Dry eye syndrome (DES) is a chronic condition that develops when your eyes do not produce and maintain enough tears to keep the eye’s surface lubricated resulting in multiple symptoms that range from person to person. This can be due to a reduction in tear production or increased tear evaporation from a lack of lipid in the tears that stem from oil glands in the eyelids. The effects can range from minor dryness and discomfort to pain, blurred vision and frequent infections.
Symptoms of Dry Eye Disease
Symptoms of dry eye syndrome can vary depending on the severity of the condition but can include:
- Dry, itchy eyes
- Burning or stinging
- Watery eyes
- Blurred vision
- Foreign body sensation
The main function of tears is to maintain the health of the cornea of your eye by washing away foreign matter and ensuring that the surface of your eye remains moist, smooth and clear. Tears also rinse away dust particles from your eyes and contain enzymes that protect your eyes from bacteria that can cause infections. Dry eyes is a condition that develops when the amount of tears produced is not sufficient to maintain the moisture balance in your eye. This can result in that scratchy sensation, a continuous feeling of dryness, stinging and a sensation of a foreign body in your eye. Ironically in an effort to fight off the condition, dry eyes can cause you to produce excessive tears, which is why some people experience watery eyes.
Causes of Dry Eye Disease
Dry eyes can occur naturally as a result of aging or hormonal changes, typically in women who are pregnant, taking oral contraceptives or going through menopause. In fact, women over 50 have a 50% greater risk of dry eye disease than men do of the same age. It can also result from taking certain medications that reduce tear production such as antihistamines, blood pressure medications and antidepressants. Environmental factors can also play a role in drying out the eyes and DED is common in areas where the climate is dry, dusty and windy. Home air conditioners or heating systems and excessive time spent staring at a computer or television screen can also dry out eyes and exacerbate symptoms due to the lack of blinking while staring at our screens.
Individuals that suffer from certain medical conditions such as diabetes, presbyopia, blepharitis, lupus, arthritis and thyroid problems are more vulnerable to developing DED. Other causes can be due to eye surgery including LASIK, certain conditions in which the eyelids don’t close properly or extended contact lens use.
Diagnosis of Dry Eye Disease By Our St. Catharines Eye Doctors
Typically, dry eye disease can be diagnosed through a comprehensive eye exam and a description of your symptoms. On some occasions the eye doctor might decide to do a test that measures how quickly your tears evaporate from the surface of your eye. By instilling a simple dye called fluorescein (much like food coloring) the doctor is able to watch and count how long it takes the tears to start to break up after they’ve asked you to hold your eyes open after a blink. This is called TBUT or a Tear Break Up Time test. A low TBUT generally indicates a lipid (aka oil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly. In another type of test, called a Schirmer test, a strip of filter paper is placed under the lid of the eye and you will be asked to close your eye for five minutes. Following the test the amount of moisture on the strip will be measured. Schirmer tests are performed less frequently than a TBUT test.
Treatment for Dry Eyes At Dr. Robertson-Woods & Associates
There are many treatment options for dry eyes which are highly dependant upon the cause and severity of the condition. Many mild forms of DED can be alleviated using artificial tears or lubricant eye drops to make up for the lack of natural tears usually produced by your eyes. If over-the-counter drops don’t alleviate your symptoms, your doctor might prescribe prescription drops that actually stimulate tear production or steroids for short-term relief.
More severe cases of dry eyes might be treated with a punctal insert which is a tiny insert containing a slow-release lubricating substance that is placed inside the lower eyelid. Since DED is often related to eyelid inflammation known as blepharitis your doctor may prescribe a heated hot compress mask, specialty eyelid scrubs and sometimes an antibiotic ointment. Finally, punctal plugs might be recommended for severe cases which would be inserted into the tear ducts to reduce the tear drainage in your eyes to keep them from drying out.
If the cause of your dry eyes is something external or environmental, eliminating that cause may solve the problem and resolve the symptoms. Avoid dry environments, hair dryers, heaters and fans, (particularly directed toward the eyes) and smoky environments and wear eye protection such as wrap around glasses or goggles when in dusty or windy areas. Use a humidifier to add moisture to dry indoor air. If working on computer or watching television, make sure to blink purposefully as our natural tendency is to reduce our blink rate when staring at a screen. Also avoid rubbing your eyes as this can further irritate them. Staying hydrated by drinking at least 8 to 10 glasses of water per day can also help.
In cases where discontinuation or switching to different medications is possible this can eradicate symptoms. Our St. Catharines eye doctor may also recommend that you limit or refrain from contact lens use for a certain amount of time or switch to a different brand or type of contact lens which will reduce dehydration.
Dry eye disease won't have a permanent effect on your vision, but there is no reason to endure dry, itchy and uncomfortable eyes, especially since there are so many treatment options to increase moisture and comfort. It’s also important to realize that this is a chronic disease that needs consistent treatment. Our eye care specialist in St. Catharines will work with you to create a long term strategy to keep your eyes as comfortable as possible.
Our Advanced Technology to Treat Dry Eye
I-PEN - Osmolarity Assessment
I-MED Pharma's I-PEN® Osmolarity System is the first quick, easy, and handheld device for optometrists to screen dry eye patients.
- Quantitative measurement of osmolarity
- Affordable point-of-care test
- Quick and simple to use (takes less than 5 seconds per eye)
- Reproducible, accurate and reliable results
- Uses Single-Use-Sensors (SUS)
The I-PEN measures tear osmolarity in a fast and effective way, aiding doctors in determining the best treatment for your eyes. Tear osmolarity has been shown to have the best predictive value for diagnosing Dry Eye Disease of any single test. The Doctor will test both eyes, and will take the highest number of the two tests, to generate Your Osmolarity Number. Your Osmolarity Number gives doctors a meaningful measure of the health and stability of the protective tear film that covers the surface of your eyes. The number generated correlates with the severity of the disease.
The Meibox Meibographer is the first HD slit lamp mounted meibographer designed for doctors by doctors. This diagnostic tool helps doctors determine if all the patient’s meibomian glands are functioning by using Meibox, a meibography imaging test which illuminates the glands with a non-invasive Infra-red light. Providing high resolution images of meibomian glands, the Meibox has helped take the mystery out of dry eyes.
iLux by TearFilm Innovations allows direct visualization of meibomian glands, blockages, and expressed meibum throughout treatment via the magnifying lens, providing a direct view of the treatment area.
The proprietary light-based heat source gently warms the inner and outer lid to a safe therapeutic temperature. Sensors in the disposable iLux Smart Tip monitor inner eyelid temperature continuously during treatment.
One-button control of heating and compression puts treatment in the doctors' hands, allowing you to choose the location and duration of treatment. iLux measures compression force, which is displayed on the LCD screen.
TearScience produces the LipiFlow® and LipiView® devices for treating Meibomian gland dysfunction (MGD). The LipiView® provides a detailed view of the tear film using interferometry which permits precise measurement of lipid layer thickness down to nanometer levels. The LipiFlow® device provides vectored thermal pulsation to warm the meibomian glands through the inside of the lids and gently massage thickened meibum (lipid) and debris from the gland. This system is cleared by the US FDA for the treatment of MGD and evaporative dry eye. With hundreds of patients successfully treated, LipiFlow® has proven to be safe and effective.
Tear Volume Assessment
Your tear volume can be assessed to diagnose and treat dry eye. Cappilary Pipette drawing is done to determine the quantity of tears. The Schirmer test is one test that can be used for tear volume assessment.
IPL - Intense Pulsed Light Therapy
- The Intense Pulsed Light (IPL) acts similar to a warm compress and liquefies secretions that are plugging up the meibomian glands. This allows for the oils to be easily released.
- IPL closes up blood vessels that transport inflammatory cytokines since these cytokines cause the glands to block up. When the glands are no blocked or inflamed anymore, they can start working again.
What can I expect?
- The applicator is placed on certain areas, and then brief pulses of light are emitted onto the skin.
- Treatment lasts about 20 minutes. Immediately after, the doctor cleans the area and the patient can return to normal activities. The use of sunblock is recommended on the treated areas that will be in the sun.
- Generally, four treatments at 4-week intervals produce good, stable results. This number may vary depending on the severity of the condition. After the first treatment, many patients can see improvement in their symptoms. The results show an increase in tear function after each treatment, but the maximum improvement happens after the fourth treatment. Patients need to have a maintenance therapy session about once a year.
An important step in treating meibomian gland dysfunction is debriding - or removing the excessive buildup of cells, debris and biofilm from the area around the meibomian glands - called Marx's line. Blephex helps to unblock the glands. The recently introduced BlephEx device is a gentle but extremely effective way of debriding the lid margins. This procedure is typically done every six months.
Optical Coherence Tomography (OCT)
An Optical Coherence Tomography scan (commonly referred to as an OCT scan) is the latest advancement in imaging technology. Similar to ultrasound, this diagnostic technique employs light rather than sound waves to achieve higher resolution pictures of the structural layers of the back of the eye.
A scanning laser used to analyze the layers of the retina and optic nerve for any signs of eye disease, similar to a CT scan of the eye. It works using light without radiation, and is essential for early diagnosis of glaucoma, macular degeneration, and diabetic retinal disease.
The OCT can be used to analyze the tear film, and help doctors in diagnosing dry eye.
With an OCT scan, doctors are provided with color-coded, cross-sectional images of the retina. These detailed images are revolutionizing early detection and treatment of eye conditions such as wet and dry age-related macular degeneration, glaucoma, retinal detachment and diabetic retinopathy.
MMP-9 Testing Inflammatory Markers
This test checks for inflammatory markers in your tear film so we can see if there is an inflammatory component to the Dry Eye.
Pharmaceutical grade Omega-3
Omega-3s are clinically proven to improve dry eyes.
Physician Recommended Nutriceuticals (PRN) sell Dry Eye Omega Benefits, a dietary supplement of fish oils, that can drastically improve your dry eye symptoms. PRN's Omega-3 supplements are easier to digest than over the counter supplements and do not come with a fishy aftertaste. You may not see improvement for about 60-90 days, but the Omega-3s are working inside your body before you notice the outward result.
We also sell NutriSea brand Pharmaceutical grade Omega-3 3:1 EPA:DHA. This is the only brand that's rigorously tested by a third party to ensure their high quality.
Lid-Care products are designed for daily eyelid hygiene. It removes any debris from the eye area. The pads are oil-free and ready to use. A clean eye reduces dry eye.
Eye-Safe Cosmetics and Creams
It is important to be aware of what you're putting on your eyes. Make sure you are using pharmaceutically approved eye-safe eye creams and cosmetics. Using eye-safe creams will lower your risk of dry eye.
For more significant cases of dry eye, your eye doctor may prescribe punctal plugs. Punctal plugs are tiny devices that are inserted in ducts in your lids to slow the drainage of tears away from your eyes, which keep your eyes more moist.
How does heat help with dry eye?
Heat dissolves the blockages in the eye, allowing a better flow. People with Dry Eye keep getting these blockages, so it is important to monitor and treat them regularly.
Scleral/"Hard-to-Fit" Contact Lenses for Dry Eye
Dry Eye Syndrome causes your eyes to feel dry, gritty, burning, red, and irritated. Dry Eye Syndrome can also cause blurred vision. Often these symptoms can sometimes worsen by the use of contacts. In fact, many people who do not normally suffer from chronic dry eyes will experience some of these symptoms as a result of contact lens wear.
First of all, if you have chronic dry eyes, you should see your eye doctor for treatment and relief before you think about contact lenses. Once your dry eyes are treated, it is safe to try contacts and there are a number of options that can be considered.
Many brands of soft contacts and products such as disinfectant and cleaning solutions are made with ingredients that are designed to be more comfortable for individuals with dry eyes. Your eye doctor will be able to recommend some of these brands and products to you. Alternatively, gas permeable (GP) or rigid gas permeable (RGP) lenses are made with a hard material that in some cases does not dry out like soft lenses and they are able to hold a certain amount of moisture beneath the lens to keep the eye from drying out. Gas permeable lenses are a very good option and can be quite comfortable for individuals with dry eyes.
Additionally, your doctor might recommend a specific wearing schedule such as limiting the time you wear your contacts throughout the day or replacing your contacts on a more frequent basis.
True tear - Nasal Trigeminal Nerve Stimulator
TrueTear causes your eyes to produce their own natural tears using tiny pulses of energy. These pulses activate a natural response through a clever technology called neurostimulation. The TrueTear tip stimulates a nerve in the nasal cavity with a pulse of energy, which sends a nerve impulse to the brain, which sends nerve signals to the tear glands to to increase tear production. The eyes then produce real tears.
TrueTear is very easy to use.
Prokera - Amniotic Treatment
PROKERA® is a therapeutic device used by eye doctors around the world to protect, repair and heal damaged eye surfaces. PROKERA® is made by clipping a piece of amniotic membrane tissue in between two rings made out of a clear, flexible material.
Amniotic membrane is part of the placenta and is the tissue closest to the baby throughout development in the womb. Amniotic membrane protects the baby from any harm and has natural therapeutic actions which help the baby develop. The tissue has healing properties that aid in ocular surface repair.
The amniotic membrane tissue in PROKERA® has natural therapeutic actions that help damaged eye surfaces heal. Eyes treated with PROKERA® have quicker healing, less pain, less scarring, and less inflammation. The amniotic membrane in PROKERA® is thin and clear like the tissue on the surface of your eye and protects your eye's damaged tissue while inserted.
Debridement refers to a process of exfoliation. This process assists in clearing away dead skin cells from the opening of the meibomian gland, which facilitates proper flow allowing better tear formation. The process also removes any harmful biofilms from the lid.
Wearing a sleeping mask can reduce exposure to night air and aid in treating dry eye.