Dry Eye Disease

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Dry eye disease is a common condition that occurs when your tears aren’t able to provide adequate lubrication for your eyes. Tears can be inadequate and unstable for many reasons. For example, dry eyes may occur if you don’t produce enough tears or if you produce poor-quality tears. This tear instability leads to inflammation and damage of the eye’s surface.

Symptoms of dry eye:

  • Stinging or burning.
  • Scratchiness or grittiness like something is in your eye
  • Your eyes are red or irritated. Especially true when it is windy or you are near cigarette smoke.
  • Difficulty wearing your contact lenses
  • Watery eyes, which is the body’s response to the irritation of dry eyes
  • Blurred vision or eye fatigue

The reasons for tear film dysfunction are many, including: hormone changes, autoimmune disease, inflamed eyelid glands or allergic eye disease. For some people the cause of dry eyes is decreased tear production or increased tear evaporation. People tend to make fewer tears as they get older due to hormonal changes.

The main causes of dry eyes due to decreased tear production:

  • Aging
  • Certain medical conditions including Sjogren’s syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, graft vs. host disease, sarcoidosis, thyroid disorders or vitamin A deficiency
  • Certain medications, including antihistamines, decongestants, hormone replacement therapy, antidepressants, sleeping pills, drugs for high blood pressure (diuretics and Beta blockers, acne, birth control and Parkinson’s disease
  • Corneal nerve de-sensitivity caused by contact lens use, nerve damage or that caused by laser eye surgery, though symptoms of dry eyes related to this procedure are usually temporary

The main causes of increased tear evaporation:

  • Posterior Blepharitis/Meibomian gland dysfunction (when eyelids are swollen or red)
  • Disorders of the eyelids including lid laxity
  • Blinking less often, which can occur with certain conditions such as
  • Parkinson’s or when concentrating during activities such reading, driving or working at a computer
  • Being in smoke, wind or a very dry climate
  • Contact lens wear
  • Preservatives in eyedrops
  • Allergies
  • Vitamin A deficiency

What is Blepharitis?

Blepharitis is a common eye condition that makes your eyelids red, swollen, irritated, and itchy. It can cause crusty dandruff-like flakes on your eyelashes. It can be uncomfortable but it isn’t contagious. Most of the time, blepharitis happens because you have too much bacteria on your eyelids at the base of your eyelashes. Having bacteria on your skin is normal, but too much bacteria can cause problems. You can also get blepharitis if the oil glands in your eyelids get clogged or irritated.

There are 2 types of blepharitis. You may have one both types at the same time.
Anterior blepharitis. Anterior blepharitis affects the outside of your eye, where your eyelashes attach to your eyelid. It usually happens because of bacteria on your skin or dandruff from your scalp or eyebrows. Allergies or mites (tiny parasites) may also cause anterior blepharitis.

Posterior blepharitis (Meibomian Gland Dysfunction-MGD). Posterior blepharitis affects the outside of the inner edge of the eyelid – the part that touches your eye. This type of blepharitis happens when the oil glands in your eyelids get clogged (sometimes causing a stye or chalazion to form). Posterior blepharitis can also lead to thickened or crusty eyelid margins and tears can look foamy.

You’re at higher risk for blepharitis if you have:

  • Dandruff — flaky patches of skin on your scalp or face
  • Rosacea — a skin condition that causes redness and bumps, usually on your face
  • Oily skin
  • Allergies that affect your eyelashes

The main treatment for blepharitis is regularly cleaning your eyelids and keeping them free of crusting Blepharitis usually doesn’t go away completely, but you can take steps to manage your symptoms. Talk to your eye doctor about what’s causing your blepharitis and the best ways to manage it.

Common symptoms of blepharitis are:

  • Feeling like there’s something in your eye
  • Burning or stinging eyes
  • Watery eyes
  • Itchy eyes
  • Sensitivity to light
  • Red and swollen eyes or eyelids
  • Tears that are foamy or have small bubbles in them
  • Dry eyes
  • Crusty eyelids or eyelashes when you wake up

Blepharitis can also cause more serious problems like:

  • Blurry vision
  • Eyelashes that fall out
  • Eyelashes that grow in the wrong direction
  • Swelling of other parts of the eye, like the cornea

Your Doctor may recommend one or more of the following treatments for dry eyes, blepharitis and Meibomian gland dysfunction

  1. Lid hygiene. Using presoaked lid wipes clean the dried debris, scales and crusting from the lashes and lid margins. DO NOT rinse it off immediately, allow the liquid to soak in and bathe the base of the lashes.
  2. ZEST treatment: In office intensive lid cleansing and debridement of the lashes and lid margins with ZocuKit treatment using ZEST proprietary formulation.
  3. Hot Compresses. Using the I-Relief apply hot compresses for 10 minutes one to two times a day. Place the I-relief mask in your microwave for 25 to 30 seconds and simply place it over your eyes for ten minutes. GENTLY massage your lids after removing your mask.
  4. Omega 3 Fatty Acids. 1500 to 2000 mg is the recommended dose to help with decreasing the inflammation and improve oil production and facilitate release from the oil at the lid margin. It is most important that the Omega 3 have a high EPA/DHA content/ratio. This is usually indicative of a better quality product
  5. Artificial tears. The special formulation of lubricants your Doctor has recommended will help supplement the missing or deficient oil layer of your tear film and help lubricate the ocular surface. We only recommend using preservative free products so as not to harm the ocular surface. Our recommended products are Thealoz Duo and Imed MGD.
  6. Mild Steroid Eye Drops. A mild dose of a steroid eye drop may be prescribed to reduce the inflammation. Carefully follow instructions and ensure to attend your follow up appointments when using a steroid medication.
  7. Antibiotic Ointment. Your Doctor may prescribe this to eliminate bacterial overgrowth at the lid margin. Gently apply a small amount at the base of the eyelashes before bedtime.
  8. Oral Antibiotic Pills. Your Doctor may prescribe Doxycycline/Minocycline once daily in more severe cases to reduce inflammation on your eyelids/margins.
  9. Cyclosporine eye drops. Your Doctor may prescribe Cequa or Verkazia
  10. Intense Pulse Light (IPL). Non-laser light energy is applied to the eyelid skin to break down obstructions in the meibomian glands, improve oil secretion, decrease eyelid redness and reduce spider veins.
  11. Phobiomodulation/Low Light Level Therapy(LLLT). Specialized devices provide controlled heat energy to the eyelids. The heat breaks down obstructions in the meibomian glands and improves oil secretion.