What is dry eye disease?

Dry eye disease or DED is a multifactorial ocular surface disease characterized by symptoms of discomfort such as redness, burning, irritation, gritty sensation, excessive tearing and blurry vision among others. It is a condition in which a person doesn’t have enough quality tears to lubricate and nourish the eye; this is a common and often chronic problem particularly in older adults. Tears provide lubrication, reduce the risk of eye infection, wash away debris and keep the surface of the eyes smooth and clear. People with dry eyes either do not produce enough tears, or their tears are of poor quality.

  • The inadequate volume of tears: tears are produced by several glands in and around the eyelids. Tear production tends to diminish with age, with some medical conditions or as a side effect of certain medications. Environmental conditions also play a role, such as wind or dry climates (both of which we experience in El Paso) can lead to increased tear evaporation. When the normal amount of tears diminishes, symptoms of dry eye can develop. This presentation comprises about 25% of dry eye cases.
  • Poor quality of tears: the tear film is composed of three layers: mucous, water, and oil. Each component plays a role in the nourishment and protection of the surface of the eyes. A smooth oil layer helps prevent evaporation of the water layer, and also help with lubrication. The oil layer is produced by the Meibomian glands, which are located inside of the eyelids. When this oil layer is inadequate due to dysfunctional glands, tears will evaporate as soon as they are produced leading to symptoms of dry eye. Meibomian gland dysfunction is the cause of dry eyes in approximately 60-75% of dry eye cases, also called evaporative dry eye.

What can cause dry eyes?

Dry eyes can develop for many reasons, including:

  • Age: dry eyes are part of the natural aging process. The majority of people over the age of 65 experience some symptoms of dry eye
  • Gender: women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives, and menopause.
  • Medications: There are many medications that can cause dry eye. Some examples are antihistamines, nasal decongestants, anti-depressants, diuretics, certain blood pressure medications, tranquilizers, birth control pills, and chemotherapy.
  • Medical conditions: people with rheumatoid arthritis, Sjögren’s syndrome, lupus, scleroderma, diabetes, and thyroid problems are more likely to experience symptoms of dry eye. Eyelid inflammation (blepharitis), inflammation of the surface of the eye or inward/outward turning of the eyelids can also cause a dry eye to develop.
  • Environmental: dry eye occurs secondary to certain environmental conditions such as dry climates, lifestyles that include time outdoors with sun and wind exposure, drafts from heating or air conditioning, ceiling fans, smoking, prolonged contact lens use, and prolonged computer work.

How are dry eyes diagnosed?

The first step is to talk to your eye care provider to discuss your symptoms and how they affect your quality of life. Here at Sun Eye Care, we offer the latest technology to diagnose and treat dry eye.

  • Case history: this is one of the most important components of your eye examination, as it can guide your doctor to a better assessment of your symptoms.
  • Tear osmolarity testing: this test measures sodium levels in your tear film, which when elevated it indicates a decrease in the amount of the aqueous or liquid layer of the eye. This test is useful to follow or monitor the condition of dry eye syndrome and the treatment process.
  • Lacrydiagnostic: this is a very informative test, which can provide detailed information about the overall health of your tear film. This test is especially useful for patients with evaporative dry eye as it can monitor the health of Meibomian glands and it can quantify gland loss if present.

How is dry eye treated?

Careful examination by your eye care provider is needed in order to determine what type of dry eye is affecting you as well as the severity. After the proper diagnostic tests are interpreted, a customized treatment plan can be implemented for your particular dry eye disease. At Sun Eye Care, we have several treatment options to manage most types of dry eye.

Mild dry eye

Artificial tears: this is most often the initial therapy recommended in mild cases of dry eye. There are many brands of tears on the market, as well as different formulations such as water-like, gel-like, and ointment. The specific type of tear drop that is best for your type of dry eye will be determined and recommended by your eye care provider after your dry eye examination. At Sun Eye Care we keep a variety of formulations in stock so that you can leave our office with everything you need to start feeling relief.

 

Moist heat-releasing dry eye masks: if your eye care provider determines the glands in charge of producing the oil layer of your tear film are mildly impacted, warm compresses at home may be part of your treatment plan. In this case, a dry eye mask is an ideal and convenient way to perform this therapy at home. These masks may be placed in the microwave for the time suggested in the packaging (it varies per brand) and deliver controlled moist heat to your eyelids for the best therapeutic results. We also have stye kits available.

Eyelid hygiene: clean eyelashes are also an important part of managing dry eyes. Poor hygiene can lead to chronic inflammation of the eyelashes (blepharitis) and it can pose a higher risk of infections. We also offer several options for easy and convenient eyelid hygiene: hypochlorous spray (which helps reduce the number of bacteria), tea tree oil foaming cleansers and pre-moistened lid wipes (gentle and tea tree oil formulations).

Moderate dry eye (or non-improvement with previous initial treatment):

Thermal Therapy: For patients that are diagnosed with Meibomian gland dysfunction with inspissation of the glands, we offer an in-office treatment that uses controlled heat delivery, this therapy helps clear impacted meibum (oil) to provide relief for up to 4 weeks. The number of treatments will depend on the severity of your condition. This is a non-invasive option, that will feel like a day spa for your irritated tired eyes.

Blephex Micro-blepharoexpholiation (MEB):

Some patients may suffer from chronic eyelid inflammation (blepharitis). It is caused by an overgrowth of normal bacteria present along the lid and at the base of the eyelashes. Anyone can get blepharitis at any age, but the prevalence increases with age; this is in part due to the fact that as we get older we make fewer natural antibodies in our tears if this is combined with poor eye hygiene it makes for a breeding ground for pathogens. This overgrowth of bacteria causes crusting along the eyelid and creates a sticky biofilm that harbors bacterial exotoxins. Since the eyelid margins are difficult to clean, this overgrowth of bacteria, scurf, and biofilm can build up over many years. Developed by a board-certified Ophthalmologist, Blephex is an in-office procedure performed directly by our eye care providers. With Blephex your doctor can deliver a fast and convenient treatment that thoroughly and precisely eliminates the scurf, bacterial debris, and biofilm that causes inflammatory lid disease. Treatments are repeated at regular monthly intervals depending on the severity of the disease.

Moderate to severe (or non-improvement with previous treatment)

Intense Pulsed Light (IPL):

For patients who experience chronic inflammation in combination with ocular rosacea, we offer an innovative treatment option that targets the root cause of inflammation. Brief, powerful bursts of light at specific wavelengths cause changes in the skin surface. These changes minimize redness and improve the look of skin. Furthermore, when the light is absorbed by the blood vessels, it generates heat in the dermal layer that melts the secretions and opens the glands. In addition, IPL decreases the bacterial load on the skin, which is one of the reasons it helps with acne. There’s also some evidence that IPL decreases parasites on the eyelash margin that can cause meibomian gland problems. Skin and eyelid inflammation can be relieved with as few as 1-2 treatments. Typically 3-4 sessions with 3-6 weeks in between are needed to achieve optimal results.

 

 

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