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.
  • Fluorescein images/evaluation: visualizes damaged cells on the front surface of the eye due to dryness.
  • External photos: Documents severity of dry eye and progression throughout treatment.

Treatment Recommendations

Based on your evaluation on Keratograph, we may recommend:

  • Artificial tears 3-4x/day
  • Bruder mask 2x/day for 10-15 minutes with lid massage
  • Omega 3 fatty acids/Nordic Naturals ____mg/day with meal
  • Nighttime ophthalmic ointment
  • Daily Disposable contact lenses
  • Bleph-Ex Treatment
  • Hypochlor eyelid cleanser
  • Cliradex demodex treatment
  • Sleep mask/tape lids
  • Lotamax
  • Restasis/Xiidra 2x/day
  • Scleral Contact lenses
  • Amniotic membrane therapy – Prokera
  • Lid debridement
  • Lipiflow
  • Lumify
  • Doxycycline
  • Blink/Lid exercises

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.

Cosmetics:

  • Makeup removers- wipes from Trader Joes, Argan oil, or Norwex cloths. Do not use Neutrogena wipes.
  • Mascara- Blinc or Smashbox.
  • Eyeliner- Physicians formula.
  • Lash enhancers will cause inflammation of the lids and increase symptoms of dry eye.
  • Lash extensions increase risk of bacterial infections and inflammation.

Additional Websites/resources: