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Dry Eye

Dry Eye (Ocular Surface Disease)

Ocular surface disease, which is often referred to as dry eye, is a very common ocular condition. It can affect anyone, but its prevalence increases with age and it is more common among women. According to analyses from large long-term studies, such as the Physicians’ Health Studies and the Women’s Health Study, in the United States approximately 1.6 million men and 3.2 million women over age 50 experience ocular surface disease (Dry Eye) symptoms.

Symptoms of Dry Eye Disease

Ocular surface disease causes a variety of symptoms, including:

  • A feeling of dryness, irritation or grittiness
  • Burning or stinging
  • Fluctuations in vision
  • Itching
  • Redness
  • A feeling of eye strain or tiredness
  • Excessive tearing (watery eyes)
  • Sensitivity to light
  • Sensitivity to wind
  • Discharge

Dry eye symptoms can range from mild to severe and can cause significant discomfort as well as an inability to wear contact lenses and difficulty performing visual tasks such as reading, watching TV, using a computer or driving. Symptoms may follow a certain pattern during the day. For example, vision may be worse in the morning or later in the day. So what causes types of dry eye?

Aqueous-deficient dry eye

In aqueous-deficient dry eye, the lacrimal glands do not produce an adequate aqueous layer, in many cases because they are affected by inflammation.

This can be caused by:

  • An autoimmune disease, such as Sjögrens Syndrome, rheumatoid arthritis or lupus
  • Some medications, such as oral contraceptives, hormone replacement therapies, antihistamines, sedatives, anti-depressants, isotretinoin for acne, anti-hypertensives, and medications to treat benign prostate hyperplasia
  • Some medical treatments, such as chemotherapy, radiation or corneal surgeries

Evaporative dry eye

In evaporative dry eye, the lipid layer of the tear film is deficient or of poor quality because the meibomian glands are not functioning properly or are blocked, which is known as meibomian gland dysfunction. Common causes of meibomian gland dysfunction are eyelid inflammation known as blepharitis as well as rosacea and other skin disorders. Because evaporative dry eye compromises the lipid layer of the tear film, tears evaporate too quickly, leaving the surface of the eye exposed to discomfort and damage.

The eyelids and the eye’s surface can also play a role in ocular surface disease. If the lids are not working properly, either because of a problem with their structure or because they are inflamed, they cannot perform their crucial functions of spreading the tears across the surface of the eye to evenly lubricate it and remove irritants. When the surface of the eye itself is not smooth and regular, it can also result in problems with tear distribution.

Diagnosis and Treatment of Dry Eye

If you are experiencing symptoms of ocular surface disease (dry eye), it is important to discuss it with an eye doctor. Dry eyes can not only make you significantly uncomfortable and cause difficulty with visual tasks but also can increase your risk of eye infections. If left untreated, severe cases can lead to corneal scarring and diminished vision.

The doctors at Vantage Eye Center utilize all of the latest diagnostic methods and treatments for ocular surface disease. Our doctors throughout the state have extensive training in this area and can recommend an individualized management and treatment plan.

Diagnostic Tests

Some of the in-office tests that can be used to diagnose ocular surface disease, determine its cause, and tailor a treatment plan include:

  • Schirmer Test: Filter-paper testing strips that are placed inside the lower eyelid measure the amount of tear production.
  • Staining Test: drops of dye, such as lissamine green, fluorescein, or rose Bengal, are instilled in the eye to reveal areas of uneven tear film distribution.
  • TearLab Osmolarity Test: This lab-on-a-chip diagnostic device uses a tear sample to evaluate tear osmolarity, which is an accurate and objective measure of tear quality. Research shows that elevated osmolarity, which alters the stability of the tear film, is increased in both aqueous-deficient and evaporative dry eyes, making it a strong indicator of ocular surface disease. This test is also helpful for monitoring the effectiveness of treatment over time.
  • LipiView Ocular Surface Interferometer: This imaging device measures the absolute thickness of the tear film lipid layer by analyzing more than one billion data points. It also helps the doctor to evaluate the blinking pattern.

Treatment

The treatment of the ocular surface disease depends on the underlying cause and includes many strategies. Mild symptoms can often be alleviated with over-the-counter artificial tears (preservative-free is usually best) or longer-acting gels or ointments. If these remedies do not sufficiently reduce the signs and symptoms of ocular surface disease, or have to be used constantly, other treatments or a combination of treatments may be necessary.

Depending on the cause and severity of ocular surface disease, treatment beyond artificial tears may include:

  • Restasis: This prescription eyedrop contains the immune-suppressing medication cyclosporine for controlling inflammation and increasing tear production.
  • Prescription Eyedrops: Steroid or antibiotic drops or ointments help to control inflammation.
  • Punctal Plugs: These tiny devices (about the size of a grain of rice), typically made of silicone or dissolvable collagen, can be placed in the tear ducts to prevent tears from draining out of the eye too quickly.
  • LipiFlow Thermal Pulsation System: Designed to treat evaporative dry eye, the in-office LipiFlow treatment uses an eyepiece to apply precisely controlled heat and gentle pressure to the eyelids to unblock clogged meibomian glands. It takes approximately 12 minutes and most patients describe the experience as a soothing eye massage.
  • Intense Pulsed Light Therapy (IPL): IPL therapy can address the underlying dysfunction of the meibomian glands with intense pulsed light (IPL) therapy. In IPL therapy, light is applied to the area around the eyelids. The light has several effects that benefit the meibomian glands. One effect is a reduction in bacteria. Another effect, a decrease in inflammation, occurs when blood vessels absorb the light. The heat generated by the light also melts and thins the low-quality secretions that clog the glands.
  • Warm Compresses: Some patients with an evaporative dry eye find that applying warm compresses to the eyelids helps to unclog meibomian glands and relieve symptoms.
  • Lid Scrubs: Pre-moistened pads and specialized solutions, many available over-the-counter, can be used to remove debris and bacteria from the eyelids and improve meibomian gland lipid secretion. (Using shampoo or soap for this purpose is not recommended.)
  • Nutrients: Some evidence suggests that increasing the amount of Omega-3 fatty acids in the diet can improve the signs and symptoms of ocular surface disease. Omega-3s are found in foods such as fish, vegetable oils, and flaxseed and are also available as supplements.
  • Oculoplastic Surgery: When the eyelids or other structures near the eye are the cause of ocular surface disease, a corrective procedure may be recommended. For example, when eyelids are turned in (entropion) or out (ectropion), surgery can be done to restore normal functioning.

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