Dry Eye
Krug Optometry - Dry Eye Clinic
Recent studies estimate that there are more than 30 million people who suffer from dry eye disease in the U.S., but less than 2 million are being treated therapeutically. In western Kansas, our climate of low humidity and windy conditions can exacerbate dry eye symptoms. Untreated dry eye can lead to eye infections and scaring of the cornea resulting in permanent vision loss.
Mucous Deficient Dry Eye-
Mucous secretions from glands located in the conjunctival lining of the eyes. The mucous layer is the bottom layer of the tear film which covers the surface of the cornea and holds the other layers to the surface of the cornea.
Aqueous Deficient Dry Eye-
The middle, watery component of the tear film is produced by the lacrimal gland and is responsible for reflex tearing and crying.
Meibomian Gland Dysfunction-
The outer most layer of the tear film is oily in nature and is produced by meibomian glands in the eye lids. This layer prevents evaporation of the tear film.
Dry eyes can result if one or more of these layers is not functioning properly. The level of eye irritation and corneal deterioration can range from mild to very severe and can be sight threatening.
We also know that certain systemic diseases such as Sjogren's Syndrome and inflammatory diseases (rheumatoid arthritis, lupus) can contribute to dry eyes. In addition, certain prescriptions medication can exacerabte an existing dry eye.
Treatments for Mucous Deficient and Aqueous Deficient dry eye
There are many over the counter artificial tears in the liquid, gel and ointment form which can be helpful in the mild stage of dry eye disease. These must be used multiple times a day to be most effective.
As the dry eye condition worsens, symptoms of the constant irritation and blurred vision develop and will tend to worsen as the day goes on. At this stage prescription eye drops such as Restasis and Xiidra maybe helpful. They work by stimulating the tear glands to secrete more tears.
If the dry eye condition is causing significant inflammation of the cornea and conjunctiva, topical steroid eye drops may be helpful for limited periods of time.
Punctal Plugs
An alternative to daily drops for moderate to severe dry eyes is the use of punctual plugs. These small silicon devices are placed in the puncta and block the normal flow of tears away from the eyes. These are a good alternative for aqueous deficient dry eyes and for those who have difficulty with putting in eye drops. Medicare and most medical insurance will cover the cost of this procedure.
Specific conditions responding to punctual plugs:
- Aqueous deficient dry eyes
- Systemic medications such as antihistamines and anti-depressants
- Symptomatic contact lens wearers
- Dry eyes related to refractive surgery (LASIK)
- Lid closure abnormalities
- Corneal scarring and toxic epitheliopathy
- Superior limbic keratoconjunctivitis
Meibomian Gland Dysfunction
The new paradigm in the dry eye treatment is concentrating on the Meibomian Gland Disease (MGD) related dry eye disease. In a dry environment like Western Kansas where we have low humidity and windy conditions, meibomian gland dysfunction is the leading cause of dry eye disease.
The meibomian glands are located in the upper and lower eyelids and secrete the oily layer of the tear film, which is responsible for preventing the aqueous layer from evaporating. MGD occurs when the glands become blocked and the oily meibom cannot be secreted onto the ocular surface. If these blocked glands become infected, a condition known as a hordeolum or stye can occur, which may require antibiotic treatment to resolve.
Meibomian Gland Disease Diagnosis
Cornea and tear film analyzer
Normal meibomian gland appearance
Meibomian gland loss
Tear film disruption
Dry Eye Clinic - Treatment Recommendations
Determine type dry eye disease
Clean scurf from eye lid margins and uncap the meibomian gland openings.
Debride eyelid margin.
Concentrated heat treatment directly to eyelids.
Express meibomian glands
At home
Continue warm compresses to eyelids
Blephadex or other eyelid scrubs daily to remove debris and stimulate meibomian gland secretions.
If Aqueous deficiency
Use OTC or Rx eye drops to replace low tear volume
If the dry eye condition is causing significant inflammation of the cornea and conjunctiva, topical steroid eye drops may be helpful for limited periods of time.
