Treatment of Dry Eye Disease

If your eyes are constantly itchy or dry, you may have dry eye disease, which affects many millions of Americans. Dry eye disease is caused by a lack of, or poor quality of, tears. Tears lubricate the outer layer of the eye called the cornea. If the tears are not adequate or are not composed of a proper balance of mucous, water, and oil, the eye becomes irritated.

Dry eye disease leads to a number of symptoms, including itchiness, irritation, burning, excessive tearing, redness, blurred vision that improves with blinking, and discomfort after long periods of watching television, using a computer, or reading.

There are many factors that can contribute to dry eye disease. These include dry, hot, or windy climates; high altitudes; air-conditioned rooms; and cigarette smoke. Contact lens wearers, people with abnormally dry skin, and the elderly are more likely to develop dry eye syndrome. You may also be more at risk if you take certain medications, have a thyroid condition, a vitamin-A deficiency, Parkinson’s or Sjogren's disease, or if you are a woman going through menopause.

Since Dry Eye Disease is a multifactorial disease there are many products and procedures that we have in house to help manage this disease, such as Oasis Tears drops and scrubs, EyeEco eyelid & facial cleansers and Bruder Masks. Procedures include LipiScan, LipiFlo and Blephex.   

What is Dry Eye Disease?
Dry eye disease, also known as dry eye syndrome, occurs when your eyes do not produce enough quality tears or the tears produced evaporate too quickly. Tears provide moisture, nourishment, and protection to the front surface of your eyes. When the quantity or quality of tears is compromised, you can experience discomfort, irritation, and even damage to the delicate tissues of your eyes.

Signs and Symptoms of Dry Eye

Meibomian Gland Dysfunction (MGD) and Blepharitis: Meibomian glands are tiny structures located in the eyelids that are responsible for producing the oily layer of tears, which helps prevent tear evaporation. When these glands become dysfunctional, it's referred to as Meibomian Gland Dysfunction (MGD). Blepharitis occurs when the tiny glands along the meibomian glands become clogged or infected. Blepharitis is a common eye condition characterized by inflammation of the eyelids.

Causes of Meibomian Gland Dysfunction:
Aging: As you get older, the function of these glands can naturally decline.
-Biofilm and Microbiota Overgrowth: Biofilm is a protective matrix created by microorganisms, including bacteria, that stick to surfaces like the eyelid margins. An overgrowth of normal bacterial populations on the eyelids can lead to the formation of biofilm. Excess biofilm can cause irritation, inflammation, and contribute to the development of blepharitis.
-Excess or Low Quality Oil Production: Meibomian glands produce oils that help prevent tear evaporation. When these glands produce excess oil or the oil becomes thick and sticky, it can block the openings of the glands.
-Rosacea Connection: Rosacea is a skin condition characterized by redness and visible blood vessels. Ocular rosacea involves inflammation of the eyes and eyelids and is closely associated with blepharitis. Both conditions share similar inflammatory pathways. Dermatitis, eczema, and other dermatological immune system diseases share similar characteristics.
-Environmental Factors: Air conditioning, low humidity, and extended screen time can exacerbate MGD symptoms.

Our Approach to Dry Eye Treatment

-Regenerative: These treatments have been shown to positively impact the structures which create tears, often leading to the regeneration of damaged/atrophic meibomian glands

-Natural: These treatments focus on restoring the natural function of your tear production system, which can lead to more sustainable relief without relying on artificial substances.

-Greater Effectiveness: By addressing the underlying causes of dry eye, these treatments offer distinct advantages over ongoing pharmaceutical solutions such as eye drops which primarily provide temporary relief.

1. Intense Pulsed Light (IPL) Therapy:
   IPL is a non-invasive therapy that utilizes precise, gentle pulses of light to target inflammation in the eyelids, which can regenerate meibomian gland structure and function thus reducing discomfort associated with dry eyes.

What to expect:
-Typically 4 sessions, each 2-4 weeks apart
-Each session is about 30 minutes with the actual treatment lasting around 10-15 minutes
-A conductive gel will be applied to the treatment area prior to beginning the treatment; The treatment area should be cleansed of all makeup, lotions, foundations, bronzer, etc. prior to this.
-Protective eyewear will be provided at the beginning of the treatment.
-The treated areas may become red and/or slightly irritated but this usually subsides within a few hours
-Patients usually notice a decrease in symptoms around the second or third treatment, though systemic/structural improvement starts after the very first treatment
-Some patients may require a maintenance IPL treatment annually for the best possible results

Advantages:
-Cosmetic Benefits:
-IPL works to decrease inflammation, thus reducing facial redness.
-IPL decreases the amount of weak collagen structures and promotes the production of healthier and stronger collagen structures. Good quality collagen improves the elasticity of the skin, meaning fewer wrinkles and smooth, lifted skin.
-Long-Term Savings: While the initial cost may seem higher, the potential for sustained relief could lead to cost savings over time by reducing the need for ongoing pharmaceutical purchases.
-Potential Combined Benefits: When combined with gland expression, you might experience enhanced results, as gland expression can improve meibomian gland function, further addressing dry eye causes.

2. LipiFlow & Tearcare Treatments:
   LipiFlow and TearCare are revolutionary treatments specifically designed to address Meibomian Gland Dysfunction. They both use a combination of heat and gentle pressure to clear blockages in meibomian glands by melting and removing obstructions, allowing the natural flow of oils and improving tear stability. These treatments are often used in combination with IPL therapy.

Advantages:
-Focused Treatment: Specifically targets the meibomian glands, addressing the underlying cause of dry eye by restoring their proper function.
-Long-Lasting Relief: By unclogging and improving meibomian gland function, these treatments can offer long-lasting relief from dry eye symptoms, and may reduce your need for ongoing pharmaceuticals, leading to cost savings over time.

What to expect with LipiFlow:
-Typically lasting around 12 minutes
-Single use sterile devices deliver a combination of heat to the inner lids and simultaneous therapeutic massage to the outer lids, to remove blockages from the meibomian glands
-Vision may become blurry for a few minutes post treatment due to the secretion of the lids’ natural oils
-Your eyes may feel dryer for a couple days post treatment as your glands resume proper oil production

What to expect with TearCare:
-Typically lasting around 15-minutes
-The sterile single-use flexible eyelid devices gently adhere to the contours of the patient’s eyelids and apply low heat.
-Works in conjunction with the blinking eye to facilitate natural meibum expression as the meibum melts.

-Post treatment, the doctor will manually express your meibomian glands to free any blocked glands and to stimulate oil production
-Vision may become blurry for a few minutes post treatment due to the secretion of the lids natural oils
-Your eyes may feel dryer for a couple days post treatment as your glands resume proper oil production

3. Blephex Treatment:
   Blephex is an exfoliation procedure that removes accumulated debris, bacteria, and biofilm from the eyelid margins.