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, fans, age, 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.
Diagnosing Dry Eyes
There are several tests for dry eye including measuring the time it takes your tears to break up after a blink, using dyes to visualize damaged cells on the surface of your eye, evaluation and imaging of eyelid gland function, and lab tests for inflammation.
How can the eyes water when they’re dry?
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 eye thinks there’s a foreign body in the eye, so they over water.
It’s like a teeter totter. When the good tears are down, the bad tears are high, and visa-versa. When we improve the good tears, your excess bad tearing will stop.
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
Treatment varies for every individual based on findings from your Dry Eye Evaluation. It is important to properly diagnose the cause of your symptoms prior to creating a custom treatment plan just for you.
Treatment for Dry Eye may include artificial tears, anti-inflammatory eye drops, inserting a small plug in the drainage for your tears, hot compresses (using a Bruder Mask, shown to the right), or environmental modification.
In severe cases we may prescribe special contact lenses, membranes, or medications to achieve optimal comfort and vision.
Meibomian Gland Treatment
The goal is to lengthen your tear break up time. We can do this by heating up those glands and applying pressure to them, once to three times per day, over a period of weeks. We recommend doing this with a Bruder Mask that you can purchase on Amazon for about $20.00. You heat the mask in the microwave and lay it on your eyes for about 10 minutes, then massage the lids by rubbing them for about 20-40 seconds afterward.
Low-dose doxycycline, taken for several months, has been shown to significantly improve the health of the meibomian glands. We have seen this to be true in moderate to severe meibomian gland disease.
Manual expression of the glands in office or use of a specialized device to express the glands may be necessary to prevent future damage to the glands and to preserve stable tears.
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.
Medicated Eye Drops
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.
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.