Dry eye might sound like a simple condition, but it is actually very complicated. Many things can influence dry eyes, such as health conditions, medications, computer usage, and exposure to air flow. Other factors such as blink rate, lid closure, tear production, and tear evaporation also play a critical role.
Even symptoms of dry eye can be misleading. Persistent scratchiness, redness, tearing, light sensitivity, and burning are all common symptoms of dry eyes. These can feel even worse in the presence of extensive periods of computer use or reading.
Many people have used tears for years but without relief. It is essential that the underlying cause of the dry eye be diagnosed in order to prescribe a specific and effective treatment that brings relief. At Focus Eye Care we pride ourselves on our very advanced equipment specific to diagnosing dry eye. It allows us to determine if the symptoms are being caused by poor oil production or inadequate tear production. And it allows YOU to see how quickly your tears evaporate, how healthy your tear layer is, and how balanced the oil and water are. This equipment even allows both you and the doctor to see the oil producing glands through the lids! These glands can atrophy and degrade after years of not producing oil correctly, and once this happens it cannot be undone. Your body cannot regenerate regrow these glands. For this reason, it is essential that if there is gland loss it be diagnosed and the existing glands be treated in order to prevent additional gland loss. The oil produced from these glands is essential in keeping the tears from evaporating off the surface too quickly.
Once the diagnosis is confirmed, our doctors will discuss all options with you and create a treatment plan with you, specific to your type of dry eye. There are many treatments available. Some of which are simple and might include warm compresses, tear gels, or prescription drops. Other common but more involved treatments include punctal occlusion, blink exercises, oral prescriptions and vitamins. And advanced treatments include meibomian gland treatment procedures, amniotic membrane treatments, and blood serum drops.
Unfortunately, there is no cure for dry eyes. And ultimately, the success of any treatment depends significantly on your willingness to be compliant with the at home procedures and drops. If at any time, you feel like you can’t keep up with the plan, you should come in so we can create revise the treatment.
At Focus Eye Care, we has invested significant amounts of research and resources to find and acquire cutting edge equipment that no one in a 2 hour radius has.
The Oculus 5M is used to help us diagnose why your eyes are dry. It allows us to take high-resolution images and videos of the front of the eye, but we can also image the meibomian glands within the lid. This tells us if these glands are scarred, thereby limiting the amount of oil being deposited into the tear and causing them to evaporate too quickly. This is essential information, because if you are loosing glands we need to take every effort to preserve the ones you have left. The 5M also takes a video and evaluates how quickly the tears break up between blinks. It shows any dry patches as they appear. The 5M can measure how thick the fluid layer is in the eye, how well the oil and water are balanced, and how much debris is in the tear film. At the completion of all the individual tests, a comprehensive report is printed that shows you a description of each test and how your eye scored. These are just a few of the benefits of this very specialized piece of equipment that so few doctors have.
The Lipiview also allows our doctors to see an enhanced image of these special, oil-producing glands. In addition, it evaluates how many times you blink and if you actually close your eyes all the way. This is important information, otherwise difficult to obtain. There are exercises for those who don’t complete their blinks.
If you already have meibomian gland loss, it is imperative that we try to open up any glands you have that are still functional. Once the oil because thick and stagnant, the gland starts to back up, thicken, and then atrophy. Once this happens, it will never produce oil again. The oil is essential to both vision and comfort, because it keeps the tears from evaporating and causing dry patches. If you suffer from dry eyes, then you may notice that your vision is better just after you blink. This is because those dry patches affect your vision in addition to your comfort.
A basic treatment to help rejuvenate these glands is to sit with a microwave heated mask in the office for 20 minutes. Following this procedure, we expresse these glands with special forceps at the slit lamp. To increase the effectiveness this procedure must be repeated frequently, dry eye specific omega 3s should be taken daily, and warm mask compresses at home daily.
We also have the Meiboflo, which is an in office device that delivers intense heat to the outside of the lids in order to express the thickened secretions, and allow an avenue for clean oil to travel. This is an 8 minute procedure, done one eye at a time, and it is a series of 3-4 treatments spread over 6-8 weeks.
In addition to the Meiboflo, we have the Lipiflow. It is a very advanced device that heats the lid from both the inside and outside, while compressing the glands within the lid. This aides in expressing these glands and opening the pathway for them to flow. It is a 12 minute procedure performed one time, and on both eye simultaneously.
The BlephEx is different than each of these devices, in that it focuses on removing the bacteria (biofilm) from along the lid line and lashes. This is a mechanical in-office cleaning process that is especially helpful for those with crusty eyelashes (blepharitis) or morning discharge, but can also help dryness caused by this biofilm.
Prokera is amneotic tissue that is placed over the eye and worn for approximately 5 days. This tissue is extremely rich in regenerative proteins and can offer significant recovery to corneas damaged from dry eyes. Another way to get some of these helpful proteins and factors is to use eye drops created from your own blood. If we prescribe this treatment for you, your blood is drawn at the lab a few doors down, and then the drops are compounded at a compounding pharmacy. Many severe dry eye patients have received significant relief from this unique treatment.
Know that the vast majority of offices don’t have even one of these devices, but we are fortunate enough to have all of them under one roof! This is an enormous honor and it signifies how devoted we are to helping those with dry eyes in our community.