What is Dry Eye Syndrome?
When you blink, a film of tears spreads over the eye. This keeps the eye’s surface smooth and clear. The tear film is important for clear and consistent vision. The tear film is made of three layers;
An oil layer (Lipid): thin surface layer of the tear film which prevents tear evaporation. This layer is produced in the meibomian glands that line the upper and lower eyelid margins.
A water layer (Aqueous): thick middle layer of the tear film that keeps the eye protected from particles and debris. This layer is produced in the lacrimal gland in the upper eyelid.
A mucus layer (Mucin): thin inner layer of the tear film that spreads the water layer out over the eye’s surface. This layer is produced by the conjunctiva, the clear tissue covering the white of the eye and lining the inner eyelids.
An insufficiency of any of the tear layers leads to symptoms including:
- Fatigued and heavy eyes
- Sandy/gritty sensation
- Light sensitivity
- Blurry or fluctuating vision
- Contact lens discomfort or intolerance
Complications of Dry Eye:
Eye infections. Your tears protect the surface of your eyes from exposure. Without adequate tears, you may have an increased risk of eye infection.
Damage to the surface of your eyes. Severe dry eyes may lead to eye inflammation, corneal abrasion, ulcers and vision problems.
Decreased quality of life. Dry eyes can make it difficult to perform everyday activities.
What causes Dry Eye Syndrome?
Put simply, for some, the cause of dry eyes is decreased tear production. For others, it's increased tear evaporation and an imbalance in the makeup of your tears.
The majority (86%) of cases are caused by progressive and irreversible meibomian gland dysfunction (MGD). MGD is a dropout and loss of many or all of the meibomian glands in the eyelids, reducing the quality and flow of oil (meibum) to create the necessary outer tear layer. Reduction of the oil layer causes rapid evaporation of the water layer and subsequently the mucin layer, leaving the surface of the eye completely exposed.
Stages of Meibomian Gland Disease:
Risk Factors and Causes that contribute to dry eye disease:
Environment: Extended exposure to wind, smoke, dry climate, dry heat in winter, AC in car
Lifestyle and occupational requirements: computer use, environmental exposure, contact lens wear
Insufficient Diet: lacking Vitamin A and Omega 3 (EPA)
Dehydration: less than half your body weight in ounces of water a day
Blepharitis: an overabundance of bacteria or demodex mite infestation
Ocular surface inflammation
Anatomical eyelid dysfunction: incomplete blinking or lagophthalmos, out-turning of the lids (ectropion) or in-turning of the lids (entropion), use of a C-Pap machine
Medical conditions: Diabetes, Rheumatoid Arthritis, Lupus, Scleroderma, Sjogren's Syndrome, Thyroid Disorders, Vitamin A Deficiency
Medications: high blood pressure meds, antihistamines, decongestants, hormone replacement therapy, antidepressants, acne treatments, birth control, Parkinson's disease medications
Eye surgery: any laser eye surgery including LASIK, cataract surgery
Do you think you have dry eye disease?
Contact our office for more information and schedule a comprehensive dry eye evaluation. Not sure? Stop in anytime for a free dry eye screening test. We’ll be happy to answer all of your questions.
How is Dry Eye Syndrome Diagnosed and Treated?
At NVC, we take a comprehensive and customized approach to diagnosis and treatment of Dry Eye Syndrome. First, we will utilize specialized diagnostic testing and imaging to pinpoint the underlying combination of causes for each individual case. It is essential that we treat each factor simultaneously to prevent disease progression and achieve symptom relief.
- Infrared imaging of the tear film and ocular surface
- Meibography of the bottom AND top eyelids
- Corneal topography
- Blink rate and Lid function analysis
Oculus Keratograph 5M: Complete Tear Film and Lid Structure and Function Analysis
As part of your dry eye evaluation, we will take a small sample of tears from each eye and use the TearLab device to measure osmolarity (the saltiness of your tears). As osmolarity in your tears increase ocular surface cells become damaged.
InflammaDry is the only in-office test that detects elevated levels of MMP-9, an inflammatory marker that is consistently elevated in the tears of patients with dry eye disease. Using a simple 4-step process, InflammaDry recognizes elevated levels of MMP-9, to identify patients that may otherwise be missed with other dry eye testing
LipiFlow: Treating MGD With LipiFlow
LipiFlow is the only electronic device cleared by the FDA for treatment of (MGD) Meibomian gland dysfunction with clinical studies that demonstrate safety and effectiveness.* LipiFlow utilizes Vectored Thermal Pulsation technology and a patented algorithm of precise heat that is applied to the inner eyelids with directed gentle massage to remove blockages from the meibomian glands. This treatment is designed to restore the natural oil flow to the tear film that covers the eye’s surface.
Blephex: How BlephEx® Works
BlephEx® is a painless in-office procedure used to very precisely remove scurf and debris while exfoliating your eyelids.
The procedure lasts about 6 -8 minutes. Most patients simply report a tickling sensation. A numbing drop is usually placed in each eye prior to treatment for increased comfort.
After the procedure, the patient is instructed on how to maintain their clean eyelids with regular nightly lid hygiene. Since home treatments are only semi-effective, the procedure is typically repeated at 4-6 month intervals.
For more information see: Rysurg
Prokera: Heal the Ocular Surface
What does PROKERA do?
The amniotic membrane tissue in PROKERA has natural therapeutic actions that help damaged eye surfaces heal. Eyes treated with PROKERA have quicker healing, less scarring, and less inflammation. The amniotic membrane in PROKERA is thin and clear like the tissue on the surface of your eye and protects your eye's damaged tissue while inserted.
What does PROKERA treat?
PROKERA is used by eye doctors to treat eye diseases such as keratitis, corneal scars, chemical burns, corneal defects, partial limbal stem cell deficiency and many other ocular surface diseases with inflammation.
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Punctal Occlusion (tear drainage duct occlusion) is a procedure that eye doctors use to improve the symptoms of dry eye syndrome. Punctal occlusion consists of inserting punctal plugs (silicone or collagen) into the tear drainage area of the eye to keep the tears in the eyes longer.
At the end of your visit, you will be given a detailed report and customized treatment plan with explanations of your unique dry eye disease components. We will work together to establish a plan that improves not just your day to day symptoms but also the underlying deficiencies. More than anything we want to prevent further disease progression. Dry eye disease is chronic and there is no quick fix. We will follow-up at least every 3 months for progress evaluations and treatment plan adjustments as you improve.