Dry eye disease is a chronic condition that can cause either a decrease of tear production or an increase of tear evaporation.
For many people, dry eye symptoms can be caused by not blinking appropriately. This can cause the lubricating oil (called meibum) in your eyelid glands to harden which affects your eye’s ability to produce the oil and spread it across the eye consistently.
Dry eye has two different types associated with it: evaporative and aqueous – deficient. Although it is possible to have a combination of the two conditions, they differ in how they affect the overall health of your eye. When examining your eye, our team will try to pinpoint which type of dry eye is likely affecting you.
Evaporative Dry Eye
If you suffer from evaporative dry eye, the tear film in your eye has essentially been weakened because of a deficiency in the oil layer of the tear film. This is the most common type of dry eye and is usually addressed by working to improve Meibomian gland function.
Aqueous-Deficient Dry Eye
With this type of dry eye, your tear production and volume are very low. Your body is having difficulty producing its own tear, and as a result, your eyes are not receiving the amount of moisture they need. This condition is generally treated with tear duct plugs, artificial tear drops, and inflammatory suppression medications.
To understand what type of dry eye you may have, our team will conduct a complete dry eye examination. The process begins by using a patient questionnaire to understand and track those symptoms over time. We use the SPEED (Standardized Patient Evaluation of Eye Dryness) questionnaire, which includes specifically asking you have fluctuating vision.
Evaluation and Testing
At your evaluation, we will look very closely at your lid margins and use lid pressure to express the Meibomian glands. We pay special attention to patients who are contact lens intolerant (more often than not, this is why they may want refractive surgery) and scrutinize the ocular surface very closely. When then have our technicians use Dynamic Meibomian Imaging to assess your Meibomian gland function. Thus system allows us to visualize the Meibomian glands themselves as well as look further at their lipid layer thickness and blink0ratre analysis. For accuracy of testing, we recommend that you do not wear any contact lenses or use any eye drops for two hours prior to coming in for your appointment.
Your assessment will also include a very thorough history of your eye health. We will pay specific attention to any existing condition that may be related to your dry eye, including blepharitis, rheumatoid arthritis, acne rosacea, allergic conjunctivitis and the use of antihistamines, oral anxiety medication, perimenopause, lagophthalmos, and history or signs of epithelial basement membrane dystrophy.
This rigorous process of diagnosing, educating, and providing a customized dry eye treatment plan specific to you is what sets Mabee Eye Clinic apart when addressing and treating dry eye disease.
Mabee Eye Clinic offers a full menu of dry eye disease treatments and technologies to ensure that we can fit a treatment plan to your unique needs and symptoms. Your doctor will discuss our menu of treatment options with you and which ones might help reduce or eliminate your dry eye symptoms.
Eye drops help lubricate the eye and control inflammation. They are an excellent choice for ongoing dry eye management.
Amniotic Membranes and Drops
Amniotic membranes have been very effective in treatment severe eye inflammation. Reconstituted amniotic fluid eye drops are now also available.
Prescription Eye Drops
We may also prescribe immunosuppressant drops to be used twice daily, especially if there is some inflammation present and/or a decrease in tear production.
Immune-modulating drops (like cyclosporine or lifitegrast to be used twice daily) may also be prescribed especially if there is inflammation or decreased tear production.
Medical-Grade Omega Supplements
If there is an inflammatory component to the patients’ eyelids or a rosacea/ocular rosacea present we may suggest Omega supplements. Most diets in the US consist of corn-fed beef and processed foods, which are high in Omega-6 fatty acids but lack Omega-3 fatty acids. Diets with a high Omega-6 to Omega-3 ratio promote inflammation and need to be brought back into balance. Omega-3 supplements can restore this balance and reduce inflammation that causes dry eye symptoms.
Thermal Pulsation and Gland Expression
Since the Meibomian glands are actually close to the back of the eyelids, treatments that involve heat and gland expression have proven to be a successful option. We have completed hundreds of treatments on patients and have found the system to be very effective. Patients will still have chronic dry eye and will need to go through the treatment again, but they will have diminished symptoms. And, by having treatment, they may be to return to their normal eye care routine.
Oral doxycycline/minocycline at 50mg/100mg BID is also effective in controlling inflammation. But, while these prescription medications can help
manage the condition and symptoms of inflammation, they do not address the root cause of dry eye disease.
For more severe cases of dry eye disease in which there is a persistent corneal keratitis present, a topical steroid may be prescribed to be used four times a day for one week, then twice a day for one to two weeks.
In-Office Lid Hygiene
Debris on the eyelashes and lid margin can interfere with the team film and cause irritation to the eyes. This leads to a condition called blepharitis. There are three types of blepharitis: staph, seborrheic, and Demodex. A 10-minute mechanical in-office lid treatment reduces and clears this eyelash and lid debris and is recommended every three to six months. Take-home devices are also now available.
Tear duct plugs are a great method for improving tear volume. We have access to four or five different styles to choose from. Plugs come in a variety of sizes, are easy to insert, and are a cost effective treatment for dry eye disease.
Autologous Serum Tears
Autologous serum tears (AST) may be prescribed to be used every one to two hours.
We recommend using a spray, lid wipe, or other approved product to help improve lid hygiene, remove debris, and help resolve blepharitis conditions. Use one to two times daily for maintenance.
What Is Optilight By Lumenis?
OptiLight by Lumenis is a safe, gentle, and effective treatment done to manage dry eye disease. This non-invasive procedure is the first and only FDA-approved intense pulsed light (IPL) treatment for dry eye management.
OptiLight uses pulses of light precisely administered in the area below the eyes to reduce dry eye symptoms. This 10-15 minute procedure can relieve dry eye symptoms by:
Increasing tear break-up time
Reducing the amount of demodex mites and bacteria around your eyes
Decreasing inflammation inflammation
Improving meibomian gland functionality
What To Expect
If your eye doctor has recommended the OptiLight treatment, they will go over everything you can expect before, during, and after your appointment.
Preparing For Your Appointment
To prepare for your appointment you should avoid:
Using skin brightening agents or serums for the week before your appointment
Using tanning beds 1 month prior to your appointment
Getting botox for at least 3 months before your appointment
Taking oral isotretinoin, tetracycline, or doxycycline in the 3 months prior to your appointment
The OptiLight Treatment
This treatment is fast and simple, taking only 10–15 minutes. During your treatment your doctor will apply a cool gel on the treatment area and cover your eyes with shields to protect them. As light is applied to the skin, you may experience a warm or a tapping sensation, but you shouldn’t feel any pain.
While side effects are uncommon, your eyes may feel slightly more dry or gritty for the day following your procedure. If you do experience dry eyes, you can use preservative-free artificial tears. Following your treatment, your skin will be sensitive, so we recommend avoiding sun exposure and wearing sunscreen.
Am I A Good Candidate For OptiLight By Lumenis?
How do you know if OptiLight is the right treatment for you? During an eye exam, your doctor can determine whether or not it is the right option for you.
In general, OptiLight isn’t recommended for patients who:
Are taking certain medications, like Accutane
Have active acne
Suffer from certain skin disorders
Are susceptible to keloid scarring
Have severe scarring
Have severely sunburned recently
Dry eye disease can be a painful and frustrating condition, and it can affect your daily vision and your eye surgery outcomes. If you are experiencing dry eye symptoms, talk to your dye doctor and consider scheduling a dry eye disease evaluation.