Dry Eye Syndrome

Dry eye syndrome is caused by a chronic lack of sufficient lubrication and moisture on the surface of the eye. Consequences of dry eyes range from subtle, but constant eye irritation to significant inflammation and even scarring of the front surface of the eye. Our findings show that you have:

  • Keratoconjunctivitis sicca - Describes dry eye that affects both the cornea and the conjunctiva.
  • Dysfunctional tear syndrome - Emphasizes that inadequate quality of tears can be just as important as inadequate quantity.
  • Meibomian gland dysfunction - Describes dry eye that is caused by poorly functioning oil glands which creates a poor tear film that evaporates quickly from the eye.
  • Incomplete closure/exposure - When the eyelids do not close completely when sleeping or when blinking regularly causing the cornea to be exposed to the air causing dryness and discomfort.

What Causes Dry Eye Syndrome?

An adequate and consistent layer of tears on the surface of the eye is essential to keep your eyes healthy, comfortable and seeing well. Tears bathe the eye's surface to keep it moist and wash away dust, debris and microorganisms that could damage the cornea and lead to an eye infection. A normal tear film consists of three important components:

  1. An oily (lipid) component
  2. A watery (aqueous) component
  3. A mucous-like (mucin) component

Each component of the tear film serves a critical purpose. For example, tear lipids help keep the tear film from evaporating too quickly and increase lubrication, while mucin helps anchor and spread the tears across the surface of the eye. Each tear component is produced by different glands on or near the eye:

  1. The oily component is produced by meibomian glands in the eyelids.
  2. The watery component is produced by lacrimal glands located behind the outer aspect of the upper eyelids.
  3. The mucin component is produced by goblet cells in the conjunctiva that covers the white of the eye (sclera).

A problem with any of these sources of tear film components can result in tear instability and dry eyes, and there are different categories of dry eyes, depending on which component is affected.

Risk Factors:

  • Hormonal: pregnancy, menopause, birth control
  • Medications: anti-depressants, diuretics, hormone therapy, antihistamines, acne treatments
  • Previous eye surgeries: LASIK or cataract surgery
  • Use of digital devices: cell phones, tablets, or computers
  • Smoking
  • Environmental: windy, dry environments
  • Contact lens wear

Dry Eye Symptoms

Symptoms of dry eyes and dry eye syndrome include:

  • Burning sensation
  • Itchy eyes
  • Blurred vision
  • Aching sensations
  • Heavy eyes
  • Fatigued eyes
  • Sore eyes
  • Dryness sensation
  • Red eyes
  • Light sensitivity
  • Watery eyes

Another common symptom is something called a foreign body sensation — the feeling that grit or some other object or material is "in" your eye.

And as odd as it may sound, watery eyes also can be a symptom of dry eye syndrome. This is because dryness on the eye's surface sometimes will over-stimulate production of the watery component of your tears as a protective mechanism. But this "reflex tearing" does not stay on the eye long enough to correct the underlying dry eye condition.

Medical Testing May Include:

  • Tear Meniscus measurement: an assessment of tear film quantity.
  • TBUT (Tear break-up time): an assessment of how quickly tears evaporate from the surface of the eye.
  • Redness evaluation: an objective quantification of the redness of eyes.
  • Meibography: an assessment of the Meibomian glands that secrete healthy oils for the tear film found within the eyelids and helps to track progression of Meibomian Gland Dysfunction.
  • External photos: Documents severity of dry eye and progression throughout treatment.

In-Office Treatments

Based on your evaluation on Keratograph, we may recommend:

Intense pulsed light therapy (IPL) is a treatment for dry eye syndrome that targets the meibomian glands. The Doctors at Birmingham Vision Care use the IproX instrument, which combines IPL with Radio Frequency. IPL/RF targets the root cause of dry eye syndrome by eliminating bacteria and reducing inflammation. The results leave the skin and eyes feeling tighter and more elastic, and minimizes the appearance of fine lines and wrinkles.

Lipiflow is an effective treatment in meibomian gland disease (MGD). Single-use activators are used to heat the lids to the optimal temperature. Pulsated pressure is applied throughout the procedure to express thick, clogged oil out of the meibomian glands. This empties the glands allowing the body to refill them with higher quality, more liquified oils.

Low Level Light Therapy
The LLLT mask utilizes medical grade LEDs for light modulation, a photobiomodulation technology that stimulates the production of ATP by emitting a specific wavelength of light. This results in stimulation and normalization of the meibomian glands, production of collagen and elastin, and elimination of bacteria. This technology has been used in medicine for over 10 years but only until recently did doctors discover its benefit for periocular inflammatory conditions including dry eye.

Bleph X
Bleph X is an in-office procedure that allows your doctor to take an active role in cleaning your eyelid margins. BlephEx® removes excess bacteria, biofilm and bacterial toxins, the main causes of eyelid symptoms. With regular treatments, the eyelids stay clean and symptom-free.The BlephEx® treatment only takes a few minutes to perform.

Regener-Eyes® Ophthalmic Solution are eye drops that help increase lubrication and hydration of the corneal surface. This helps to relieve dryness of the eye. It is preservative free and has an excellent safety profile. Each batch of Regener-Eyes® is tested to ensure quality, sterility, and safety. It complies with all Federal regulatory laws.

Prokera is made from amniotic membrane which has natural anti-inflammatory and anti-scarring properties. It is the only FDA cleared therapeutic device used by eye care practitioners to provide quick symptom relief and reduce inflammation associated with ocular surface disease. It helps restore your cornea and return your eye to a normal, healthy state.

Scleral Lenses
Scleral contact lenses are custom lenses that are an effective method for treating dry eye. The lenses cover your entire corneal surface, with a chamber of sterile saline held between the front of the eye and the contact lens allowing for maximum comfort. Scleral lenses protect your eyes from irritants such as smoke, wind, dust, and other debris. The lens stabilizes the tear film and the design is more comfortable to wear for long periods, decreasing the need for artificial tears.

Additional Recommendations:

  • Humidifier in bedroom
  • Do not sleep with fans in bedroom
  • Point heat / air at feet, not face, when in car
  • Increase water intake- decrease caffeine
  • 20/20/20 Rule: While using digital devices, every 20 minutes look 20 feet away for 20 seconds to avoid eye fatigue and dryness.

Additional Websites/resources: