Dry Eye Disease (DED) or Dry Eye Syndrome (DES) is a chronic condition that develops when your eyes do not produce and maintain enough tears.
Dry eye syndrome (DES) is a chronic condition that develops when your eyes do not produce and maintain enough tears to keep the eye’s surface lubricated resulting in multiple symptoms that range from person to person. This can be due to a reduction in tear production or increased tear evaporation from a lack of lipid in the tears that stem from oil glands in the eyelids. The effects can range from minor dryness and discomfort to pain, blurred vision and frequent infections.
Symptoms of Dry Eye Disease
Symptoms of dry eye syndrome can vary depending on the severity of the condition but can include:
- Dry, itchy eyes
- Burning or stinging
- Watery eyes
- Blurred vision
- Foreign body sensation
The main function of tears is to maintain the health of the cornea of your eye by washing away foreign matter and ensuring that the surface of your eye remains moist, smooth and clear. Tears also rinse away dust particles from your eyes and contain enzymes that protect your eyes from bacteria that can cause infections. Dry eyes is a condition that develops when the amount of tears produced is not sufficient to maintain the moisture balance in your eye. This can result in that scratchy sensation, a continuous feeling of dryness, stinging and a sensation of a foreign body in your eye. Ironically in an effort to fight off the condition, dry eyes can cause you to produce excessive tears, which is why some people experience watery eyes.
Causes of Dry Eye Disease
Dry Eye Disease or Dry Eye Syndrome, is a complex normally chronic condition that can have multiple causes but tends to share common symptoms. The experts at Gailmard Eye Center use some of the latest and most advanced clinical technology to assess the cause of your dry eye symptoms, in order to provide the best possible care.
Dry eyes can occur naturally as a result of aging or hormonal changes, typically in women who are pregnant, taking oral contraceptives or going through menopause. In fact, women over 50 have a 50% greater risk of dry eye disease than men do of the same age. It can also result from taking certain medications that reduce tear production such as antihistamines, blood pressure medications and antidepressants. Environmental factors can also play a role in drying out the eyes and DED is common in areas where the climate is dry, dusty and windy. Home air conditioners or heating systems and excessive time spent staring at a computer or television screen can also dry out eyes and exacerbate symptoms due to the lack of blinking while staring at our screens.
Individuals that suffer from certain medical conditions such as diabetes, blepharitis, lupus, arthritis and thyroid problems are more vulnerable to developing DED. Other causes can be due to eye surgery including LASIK, certain conditions in which the eyelids don’t close properly or extended contact lens use.
Some Causes of Dry Eye
- Poor tear quality
- Meibomian gland disorder
- Poor tear volume
- Age, gender, and dry eye
- Environmental factors and irritants
- Contact lenses and dry eye
- Medical conditions
Symptoms of Dry Eye Syndrome
- Itchy eyes
- Burning or stinging
- Scratchy or gritty feeling
- Redness and Irritation
- Watery eyes
- Blurred vision
- Sensitivity to light
- Difficulty wearing contacts
If you experience one or some of the symptoms listed above, we recommend scheduling an appointment and beginning the dry eye exam process, which is quick, easy and painless.
Diagnosis of Dry Eye Disease
Typically, dry eye disease can be diagnosed through a comprehensive eye exam and a description of your symptoms. On some occasions the eye doctor might decide to do a test that measures how quickly your tears evaporate from the surface of your eye. By instilling a simple dye called fluorescein (much like food coloring) the doctor is able to watch and count how long it takes the tears to start to break up after they’ve asked you to hold your eyes open after a blink. This is called TBUT or a Tear Break Up Time test. A low TBUT generally indicates a lipid (aka oil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly. In another type of test, called a Schirmer test, a strip of filter paper is placed under the lid of the eye and you will be asked to close your eye for five minutes. Following the test the amount of moisture on the strip will be measured. Schirmer tests are performed less frequently than a TBUT test.
Dry eye exam
The experts at Gailmard Eye Center will diagnose and assess your eyes using the latest technology combined with visual exams, questions, and excellent patient care that will determine the cause of your condition. An example of assessment patients can expect:
- How effective are your blinks and how often do you blink
- Determine if there is inflammation on your eye and/or lids
- Review the osmolarity of your tears
- Are your tears breaking down at a fast rate
- Figure out what is the volume of your tear
- Determine what shape your meibomian glands in/are they blocked, dirty or infected
Reviewing the health of your Tears
One of first things we want to check is the stability of the tear-film. This will give us a baseline reading that we can track throughout your treatment process. We use TearLab to test the osmolarity of your tears― that is, the relative concentrations of salts, water, and lipids (fatty oils). These lipids are produced by the meibomian glands. Most cases of dry eyes occur where there is a problem with these glands. They could be blocked, atrophied, or otherwise damaged. If your tears evaporate too quickly (which causes burning), it’s usually caused by a lack of these lipids. A strong imbalance between the osmolarity of one eye vs. the other is a strong indication that someone has dry eye disease.
Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire. This tool allows you to rate your dry eye symptoms based on frequency and severity. This helps the experts access and understand what you are experiencing with your dry eyes and allows us to determine the best treatment plan for you.
Another tool our dry eye experts use is InflammaDry, a specialized diagnostic tool which measures whether a patient has elevated levels of MMP-9 in their tears from the inner lining of the lower eyelid. MMP-9 is a protein which indicates inflammation, which is common for anyone suffering from dry eyes. Increased inflammation of your eye is what most patients will feel and one of the most important aspects to control when treating Dry Eye.
Fluorescein Dye Test
The experts at Gailmard Eye Center will also test your tear breakup time. Sometimes, tears don’t last long enough to work effectively. In order to test this, we use a fluorescein orange dye to test the breakup time (as well as any other corneal diseases, conditions, or foreign bodies). Using a small blotting paper, your doctor will lightly touch your eye. As you blink, the dye spreads and gently coats the tear film covering the cornea. Using a blue light (the dye is orange), problems will be revealed to the eye doctor as green.
Lissamine Green Dye Test
This test is performed similar to the fluorescein dye test. One of the most common causes of dry eye patients is poor quality of the tear layers and how they are affecting the front surface of the eye. Using a small blotting paper, your doctor will lightly touch your eye. As you blink, the dye spreads and gently coats the tear film covering the cornea. Using a similar light, the surface cells that are unprotected (from the tears) or damaged by your tear layers will be visible in a green color.
How Dry Eye is Treated
Individualized treatment plan
Depending on the underlying cause or causes of your dry eye as well as the severity, your doctor will develop an individualized treatment plan to your specific needs to target your symptoms. The Dry Eye Clinic at Gailmard Eye Center has many options to choose from and here are some of the followings:
Patients that have tear-film insufficiency, artificial tears are a basic solution that will introduce more tears into your eyes in the form of non-medicated (or lightly medicated) drops. Artificial tears only will not solve severe dry eye but can help to maintain overall hydration of the eyes.
Patients with mild to moderate dry eyes resulting from Meibomian Gland Disorder or Blepharitis, a hot compress or eye mask, often referred to as a bruder mask is helpful in alleviating symptoms. The warmth of the mask stimulates the oil glands to open up, allowing for natural lubrication of your eye.
The use of an amniotic membrane treatment that has been developed in the past few years for treating severe and chronic cases of dry eye. The results of using an amniotic membrane to treat dry eye are dramatic. Your doctor uses a wet amniotic membrane to deliver significant, dramatic, and real healing and relief for inflamed and scarred eyes due to dry eyes. The use of amniotic membranes has revolutionized the treatment of dry eyes.
The “Wet” amniotic membrane is a thin membrane held together by a small plastic ring. Applied directly to the eye, the ring holds it in place right where the eyelid meets the sclera (the white part) of the eye. The healing from this method is very fast. Usually, the membrane needs to be worn for no more than a week before dramatic improvement occurs.
Prescription Eye drops
In cases of chronic dry eye, we often see patients who have a decreased ability to produce tears. This occurs because of the constant inflammation they experience. Your doctor may use a steroid to reduce the inflammation that is present in the eye first before prescribing another prescription drop such as Restasis and Xiidra. Unlike artificial tears, Restasis and Xiidra are medicated prescription eye drops which are both proven to increase the eye’s ability to make its own tears. Over time these two medications will stimulate your eyes’ to produce more tears.
BlephEx for Blepharitis
BlephEx is a painless in-practice procedure performed by our Skilled experts to treat blepharitis, the infection, and inflammation of the eyelids which is a common cause of severe dry eyes. Gailmard Eye Center makes use of the revolutionary new patented BlephEx handpiece, which is used to spin a medical grade micro-sponge very precisely along the edge of your eyelids and lashes, removing scurf and debris and to exfoliate your eyelids.
This treatment is done in the office and takes about 6 -8 minutes and is well tolerated by patients. Prior to your treatment a numbing drop is instilled to help with comfort. Most patients simply report a tickling sensation. Each eyelid is cleaned using a disposable patented micro-sponge, so bacteria is not spread between lids. After the treatment, the eye is well rinsed using saline drops.
The patient is given detailed instructions that day, on how to maintain their newly cleaned eyelids with regular nightly lid hygiene. At home treatments can be semi-effective to maintain good lid health but it is recommended to repeat BlephEx at 4-6 month intervals.
Preventing Dry Eyes
If the cause of your dry eyes is something external or environmental, eliminating that cause may solve the problem and resolve the symptoms. Avoid dry environments, hair dryers, heaters and fans, (particularly directed toward the eyes) and smoky environments and wear eye protection such as wrap around glasses or goggles when in dusty or windy areas. Use a humidifier to add moisture to dry indoor air. If working on computer or watching television, make sure to blink purposefully as our natural tendency is to reduce our blink rate when staring at a screen. Also avoid rubbing your eyes as this can further irritate them. Staying hydrated by drinking at least 8 to 10 glasses of water per day can also help.
Dry eye disease won’t have a permanent effect on your vision, but there is no reason to endure dry, itchy and uncomfortable eyes, especially since there are so many treatment options to increase moisture and comfort. It’s also important to realize that this is a chronic disease that needs consistent treatment. Your doctor will work with you to create a long term strategy to keep your eyes as comfortable as possible.