dry eye, dry eyes, dry eye help, dry eye problems
Dry Eye

By Francis D'Ambrosio, Jr., M.D.

About Dry Eye
Dry eye is extremely common. It is estimated that in the United States alone, 20-30 million people have mild symptoms of dry eye and another 6 million women and 3 million men have moderate or severe symptoms of dry eye. In fact, dry eye problems are some of the most common complaints we hear and treat at D'Ambrosio Eye Care.

Symptoms of Dry Eye
The symptoms of dry eyes are often troubling enough that they cause patients to have a combination of the common sensations of dryness, grittiness and burning along with difficulty while trying to read, use computer screens, mobile devices, drive, or even watch television. Dry eyes and dry eye syndrome not only cause discomfort, but can also have a negative impact on performing daily activities. In order to be comfortable and see clearly we need to have a sufficient quantity of healthy tears on the surface of the eye at all times. Dry eye can result from not producing enough of your own tears or an excessive evaporation of the tears you do produce, or a combination of these factors.

Tear Production
There are many potential reasons that you may not produce an adequate quantity of tears, including certain types of systemic diseases such as Sjögren’s Syndrome, Rheumatoid Arthritis and Lupus Erythematosis, various types of inflammation, long term contact lens wear, past eye infections, allergies, and even vitamin deficiencies. 

Evaporation of Tears
Many factors can cause your tears to evaporate too quickly or excessively. These might include environmental factors such as exposure to forced air heating at home or at work, dry climate in general, air travel, reduced blinking from contact lens wear, prolonged computer use or reading, air pollution, or even just blowing your hair dry.

Your tears may evaporate too quickly if you suffer from low-grade eyelid inflammation, called Blepharitis. Within your eyelids are tiny tubular glands called Meibomian Glands. Inflammation of the eyelids, from Blepharitis, or a condition called Rosacea, can cause the Meibomian Glands to stop functioning properly and decrease the production of the oil they secrete. This Meibomian Gland Dysfunction is a common cause of dry eye as the oil is required to prevent tear evaporation. Without the oily layer being present, it is very likely that you will have dry eye symptoms.

This is an especially common problem for perimenopausal women, as it is believed that 75% of women in this age group have some presence of facial rosacea. This, along with the general hormonal changes occurring during this time, makes perimenopausal woman particularly susceptible to dry eyes.

Finally, your tear film may evaporate too quickly if the tears are not properly spread and replenished over the surface of the eye because of poor eyelid movement. This may be due to a number of factors including:

  1. Improper or incomplete closure of your eyes during sleep
  2. Eye “bulging” conditions that may be related to thyroid problems
  3. Loss of tone or shape of the eyelids so that they turn in or turn out, called entropion and ectropion.

Treatment & Help for Dry Eye
Depending on the severity and the cause of your dry eyes, we may recommend a number of different treatment options to help your dry eye problems including Restasis® prescription eye drops, punctal plugs, artificial tears, and even dietary supplements and vitamins.

If you have mild or even moderate dry eyes, the first course of treatment may be to use unpreserved artificial tears. The selection of the exact type of artificial tear eye drop is important. Depending on the nature of your tear film deficiency, we may have you use a specific type of artificial tear with specific characteristics in terms of salt content and viscosity.

There may some environmental factors that you need to alter to make you more comfortable such as how and where you are exposed to heat ducts or fans blowing, as well as attempting to keep the areas that you spend a great deal of time in at a proper humidity level.

If the oily layer of the tear film is deficient, we may suggest that you increase your consumption of oily fish, take omega 3 vitamin supplements, or even take flax seed oil as a dietary supplement. Supplements can vary in their potency and efficacy, and the eye doctors at D'Ambrosio Eye Care will make the appropriate recommendations. Most likely you will also be asked to drink plenty of water.

About Punctal Plugs
In instances where these approaches do not help relieve your dry eye symptoms, we may suggest the insertion of tiny punctal plugs that will slow down or even stop the drainage of tears from the eye. These plugs are easily and comfortably placed in the Lacrimal Puncta in your eyelids. There are two puncta per eye, one per each of the upper and lower eyelids. Initially you may have a temporary dissolving plug put in place to see if your dry eye symptoms are responsive to this treatment. If the results are good, it may be necessary to place a more permanent type of plug in the Lacrimal Puncta to affect a long-term solution. These plugs can remain in place indefinitely, but can also be removed as needed.

About Restasis® Eye Drops
For patients with moderate to severe dry eyes who may have already tried using artificial tear eye drops and punctal plugs without relief, the prescription of Restasis® eye drops with or without the other treatments may often help alleviate your symptoms. Restasis® works by preventing a type of inflammatory cell from entering the Lacrimal Gland and thus allows your Lacrimal Gland to function more effectively, allowing people who suffer from dry eye to make more of their own natural tears. Restasis® eye drops require several weeks of use to become effective, so please use these drops exactly as they are prescribed and please be patient.

Even with the above treatment options, there are some patients that may not respond as well as desired due to some underlying low-grade inflammatory or infectious process. In these cases, it may be necessary for us to also prescribe an oral antibiotic such as doxycycline or an anti-inflammatory eye drop such as a steroid eye drop.

About IPL Intense Pulsed Light for Dry Eyes
For patients who have dry eye problems resulting from Meibomian Gland Dysfunction, eyelid inflammation, rosacea or other conditions that prevent the normal secretion of a healthy tear film oily layer, we are able help the eyelids and the surrounding tissue function better with the use of the IPL Intense Pulsed Light Treatment. IPL is not a laser, but a light-based therapy. It has long been used in dermatology to treat vascular facial lesions, rosacea spots, and pigmented areas. With IPL treatment for dry eyes, we are able to use specialized filters that apply specific wavelengths of light to target abnormal blood vessels in the eyelids and skin responsible for causing eyelid inflammation and resultant Meibomian Gland Dysfunction. 

IPL can be used to help evaporative dry eye disease because it targets the abnormal blood vessels and increases the flow of impacted meibomian secretions. With IPL the light therapy is not applied directly to the eye. A protective eye shield is gently placed to cover your eyes. A cool gel is placed onto the skin surface and then the IPL treatment is performed. Most patients experience a tingling and heating sensation as the light is applied. After the light application, the meibomian glands in your eyelids are manually expressed to relieve the gland obstructions. The procedure is relatively comfortable and quick and takes only about 10 to 15 minutes in total. Most patients require four treatments initially-about one per month- and then maintenance treatments are required on an annual basis. This may vary depending upon each individual patient?s disease severity.

As you can see, the diagnosis and treatment of dry eyes is complex and requires patience and persistence on the part of the eye doctor and the patient. With careful diagnosis and a systematic therapeutic approach, sufferers of dry eye syndrome can most often experience considerable improvement.

If you or someone you know would like to learn more about dry eye treatment and help for dry eyes with IPL Intense Pulsed Light, Punctal Plugs or Restasis eye drops, please call D'Ambrosio Eye care at 800-325-3937 to schedule an appointment.