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Cataract Help

DRY EYE Education and Treatment

Dry Eye Treatment

What does it feel like?

  • Burning, stinging, scratching or pain

  • Tearing or runny eyes

  • Heavy feeling eyes

  • Even, Blurry Vision

3 Layer Tear Film

  • Oil/Lipid Layer - The outer layer prevents evaporation of your tears

  • Aqueous Layer - This middle layer is the liquid part of the tears that keeps the eye wet

  • Mucin Layer - The inner layer forms the base tear layer

Dry eye tear film

It's a Tear Film Problem

  • In dry eye, the tear film is damaged or disrupted in some form

  • There are 3 layers - Aqueous, Oil, and Mucus

  • Most often people feel like the eye is not wet enough, which is a problem with the aqueous layer (See Photo of Dry Spots)

Dry eye and corneal staining
Dry eye pain
lacrimal gland

1. Lack of Tears (Aqueous)

  • This is what people thick of when they talk about dry eye

  • Tears are produced by the lacrimal gland

  • As we age, less liquid tears are produced

  • Autoimmune conditions like Sjogrens syndrome can severely reduce tear production

  • Medications can also reduce tear production like antihistamines or antidepressants

2. Tears dry up too quickly (Oil)

  • This is called Evaporative Dry Eye

  • Tears should stay on your eye for at least 10 seconds

  • Oil glands on your eyelids protect you from this

  • #1 cause is excessive screen time

  • Computers, phones, and reading all make this worse

3. Poor tear film composition

  • Tears are composed of mucin, aqueous, and lipid layers

  • Oral medication, glaucoma drops, hormone changes all affect the composition of your tears

3 Reasons that Dry Eye Occurs

Dry Eye Testing

Dry Eye Testing
Dry Eye Testing

3 Ways To Test Dry Eye

  • Fluorescein Staining

    • Identify Dry Spot

    • Measure Tear Break Up Time (TBUT)

  • InflammaDry

    • Tests for Inflammation
  • Schirmer Testing

    • Measure Tear Production

1. Fluorescein Testing

  • Have you ever been to the eye doctor and ended up like this?

  • What is this yellow dye?

  • It's Fluorescein

  • Fluorescein is used to measure dry spots on your eye and determine the tear break up time (TBUT)

  • TBUT is the number of seconds it takes for your tear film to break up

  • 10 seconds or greater is normal

Dry Eye Testing
  • This is an eye after Fluorescein Dye application

  • We use a Blue Light

  • Notice the Green Dry Spots (ARROW) near the bottom

  • You can see single spots as well as collections of dry spots

  • This is an eye with Moderate/Severe Dry Eye

  • A person like this may be in pain or they may have no symptoms at all

  • This person NEEDS TREATMENT

Dry Eye
  • Tear Break Up Time (TBUT) is an important test

  • After blinking, we measure how long the tears stay on the eye surface

  • This is caused by Evaporation

  • Normal is 10 seconds or greater

  • People with a Quick TBUT (less than 10 seconds) may notice

    • Blurry vision

    • Aching

    • Burning

Evaporative Dry Eye and tear break up time
  • What Directly affects TBUT???

  • Your Meibomian Glands

  • These are vertical glands in your eyelid that have a small opening near your eyelashes

  • They secrete oil every time you blink

  • Good Oil often means good TBUT

  • Low Oil means bad TBUT

Meibomian Glands
  • See Meibomian Gland Testing

  • The TOP shows healthy glands

  • The MIDDLE shows mild loss of glands (ARROW)

  • The BOTTOM shows severe loss of glands

  • Gland loss means no oil production

  • No oil production means bad TBUT

2. InflammaDry

  • InflammaDry measures tear inflammation

  • We know that tear inflammation is one of the main causes of dry eye

  • The picture shows the results for a right eye (R) and left eye (L)

  • A positive result is indicated by a PINK strip

  • In this case, the right (R) eye is negative/borderline and the left (L) eye is positive (ARROW)

  • If you have inflammation we can treat you with drops to reduce it

Overview of Dry Eye

Evaporative Dry Eye and tear break up time
Evaporative Dry Eye and tear break up time

PHOTO 1: Good tear film right after blinking

PHOTO 2: Tear film is breaking up after 7 seconds (ARROW)

  • This is a VIDEO of Tear Break Up Time (TBUT)

  • The tears evaporate over a period of seconds

  • Watch the dry areas get larger

  • People experience this as pain, irritation, and blurry vision

  • This is made worse by using computers, cell phones, and reading

Meibomian gland dysfunction and dry eye
Meibomian gland dysfunction and dry eye

PHOTO 1: Plugged Glands (ARROW)

PHOTO 2: Glands after expression (ARROW)

1. What is Dry Eye?

  • There are many different causes of dry eye

  • You may not make enough tears or your oil glands may not be working

  • Cell phone and computer use makes dry eye worse

2. Testing for Dry Eye

  • Learn about Fluorescein staining, Tear break up time (TBUT), Schirmer's testing, and InflammaDry

3. Treatment for Dry Eye

  • Start with over the counter treatments like Artificial Tears and ointment

  • Learn about prescription grade medication

  • Procedures can help you as well

dry eye and artificial tears
Systane dry eye drops

1. Artificial Tears

  • First line treatment and over the counter

  • These drops lubricate the surface of the eye

  • Brands include Systane, Refresh, Genteal, Blink

  • They come in preserved and preservative free variations

  • Preservative Free are easier on the eyes

Which variations should I use?

  • Preservative Free: Contains fewer chemicals like Benzalkonium chloride that can cause irritation. Ok to use 4 or more times per day.

  • Oil-based: Your tears have oil in them to stop evaporation. These drops attempt to mimic that by adding small amounts of oil.

  • Gel: This is a thicker drop that stays on the eye longer. It might cause the vision to be blurry temporarily.

  • Ointment: Thick ointment is often used before bed for moderate/severe dryness. It makes the vision very blurry.

Bottom Line?

  • Use What You Like: many patients find they have a preference for a specific brand and type of drop

  • If one brand burns or doesn't feel good, then try another brand

  • Some patients love the thicker drops, but others think it blurs their vision for a long time

  • Always follow your doctor's recommendations

Restasis and xiidra dry eye drops
cequa dry eye drops

2. Anti-inflammatory Drops

  • Inflammation is one of the main causes of dry eye disease

  • Pain and irritation is the result of inflammation

  • It damages the liquid and oil producing glands of the eye resulting in less tears

  • Anti-inflammatory drops improve comfort and can increase the amount of tear production

Steroid Drops

  • Steroid eye drops are a temporary treatment for dry eye

  • They reduce inflammation quickly and can give relief to those suffering from pain

  • Long term use is possible at low doses, but there can be side effects

  • The most concerning side effects are pressure elevation and glaucoma

  • Patients on topical steroids should be followed by their doctor

Anti-inflammatory (Non-Steroid)

  • Anti-inflammatory drops like Restasis, Xiidra, and Cequa are used for long term treatment

  • They reduce inflammation, improve comfort, and can help with tear production

Punctal plug and dry eye
Punctal plug and dry eye

3. Punctal Plugs

  • Punctal plugs work by reducing the drainage of your tears away from the eye

  • Tears drain through the punctum into the nose

  • You have a lower and upper punctum

  • If you plug the punctum, tears stay on the eye longer to provide more lubrication

  • The lower punctum is most often plugged (ARROW)

The Procedure

  • Insertion of punctal plugs usually takes less than 1 minute

  • It is performed by your doctor

  • The eye is numbed with topical drops

  • You should feel mild pressure, but no pain

  • One or both eyes can be plugged

  • The photo shows a clear plug (ARROW)

Tyrvaya and dry eye

4. Tyrvaya Nasal Spray

  • Increases tear production for a period of hours

  • The device is placed into the nostril and pushing down releases a spray

  • One spray causes you to produce more of your own tears

  • Must be prescribed by your doctor

How it works

  • Medication within the nostril stimulates a nerve within the nose

  • This is connected to the glands that produce tears

  • Increased tear production may occur for a period of hours after using Tyrvaya

  • Patients may also experience sneezing, nose irritation, and cough

Serum tears for dry eye

5. Serum Tears

  • Serum tears (AKA autologous tears) are drops made from your own blood

  • Blood is drawn and the red blood cells are removed leaving the serum

  • Serum tears may be a good option if artificial tears and anti-inflammatory drops aren't enough

  • They have proteins and growth factors found in the serum to promote healing

Dry eye and bruder mask
meibomian gland disease
Warm compresses and meibomian gland disease

6. Warm Compresses

  • Compresses are used to treat meibomian gland disease

  • Meibomian glands express oil that sits on top of the liquid part of your tear film

  • That oil prevents evaporation of your tears

  • Compresses help turn glands that have hardened material back to soft or oily material

Instructions: Warm Compresses

  • Take a small towel and dip it in warm water

  • Wring the towel out and make sure that it is not too hot for your face

  • Place the towel over your closed eyelids for about 5 minutes

  • Reheat in warm water as needed

Bruder Eye Mask

  • Masks like the Bruder mask can be used in place of warm compresses

  • These can be heated in the microwave to the desired temperature

  • They often stay hot for a longer period of time

  • Make sure the mask is not too hot before placing on your face

What is Dry Eye?

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