Dry Eye Disease Overview Specialist

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What is Dry Eye Disease?

The surface of the eye needs to be properly coated by the tear film to allow for clear vision and eye comfort. Additionally, normal tears provide vitamins and minerals for the health of eye tissues as well as protection against eye injury and infection.

 

The normal tear film is made up of a water component (produced by the lacrimal glands under the eyebrow), an oil component (produced by meibomian glands at the edges of the eyelids near the eyelashes), and a mucous component (produced by conjunctival glands on the white of the eye). Patients with dry eye disease may have an abnormality in one or multiple of these components.

Source: American Academy of Ophthalmology

Any disruption in the normal production, composition, and/or distribution of tears over the surface of the eye is the general definition for the truly complex process of Dry Eye Disease.

The symptoms of Dry Eye can be quite variable in presentation and severity from one patient to the next, but include:

• Eye pain – sharp, stabbing, burning

• Itchiness

• Excess tearing

• Foreign body sensation

• Redness

• Increased sensitivity to wind, dust, light

• Eye strain, fatigue, or heaviness

• Blurry vision that fluctuates throughout the day

• Glare at night

What causes Dry Eye Disease?

Common risk factors for Dry Eye include:

• Age: all the glands stop working as well, the eyelids become loose and don’t hold the tears in as well, the surface layer of the eye becomes wrinkled and disrupts the normal flow and distribution of tears across the eye.

• Environmental: low humidity (air conditioning, winter, dry heat, air travel), wind, dust, allergens

• Decreased blink rate: most commonly during prolonged reading, watching TV, staring at computers. Normal blinking expresses and replenishes the tear-producing glands in the eyelids as well as sends a fresh layer of tears to coat the eye.

• Overgrowth of normal bacteria on the eyelids (known as blepharitis), which in turn leads to inflammation and clogging of the oil-producing glands in the eyelids (meibomian gland dysfunction)

• Eyelid mite infestation known demodex

• Skin conditions such as rosacea

• Contact lens usage

• Incomplete eyelid closure (Bells palsy, sleep apnea)

• Hormonal changes (i.e. post-menopausal)

• Prior eye surgery (cataract, LASIK)

• Toxicity from eye drops to treat other conditions such as glaucoma

• Nutritional deficiency (vitamin A, omega-3 fatty acids)

• Systemic medications: antihistamines, antidepressants, beta blockers, diuretics, anticholinergics, retinols, hormone replacement therapy

• Systemic conditions: Diabetes, Thyroid disease, Sjogren’s, Rheumatoid arthritis, etc.

The Dry Eye Cycle

It is well-understood now that Dry Eye Disease is a vicious cycle of inflammation. Inadequate tear coverage causes cells on the surface of the eye to become stressed and subsequently release inflammatory mediators. Those mediators in turn cause further damage to the glands producing tears, worsening and perpetuating the condition.

How are Dry Eyes diagnosed?

Because of the complex nature of Dry Eye, we have established a detailed protocol to properly diagnose as well as identify risk factors of this disease in our patients. We start with a patient questionnaire because certain dry eye symptoms correlate strongly with specific causes of the disease. We then perform extensive diagnostics including tear sample analysis, tear stability evaluation, slow-motion video blink monitoring, infrared eyelid gland imaging, ocular surface staining, and more.

How are Dry Eyes treated?

There is no definitive cure for Dry Eye Disease. The goal of treatment is to control symptoms and prevent permanent damage to the eye. Patients receive individualized treatment regimens depending on the cause and severity of their disease as well as their diagnostic results and examination findings. Normally, several different treatments need to be used concurrently.

Treatment options provided by the doctors at InVision include:

• Artificial tears / lubricating eye drops

• Nutritional supplements

• Warm compresses of the eyelids to optimize the oil-producing glands

• Eyelid and eyelash cleansers to reduce bacteria and mites (Demodex) presence. A new prescription drop (Xdemvy) can effectively eradicate  advanced Demodex infestations.

• Prescription anti-inflammatory eye drops such as steroids, Restasis®, Xiidra®, Cequa™, Klarity-C®

• Autologous serum tears: customized eye drops made from the patient’s own blood

• Temporary or permanent occlusion of the tear drainage ducts (punctal plugs) to keep natural tears as well as eye drops on the eye for longer

• Amniotic membrane placement (Prokera) to provide a nourishing and protective barrier to the surface of the eye as well as repair damage on the eye from severe dryness

• Nasal spray (Tyrvaya) which activates nerve pathways via the nose to stimulate increased natural tear production

Additionally, at InVision we offer several procedures in the office to help our patients:

Intense Pulsed Light Therapy (IPL)

InVision EyeCare was the first eye care practice in New Jersey to use IPL to treat dry eyes. We have the longest and most experience using IPL for dry eyes. IPL is a safe treatment that utilizes computer controlled pulsed light, which is then filtered to allow only specific light wavelengths to be released. We treat the skin of the face and around the eyes for dry eye disorders. This pulsed light works to improve dry eyes by reducing inflammatory mediators and closes abnormal blood vessels that worsen the inflammatory cycle as in the case of Rosacea. IPL is also very effective in warming and unclogging the eyelid oil glands (meibomian glands) as well as killing the demodex mites that often infest the eyelid and facial skin in patients with rosacea. Finally, IPL improves skin color and texture while stimulating collagen production, improving fine lines. Patients treated with IPL report better-feeling and better-looking eyes, as well as improved color, texture, and tone of their skin.

All major institutions including Johns Hopkins, Mayo Clinic, and Harvard offer this treatment. IPL has recently been FDA-approved for the treatment of dry eye disease signs due to meibomian gland dysfunction.

Blephex

BlephEx is an in-office procedure to provide a deep cleanse of the eyelid margins. In less than 10 minutes your doctor will use a painless, rotating sponge brush to remove debris, bacteria, toxins and biofilms, as well as demodex mites from your eyelids and lashes. This procedure can be repeated every 4-6 months as needed. BlephEx should be used to supplement daily lid scrubs at home, similarly to how you should have plaque routinely removed by your dentist in addition to brushing your teeth at home daily.

LipiFlow

LipiFlow is an FDA-approved thermal pulsation device to heat up and massage away blockages in the eyelid oil glands. The procedure takes 12 minutes to perform. Patients report improvement in dry eye symptoms a few weeks after the procedure and the effects can last up to 1 year without and up to 3 years with routine warm compresses at home.

Why do Dry Eyes need to be treated?

As mentioned above, healthy tears are critical for normal functioning and protection of the eye. Dry Eye Disease can cause debilitating symptoms for many patients leading to difficulty with normal daily activities, decreased productivity, and decreased quality of life. Dry Eye Disease has been associated with anxiety and depressive disorders. Oil gland dysfunction as a cause of Dry Eye can lead to recurrent chalazia, which are uncomfortable and unsightly for some patients. Finally, severe dryness can cause scarring or structural damage to the eye leading to permanent loss of vision.

If you think you may be one of the many patients suffering from Dry Eye Disease, make an appointment with us for further evaluation and management. We pride ourselves in providing the most advanced care for this common yet complex eye condition.