Dry Eye Center
Dry eyes are one of the most common ocular complaints with up to 50% of people experiencing at least one symptom attributed to dry eye disease. Unfortunately, it tends to be a chronic condition with frequent exacerbations and flares. There are many different causes of dry eye, including incomplete lid closure, medications, environmental factors, underlying medical conditions, contact lens use, and inflammatory eye conditions. We will perform a complete history and evaluation of your eyes in order to determine the best treatment options for you.
Take this questionnaire to assess the severity of your condition. Higher scores indicate the need for higher level treatments.
What patients feel
Dry eye symptoms can vary from person to person. Most common symptoms include:
- blurry vision
- fluctuating vision
- sandy or gritty feeling
- eye pain or eye fatigue
The pattern of symptoms gives us clues to the underlying cause of dry eye and dictates the strategy we use to improve the discomfort. Most common patterns are worsening first thing in the morning, by the end of the day, in windy environments, or when performing concentration tasks such as driving, reading, watching tv, or on the computer.
Types of Dry Eye
Patients can have predominantly aqueous deficient, evaporative dry eye, or a combination of both. Determining the underlying cause for dry eye symptoms is essential for guiding appropriate treatment.
Some patients have a very low level of basal tear production and are under lubricated throughout the day. In these patients, saline based artificial tears alone can help or can be supplemented with anti-inflammatory medications or punctal plugs. Patients with Sjogrens syndrome are often in this category as they have a very low level of tear production. We can determine the level of aqueous deficiency on the slit lamp examination.
Some patients suffer from excessive evaporation of tears, because of incomplete lid closure, excessive ocular surface inflammation, or because the tear film lacks essential components, such as in meibomian gland dysfunction. These patients are especially sensitive first thing in the morning (if lids are not closed overnight) or during tasks where they blink less often, such as when on the computer, reading, driving, or watching tv.
As you can see, there are a lot of treatment options for dry eye syndrome. Patients with mild dry eye may only need one treatment modality to keep the symptoms at bay, while in more severe cases we may use multiple strategies. We are happy to talk you about what we think would be the right treatment options for your particular situation.
Usually artificial tears are the first line therapy. There are many varieties of artificial tears, each tailored for a specific purpose. Amongst the variables are saline vs oil based tears, thin drops vs gels and ointments, and preserved drops vs preservative free. While any drop may be okay if someone is mildly symptomatic, severe cases require tailored artificial tear usage
Studies have shown inflammation in the tear film can create a vicious feedback loop that needs to be broken for patients to feel relief. Anti-inflammatories including topical steroids, Restasis, Xiidra, and Cequa important to break this cycle, particularly in patients who have dry eyes secondary to an auto-immune condition like rheumatoid arthritis, Sjogrens, or Lupus.
In patients who suffer from decreased tear production, punctal plugs are useful for keeping your natural tears or artificial tears in your eyes before they are drained away into the nose and throat. Permanent silicone plugs are placed on the surface of the tear drain while temporary collagen plugs go inside the tear drain and last approximately 3 months.
Omega 3 supplementation with DHA and EPA, such as found in Fish Oil, Krill Oil, Cod Liver Oil or Flaxseed Oil, improves the consistency of oil secretion from the meibomian glands which helps prevent the quick evaporation of tears from the ocular surface. This can also be found naturally when ingesting salmon, tuna, or mackerel.
Meibomian Gland Therapies
More and more research has shown that Meibomian Gland Dysfunction is a primary cause of dry eyes, especially if you get styes, crusty discharge in the morning, or itching. There are a variety of treatments recommended including warm compresses, lid massage, lid scrubs, antibiotic ointments, oral antibiotics, topical steroids, or lid expression treatments.
Higher Level Treatments
When traditional therapies are unsuccessful, there are higher level therapies which can help. These include amniotic membrane transplant, serum tears, large diameter scleral contact lenses, and specially compounded anti-inflammatories. Patients with neuropathic dry eyes may also require systemic treatment with Lyrica or Neurontin.
Make an appointment with one of our specialists for a complete dry eye assessment and a tailored treatment plan.