Dry eye syndrome (DES) is a chronic condition that develops when your eyes do not produce and maintain enough tears to keep the eye’s surface lubricated resulting in multiple symptoms that range from person to person. This can be due to a reduction in tear production or increased tear evaporation from a lack of lipid in the tears that stem from oil glands in the eyelids. The effects can range from minor dryness and discomfort to pain, blurred vision and frequent infections.
Symptoms of Dry Eye Disease
Symptoms of dry eye syndrome can vary depending on the severity of the condition but can include:
- Dry, itchy eyes
- Burning or stinging
- Watery eyes
- Blurred vision
- Foreign body sensation
The main function of tears is to maintain the health of the cornea of your eye by washing away foreign matter and ensuring that the surface of your eye remains moist, smooth and clear. Tears also rinse away dust particles from your eyes and contain enzymes that protect your eyes from bacteria that can cause infections. Dry eyes is a condition that develops when the amount of tears produced is not sufficient to maintain the moisture balance in your eye. This can result in that scratchy sensation, a continuous feeling of dryness, stinging and a sensation of a foreign body in your eye. Ironically in an effort to fight off the condition, dry eyes can cause you to produce excessive tears, which is why some people experience watery eyes.
Causes of Dry Eye Disease
Dry eyes can occur naturally as a result of aging or hormonal changes, typically in women who are pregnant, taking oral contraceptives or going through menopause. In fact, women over 50 have a 50% greater risk of dry eye disease than men do of the same age. It can also result from taking certain medications that reduce tear production such as antihistamines, blood pressure medications and antidepressants. Environmental factors can also play a role in drying out the eyes and DED is common in areas where the climate is dry, dusty and windy. Home air conditioners or heating systems and excessive time spent staring at a computer or television screen can also dry out eyes and exacerbate symptoms due to the lack of blinking while staring at our screens.
Individuals that suffer from certain medical conditions such as diabetes, blepharitis, lupus, arthritis and thyroid problems are more vulnerable to developing DED. Other causes can be due to eye surgery including LASIK, certain conditions in which the eyelids don’t close properly or extended contact lens use.
Diagnosis of Dry Eye Disease
Typically, dry eye disease can be diagnosed through a comprehensive eye exam and a description of your symptoms. On some occasions the eye doctor might decide to do a test that measures how quickly your tears evaporate from the surface of your eye. By instilling a simple dye called fluorescein (much like food coloring) the doctor is able to watch and count how long it takes the tears to start to break up after they’ve asked you to hold your eyes open after a blink. This is called TBUT or a Tear Break Up Time test. A low TBUT generally indicates a lipid (aka oil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly. In another type of test, called a Schirmer test, a strip of filter paper is placed under the lid of the eye and you will be asked to close your eye for five minutes. Following the test the amount of moisture on the strip will be measured. Schirmer tests are performed less frequently than a TBUT test.
How does the Dry Eye Center treat dry eye diseases?
The Accent Vision Specialists Dry Eye Center offers a wide range of treatment options for dry eye disease. After Dr. Thibodeaux or Dr. Tachau examines your eyes and review your symptoms, they can prescribe one or more of the following solutions.
They may recommend warm masks at home, along with improved eyelid and lash hygiene. Hypochlor® spray is a gentle, refreshing, and soothing spray used for lid and lash hygiene.
Hypochlor contains hypochlorous acid, which is produced and released by neutrophil cells, part of the body’s natural defense mechanism against pathogens such as bacteria or viruses.
Meibomian gland expression
Meibomian gland expression can relieve irritation and stabilize vision and also revitalize gland tissue. This treatment can prevent the eventual loss of the glands entirely. Your Accent Vision Specialists eye doctor performs this treatment in-office while using topical anesthesia in the form of eyedrops.
The procedure is part of a comprehensive strategy for difficult-to-treat dry eyes. You may need meibomian gland expression if other treatments aren’t successful.
The benefits of meibomian gland expression often last 6-12 months if you continue good lid and lash hygiene and home treatments as recommended. The treatment takes around an hour.
Intense pulsed light (IPL) therapy
Intense pulsed light (IPL) therapy is an alternative light-based treatment that can be highly effective for moderate-to-severe dry eyes that don’t respond to other therapies. In clinical studies, the procedure increased oil secretions, tear stability and comfort in up to 90% of dry eye sufferers.
An IPL session takes about 20-30 minutes and is typically combined with meibomian gland expression for optimal results. Most dry eye sufferers need a series of four treatments, spaced over 3-5 months, with follow-ups once or twice a year.
After the IPL/meibomian gland expression combination treatment, most dry eye sufferers can reduce topical medications and eye drops significantly.
Lacrimal occlusion is a very safe, painless and effective treatment option for many dry eye patients. Plugs partially block the tear drain in the eyelids to decrease the loss of tears from the surface of the eye.
There are two main types of lacrimal plugs, temporary (dissolvable) and permanent. The dissolvable plugs are for diagnostic purposes or short term treatment pre or post-surgery. Permanent plugs do not dissolve but removal, if necessary, is easy.
The most common (but rare) side effect is excess tearing. Occasionally, they can be dislodged and lost. If the plugs are repeatedly lost, a minor surgical procedure can close the tear drain permanently.
Restasis® / Xiidra® / steroids
Restasis is a prescription eye drop used twice per day to stimulate tear production. This drop is instilled twice daily on a long-term basis. Occasionally, a short burst of steroid eye drops before starting Restasis gives more immediate relief.
Xiidra is a similar, newer drug used to treat dry eye disease by reducing inflammation which increases tear production. This drop is also used twice per day and works in as little as four weeks to relieve the signs and symptoms of dry eye.
Lubricating drops are solutions specially formulated to moisten the eyes. Artificial tears should be used to supplement other dry eye treatments and do not provide long-term relief.
A recommendation for preservative-free drops occurs when lubrication is used four or more times per day to avoid any toxic effects from the preservative. For MGD, oil-based drops are used to provide the lipid layer of the tear film that prevents rapid evaporation.
In some cases of dry eyes due to MGD or blepharitis, a short course of very low dose oral antibiotics works to help thin the oils of the meibomian glands and reduce inflammation along the eyelid margin.
Omega-3 fatty acids
Omega-3 fatty acids, found in oily fish such as salmon, krill, flaxseed, and dark leafy vegetables, has been clinically found to benefit patients with evaporative dry eye. Many patients who regularly take Omega-3 supplements have noted a significant decrease in their symptoms.
Your Accent Vision Specialists Dry Eye Center eye doctor tailors a dry eye disease treatment for your needs to help you recover fast.
TearCare® is an innovative Dry Eye procedure that targets the blocked meibomian glands in your eyelids that produce oils to keep your tears healthy. When these glands become blocked or have reduced function, your tears may evaporate more quickly. Unblocking these glands with the TearCare® System can help restore their function and stabilize the tear film, improving the quality of tears and reducing symptoms like dryness, gritty or scratchy sensations, blurry vision, and watery eyes.
Take this quiz to find out if you could benefit from TearCare.
When is dry eyes an emergency?
The Dry Eye Center at Accent Vision Specialists is always ready to help in an emergency. If your dry eye disease is causing serious pain, discomfort, eye discharge, eye inflammation, or other problems, call the office.
The Accent Vision Specialists team is on-call for emergencies, even after normal business hours and on weekends. If you suffer from an eye injury, have an eye infection, or need urgent care for vision problems or eye diseases like dry eye, don’t hesitate to reach out now.
For help with dry eyes from a leading practitioner, call Accent Vision Specialists today.