Here at Sonoran Desert Eye Center, we are proud to offer dry eye diagnosis and treatment for our patients.
The Tear Film
Tears, which provide nutrients and lubrication, are secreted by various glands around your eyes. When your tears are not functioning properly and beginning to cause visual changes or discomfort, this is commonly called Dry Eye Syndrome.
Causes of Dry Eyes
Contributing factors to dry eyes include: dry environment, gender, fans, age, lack of sleep, extended computer use, clogged eyelid glands, medications, inflammation, contact lens use, hormonal issues, dehydration, and inadequate nutrition.
Symptoms of dry eye can include a sandy/gritty feeling, mucous discharge, fluctuating vision, burning, mild itching, and paradoxical watery eye.
Many people ask how the eyes can be dry when they water so much. When we say “dry eyes” we are not talking about a deficiency in reflex tears. There are baseline tears and reflex tears. Baseline tears have all of the nutrition necessary for the surface cells to be healthy. Reflex tears are filled with harsh enzyme for the purpose of getting rid of bad things that get in the eyes. When you don’t have enough good tears, your eyes get irritated and the eyes over water reflex tears. Reflex tears will stop being produced when there’s a higher volume and quality of normal baseline tears, thus the eyes will stop watering.
Diagnosing Dry Eyes
There are several tests for dry eye including measuring the time it takes your tears to break up after a blink, measuring the tear meniscus, measuring tear production over time, using dyes to visualize the tear film and damaged cells on the surface of your eye, evaluation and imaging of eyelid gland function, and lab tests for inflammation.
There are about 20 to 30 vertical glands in the upper and lower eyelids that keep your good tears on your eyes longer. Often these glands don’t function because they become clogged and shrink over time. Instead of a clear oil discharge, they often express a thickened discharge. Unhealthy glands can cause significant inflammation in the eye, leading to redness and discomfort.
When the meibomian glands don’t function well, your tears evaporate faster. We call this a “decreased tear break up time (TBUT)”. The video below shows tears that have been stained with a dye and how they look when they break up on the eye.
TREATMENT FOR DRY EYES
The Bruder Mask improves function of the meibomian glands in the eyelids. When those glands are healthy, the tear layer is thick and stays on the eyes longer.
The Bruder mask is warmed in the microwave oven for about 20 seconds, then placed on the eyes for 5-10 minutes, once or twice per day, followed by lid massage for about 20-40 seconds. After a few weeks the meibomian glands will begin functioning better. Many patients have found significant improvement in their dry eye symptoms just by using the Bruder mask.
In-office meibomian gland expression
We can perform in-office expression of the meibomian glands to assess the severity of inspissation and to jump-start healing of those glands.
Systane Complete is a new eyedrop that is fast becoming very popular with patients. Systane Complete combines the best components of their Ultra and Balance drops into one drop that works well for most dry eye patients. It works best when you close your eyes for a minute after instillation.
Some patients have said that using a liquigel drop before bed helps their eyes feel better the next day. Systane and Refresh make good liquigel drops.
Sometimes a person has to use drops so often that they become sensitive to the preservative in drops. When we think sensitivity to preservative becomes an issue, we can recommend non-preserved artificial tears as an option.
One way to increase the volume of good tears on your eyes is to insert a small plug into the opening of the drainage canals, so your tears recycle rather than drain. This is a simple, painless procedure done in the exam room that takes only a minute or two. We initially try temporary plugs that last about 3-5 days. If that improves your symptoms, then we insert permanent plugs. These can be removed later if necessary. Most health insurances cover this procedure.
At present there are two prescribed long-term anti-inflammatory eye drops for dry eye. These are Restasis and Xiidra.
Restasis increases the tear volume and quality. It begins to work a month after initiating therapy and shows increased improvement over a year period of time.
Xiidra improves the symptoms and signs of dry eye. It begins to show benefit within a couple weeks of initiating treatment and shows increased improvement over time as well.
Steroid eye drops can be used short-term in some cases to decrease inflammatory causes of dry eye.
Low-dose doxycycline, taken orally for several months, has been shown to significantly improve the health of the meibomian glands in even moderate to severe disease.
Scleral shell contact lenses are large rigid lenses that breath oxygen that maintain a tear layer on the cornea at all times. Scleral lenses provide relief from light sensitivity, eye irritation, and blurriness that come from severe dry eye. When they are fit properly, scleral lenses are very comfortable and provide excellent vision. Scleral lenses have been life-changing for hundreds of our patients.
Sleep deprivation, dehydration, dry environment, and long-term computer use have all been shown to increase the symptoms and signs of dry eye. So make sure you get adequate sleep, drink enough water, consider using a humidifier, and take enough breaks while working on the computer. The 20/20 rule says that you should take a 20 second break from the computer every 20 minutes.