Dry Eye Answers & Relief

Aqueous tear deficiency

• Not enough tears are produced
• A disorder of the tear film quantity

Blepharitis/Meibomian gland dysfunction

• Chronic inflammation of the eyelids
• Insufficient or abnormal oil layer in the tear film
• Oil glands can be obstructed or blocked
• Non-obstructed glands can produce abnormal oil
• A disorder of the tear film quality and stability

Goblet cell/mucin deficiency

• Not enough mucin is produced
• Tears are not adequately spread across the surface of the eye
• A disorder of the tear film stability

Exposure-related

• Eyelids do not fully close, do not function properly, or are not correctly positioned
• The surface of the eye is exposed
• Tears are not properly spread over the surface of the eye
• The tear film is dysfunctional

Demodex skin mites are a normal and common microscopic parasite of human skin.  They have an affinity for the eyelids, specifically the eyelash follicles and eyelid oil glands.  Infestation occurs when they become too numerous, often resulting in symptoms that overlap with dry eye, even worsening dry eye.

Demodex live within the eyelash follicles and eyelid oil glands; feed on the eyelash follicle and oil gland tissue causing direct damage; mechanically block the oil glands with their bodies and waste; lay eggs at the base of the eyelashes; cause irritation of the eyelids due to biting, contact with their digestive enzymes, and regurgitation of undigested material; and release bacteria and other debris upon their death causing an inflammatory and hypersensitive immune response.

Symptoms of Demodex infestation:

• Itching
• Dry eyes
• Irritation
• Inflammation of eyelid
• Redness of eyelid
• Missing or misdirected eyelashes
• Sensitivity to light
• Blurred vision
• Difficulty/intolerance wearing make-up

Questionnaires
In addition to a detailed review of medical history, questionnaires are used to identify risk factors and other contributors to dry eye and to track response to treatment. 

Examination and Testing
A comprehensive eye exam and non-invasive testing can help identify the type of dry eye as well as the stage and severity. Schirmer testing assesses the rate of tear production. Ocular surface staining uses special dyes to evaluate the condition of the ocular surface. Tear breakup time reflects the stability of the tear film. Tear osmolarity is a useful test to diagnose dry eye and to measure response to treatment. Meibography uses infrared light to image the structure of the meibomian glands in the eyelids, providing useful information about their health and functioning. Laboratory tests can help identify underlying medical conditions that predispose to dry eye.

Counseling
Dry eye is a complex condition. Patients may feel overwhelmed, frustrated, confused, and previously dismissed when seeking care for their dry eye. Increasing each patient’s knowledge and understanding of their dry eye diagnosis through patient counseling is a critical component in the successful treatment of dry eye. 

Personalized Treatment Plan
There are many effective options for relieving and managing the symptoms of dry eye. The treatment of dry eye is not an overnight process, but rather a long-term course of therapy. Past treatment failures may be the result of therapies pursued in a disadvantageous order, therapies that were prematurely discontinued, or therapies that were not tailored specifically to the patient. A thorough and comprehensive dry eye evaluation culminates in a tailored, personalized treatment plan. 

Artificial Tears
First line therapy for ALL types of dry eye.

What do they do?

• Lubricate the surface of the eye
• Remove debris
• Supplement deficient components of the tears
• Dilute tears that are too concentrated
• Reduce components in the tears that promote inflammation

Warm Compresses
First line therapy for dry eye due to meibomian gland dysfunction, the #1 cause of dry eye.

What do they do?

• Heat and melt the oil in the oil glands so that it can flow out of the glands in liquid form and into the tear film where it belongs

Why is oil so important?

• The oil made by the oil glands in the eyelids is a critical ingredient in the tear film
• The oil makes up the outermost layer of the tear film and helps prevent the tears from evaporating

Nutritional Supplements
First line therapy for dry eye due to aqueous tear deficiency and/or due to meibomian gland dysfunction

Omega-3 (EPA, DHA) and Omega-6 (GLA):

• essential fatty acids
• required for normal cellular functioning
• GLA difficult to obtain from diet, available in HydroEye
• supplementation provides the nutrients needed to metabolize essential fatty acids

What do they do?

• lessen symptoms
• improve corneal smoothness
• improve tear evaporation time
• improve oil expression
• improve inflammation of the eyelid margin

Eyelid Cleansers
First line therapy for dry eye due to meibomian gland dysfunction, the #1 cause of dry eye.

What do they do?

• Remove dirt, oil, debris, skin mites, and bacteria that can clog the oil glands and cause inflammation

Pharmaceuticals
Sometimes prescription medications are beneficial when more relief is needed, especially in cases of advanced dry eye disease or dry eye associated with other systemic diseases.

For best results, home therapy is combined with office-based treatments.

Microblepharoexfoliation with ZEST (Zocular Eyelid System Treatment)

Microblepharoexfoliation removes the overgrowth of bacteria that live on the eyelid margin and the Demodex mite which feeds on them. The exotoxins produced by these bacteria cause inflammation and damage to the oil and tear producing glands. Damage of the oil and tear producing glands causes dry eye. 

Microblepharoexfoliation with Zest and Tea Tree Oil 50%

Tea Tree Oil 50% stimulates mites inside of the eyelash follicles and oil glands to migrate out onto the skin where the TTO50% has a direct killing effect.

TearCare (Heat treatment and oil gland expression)

TearCare is a 15-minute heat treatment applied to the eyelids in order to melt the oil in the oil glands so that it can be more easily expressed and cleaned out.  

TearCare unclogs the glands.

• Unhealthy oil is cloudy
• Clogged oil is thick
• Healthy oil is clear and liquid like olive oil
• Healthy oil in normal amounts is needed for a healthy and normal tear film, and therefore for a healthy eye surface
• If our tear film does not contain healthy oil or not enough of it, our tear film will be abnormal, inflammatory, and will evaporate too quickly
• Abnormal oil glands (cloudy or clogged oil) are the most common cause of dry eye
• Heating the oil glands and expressing the abnormal oil is a well-established, accepted, and FDA-approved treatment for dry eye due to oil gland dysfunction

IPL (Intense Pulsed Light)

IPL, or intense pulsed light, is a light-based treatment applied to the face and eyelids for the treatment of dry eye disease due to meibomian gland dysfunction, the #1 cause of dry eye. It’s a comfortable, safe, precise, effective, and fast treatment that can often be completed in 4 sessions lasting about 15 minutes each. The light is absorbed by the red pigment in abnormal blood vessels and converted to heat, which causes the abnormal blood vessels to regress.  With fewer abnormal blood vessels delivering inflammatory cells to the eyelids and oil glands…

IPL treats the underlying reason for the inflammation and gland clogging.

IPL addresses 5 out of 6 mechanisms involved in dry eye due to meibomian gland dysfunction, making it the most powerful treatment in our dry eye toolkit. It works through:

• Photocoagulation – regression of abnormal blood vessels leads to less inflammation, damage, redness, swelling, and tenderness
• Photoimmunomodulation – inflammation in the tear film decreases, inflammatory cells around the oil glands regress, oil inside the glands normalize, structure of the glands improve
• Photosanitization – death of Demodex mites, abnormal levels of bacteria return to normal levels
• Photobiomodulation – photons from bright light stimulate the cells to be more metabolically active, oil gland stem cells have more energy to produce good oil
• Photorejuvenation – cells behave (and look!) younger

Meibomian Gland Probing

There is a great need for patients to be heard, to have their dry eye adequately evaluated and treated, and to be properly educated and counseled on their condition. When you’re ready for your eyes to finally feel good again, find the answers and relief you’re seeking at Landes Eye Associates. Call us at (330) 864-3937 or request an appointment online today!