. It’s great for your skin, bowels, kidneys and your eyes.
Omega-3 fatty acids
Ensure that your Meibomian glands are secreting enough oil to keep the tears from evaporating too fast. Fish, leafy vegetables, vegetable oil, soybeans, nuts, and seeds are good sources of omega-3s. Fish oil supplements will also help to reduce inflammation of the Meibomian glands for proper oil secretion. Not all fish oil supplements are created equal. A correct DHA/EPA percentage and encapsulation is crucial for improving tear film quality We partner with De3 by PRN to deliver a high quality omega 3 source.
Medications for Dry Eye
Artificial tears
This is probably the most common medication used to address dry eyes due to availability. Artificial tears help lubricate the eyes and treat irritation, dryness, and inflammation. While it can relieve some of the common symptoms, it will not be able to deal with the underlying cause of dry eyes. Look for preservative-free drops, especially when using multiple drops, or using them more than four times per day.
Prescription eye drops
Prescription eye drops that contain immune-suppressing medication cyclosporine (Restasis, Xiidra) or corticosteroids can help relieve inflammation in the cornea. Restasis and Xiidra normally take a period of time to take effect. Topical corticosteroids (e.g. EYsuVIS) are usually used in short term doses to rein in inflammation. Unlike artificial tears, these medications requires a prescription.
Eye ointments
Eye ointments are helpful for uncomfortable eyes when you wake up. Sometimes you can have a small gap between your eyelids overnight. This is called Lagophthalmos and can lead to exposure and dryness. Eye ointments (e.g. Systane Gel), give soothing relief to your eyes overnight.
Concourse Optometry In Office Dry Eye Treatment Options
Heat Therapy
This treatment involves ThermaMedex EverTears eye pads, eyelid margin debridement , and manual Meibomian gland expression. This treatment will heat the meibum to the correct temperature for expression. The debridement removes skin that my be growing over the gland orifices to allow of optimum oil flow. The manual expression is done with a Mastroda paddle to allow for a thorough expression.
Blepharitis Treatment
This treatment involves ZEST eye lid scrubs, heat therapy with ThermaMedex EverTears eye pads, eyelid margin debridement, and manual Meibomian gland expression. This treatment will involve a thorough cleaning of the eyelid margin with Zocular’s okra gel and it will heat the meibum to the correct temperature for expression. The debridement removes skin that my be growing over the gland orifices to allow of optimum oil flow. The manual expression is done with a Mastroda paddle to allow for a thorough expression.
Intense Pulse Light Therapy (IPL)
This treatment is designed to apply light therapy to the cascade of blood vessels (located along your cheeks/flanks of your nose) feeding inflammatory mediators to the meibomian glands along the eye lid margin. This treatment photo-disinfects bacteria and demodex, desaturates meibum for expression, decreases inflammation to the treated areas, and increases mitochondrial activity to the glands for remaining meibomian gland preservation.It also stimulates collagen deposition to the periorbital skin.Four sessions are needed for four consecutive months to effectively restore the meibomian gland function.Maintenance after the four consecutive sessions usually occurs every 6 months to a year. If there is severe blepharitis a ZEST eye lid treatment may be recommended prior to the first IPL session.
Punctal Occlusion
This treatment can bring great relief to patients with advanced aqueous deficient dry eye. The puncta are four tiny openings found in the inside corner of the eyelids toward the nose (one in each lid). These openings lead to unseen ducts responsible for draining tears in to our nose and throat. Those suffering from severe aqueous deficiency often benefit by having their punctal openings painlessly occluded (blocked) to improve tear retention. Punctual occlusion options include: a temporary “plug” (1 week up to 3 months) made of dissolvable collagen or synthetic materials, or semi-permanent “plugs” made of silicone or hydrogel. These semi-permanent plugs are explantable if the need arises to remove them.