Dry eye occurs when your eyes are inadequately lubricated, either because they don't produce enough tears or the tears they do produce have the wrong mix of ingredients. This leads to rapid tear evaporation from the surface of your eye.
There is a film of tears that coats the surface of the eyes, lubricating and protecting the cornea from infection, eliminating debris, providing comfort, and also creating a smooth coating that allows light to be properly focused into your eye, allowing you to see clearly.
Dry eye complications are a fairly common problem among Americans, even for those with otherwise healthy eyes. According to the National Eye Institute, dry eye is one of the two most common reasons people visit the eye doctor. Dry eye can occur at any age and affects women more often than men.
Dry Eye has become a growing problem in the past 20 years due to the increased use of computers and contact lenses, increased air travel, poor air quality, and an increase in environmental allergies.
Chronic dry eye can lead to very serious long-term consequences if it is not diagnosed and properly treated. If left untreated, chronic dry eye can not only cause discomfort affecting your quality of life but can also lead to scarring and increased infections that may result in vision loss. This can damage the cornea and other parts of the eye, preventing them from functioning correctly.
The most common causes and risk factors of dry eye include:
There are some common dry eye symptoms but not everybody suffers from the same ones. These can include:
There are several tests that can be performed by your eye doctor to diagnose dry eye and to assess its effect on your eye health. They are:
In this test, your eye doctor numbs your eye and then dips the tip of a special filter paper strip inside your lower lids. He or she reads the paper strip after a few minutes. The amount of moisture on the strip indicates the quantity of your tear production and lets your doctor determine if you have dry eye.
This is the most accurate way to diagnose dry eye syndrome. A colored droplet is placed into each eye to stain abnormal or dead surface cells on the cornea and the conjunctiva (the protective membrane lining your eyelids and part of the whites of your eye). Your doctor then examines the cells through a microscope looking for signs of damage. Your doctor will also look for signs of allergies which can be another culprit in dry eye.
As part of your eye exam, your doctor will inspect your eyelids to look for signs of blocked oil glands (called Meibomian glands). These glands create the oily component of your tears. If they're blocked, then the tear composition doesn't have enough oil and is more likely to evaporate quicker, causing dry eyes. Your doctor will also examine your eyelids for signs of inflammation, your tear ducts to look for blockage, and your corneas to look for signs of wear due to long-term dryness.
Dry eye treatments fall into three different categories that can be prescribed based on the severity of your symptoms and your response to treatment. These are lifestyle modifications, medications (which include lubricants, anti-inflammatories, and homeopathic options), and procedures.
Lifestyle modifications are the first line of treatment and can include:
If your doctor finds that you have clogged Meibomian glands, you might be prescribed an eye care regimen that involves applying warm compresses to your eyes, and then carefully washing your eyelids with baby shampoo, followed by gently massaging to stimulate oil flow.
The types of medications we recommend fall into 3 broad categories:
Preservative Free Artificial Tears
These drops can vary in consistency and can usually be used by contact lens wearers.
These products are thicker than eye drops so they remain on the surface of your eye longer. The only drawback is that they can blur your vision for one to two minutes after applying. Gels are also great to use at bedtime and in airplanes which tend to have extremely dry air.
Prescribed for more severe dry eyes and for people whose eyelids don’t close at night.
The underlying problem with dry eye is a persistent inflammation of the cornea and the inner lining of your eyelids. This causes long term damage to the surface of your eyes and to your tear-producing lacrimal glands. This results in reduced tear production over time if not properly treated. Anti-inflammatory treatments include:
Can be used in the form of eye drops that are available in varying strengths. Steroids also come in ointment form which is usually used at bedtime. Throughout any treatment with steroids, your eye doctor will monitor you closely to watch for side effects or complications.
Restasis treats dry eye by suppressing inflammation and increasing tear production.
This eye drop improves both the signs and symptoms of dry eye. Contact lens wearers must wait 15 minutes before inserting their lenses after applying their Xiidra drops.
Has been shown to improve tear stability and the health of the ocular surface. It also treats allergies which can affect your eyes.
Is an antibiotic that, when used over time in low doses, can greatly improve the function of the Meibomian oil glands. It is contraindicated with pregnancy and breastfeeding. It can also predispose people to sunburns and yeast infections (in women).
This advanced organic eye drop was developed in Europe and contains familiar natural ingredients like Aloe Vera, Chamomile and Propolis, which have been used for centuries to treat inflammation and infection.
Oculocin has been used to treat dry eye, blepharitis, certain skin disorders, and burns because all of these conditions have components of inflammation and bacterial infection.
We’re pleased to have been asked to serve as Los Angeles County’s exclusive provider of Oculocin. Here's how some of its key ingredients work:
If lifestyle changes and medications are unable to relieve your dry eye symptoms, your doctor may recommend minimally invasive procedures to help manage the condition.
At AGEI, we are proud to offer the latest, most promising treatment for dry eye caused by blocked oil glands (called Meibomian glands).
Meibomian glands secrete oil that is one of the components of your tears. When these glands get plugged up with hardened oil, this creates an imbalance in the composition of your tears. When tears don't have enough oil content, they evaporate 20 times faster, thus causing dry eye.
The term DELIT (Dry Eye Light Intense Therapy) was coined at our Eye Institute and was developed by modifying an FDA approved platform called Intense Pulsed Light (IPL) therapy, originally developed for cosmetic use. By super-heating the area around your eyes, IPL kills germs, suppresses inflammation, and shrinks blood vessels that could be pressing on and blocking oil ducts.
After the light therapy is administered, we massage your eyelids to help break up the oil blockage and encourage oil flow. Four treatments are administered one month apart. Over this time, your oil becomes less thick and flows more easily, correcting the imbalance in your tear composition.
Because DELIT is an IPL treatment using the same light wavelength used for photo facials, you get the added benefit of improved skin texture and complexion in the facial areas treated.
BLEPHEX is a new in-office procedure for treating eyelid inflammation (known as blepharitis). Blepharitis is responsible for many dry eye symptoms such as itching, perceiving a film over your visual field, eye redness, and fluctuating blurred vision.
BlephEx eliminates the biofilm and bacterial toxins that cause eyelid inflammation and dry eye, thus improving the overall health of your eyelid.
TearCare is a wearable eyelid technology device that administers gentle heat directly to the meibomian glands to liquefy the meibum, express clogged oil glands and stimulate tear production. The TearCare device allows for your eyes to be open and blinking during the procedure which typically takes less than 3 minutes.
Sometimes, even despite lifestyle modifications, people may notice that their eyes become drier over time, and techniques that used to provide relief are no longer effective. That's why it's important to have regular follow-up appointments with your eye doctor to monitor any changes in your symptoms and explore new treatment options that can address your situation.
You should know that there may be no single treatment that completely addresses your condition. Your doctor can work with you to find the underlying causes of your dry eye to provide the correct combination of therapies that best suits your specific dry eye symptoms.
Dr. May is an optometrist who has worked with Dr. Assil and the Assil Gaur Eye Institute for over a dozen years . He provides a broad range of care for patients including pre and post-surgical management, comprehensive eye exams, urgent care as well as dry eye consultation and therapy. He's also assisted in numerous FDA supervised clinical trials run at AGEI.