Hello I’m Doctor Croley and welcome to Case of the Day. Today we are going to talk about an interesting lady who came in with a complaint that her eyes are being irritated and she felt that they were dry. She’d been actually to one of the major universities in the country, about her dry eyes and didn’t think she was given relief, and read about a new system called LipiFlow and LipiView, which is a new treatment and for that the first FDA-approved treatment for dry eyes or meibomian gland dysfunction. She’ve read that we had the system and wanted to see if we can help her with her irritated eyes.
So, she came in, and actually the LipiView part of the test, is a scanning interferometer, that actually scans the surface of your tear film on your eye. It takes a video of your eye. As we watch the video, from the machine, you can actually see the oily layer on the surface of dye, that there is an oily layer present, and how much is there. And also interesting is that you can watch the blinking pattern of someone’s eyes.
So, after we did the test, it was noted that she was not blinking her left eye more than basically not even quite halfway down. And on that left eye, in which eye she’s been complaining about, she had a lot of scarring of her cornea. Basically after these tests, it turns out she was not blinking that eye and therefore the eye is drying out and getting irritated. Actually the lipid layer of her tear film was normal, also was her tear osmolarity. Actually she did not have really dry eyes per se, she actually had very poor blinking on one side that was causing dry-eye-like symptoms.
That brings us to dry eyes. So what are dry eyes? Basically that is, the tear film on the surface of your eye is inadequate and therefore that leads to symptoms. Those symptoms could be: redness, irritation, the variety of types; people complain of a foreign body sensation; the dry eye feel scratchy; that they have blurred vision, a lot of times there is intermittent blurred vision; that they could have mucous or their eyes feel sticky; and so there is a variety of symptoms along that line that people could complain of. Probably the most common thing that people come in and complain about is their eyes burn and water. And so when someone comes into my office and their eyes are burning and watering, and I examine their eyes and I say, “Guess what, you have dry eyes.” And they think, “Doc, you gotta be crazy! Mine is watering all day long, how can that be? You just don’t know.” So I have to sit down and explain what dry eyes are and how their eyes could be watering when their eyes are dry.
Your tear film is made up of three layers. There is a mucus layer on the bottom surface, on the outer coating of the eye, then there is the middle water layer, and there is the oily layer or lipid layer. And you have to have all three of those layers in the proper amount, and for your tear film to be normal, and for your eyes to be healthy.
If you’re missing some of those tear components, then your eye will not be covered with the proper amount of tears, and the cells of your eye will then become irritated. Actually some of them die, so many people have spots or staining on their cornea when we put a dye their eye, where the cells are broken down and they actually have dead cells on the surface of their eye. And all these irritation causes inflammation of the eye and over time this chronic inflammation makes your eye get worse.
So, if you got something in your eye, or you scratch your eye, or you’ve got the pink eye or eye infection or you do something with your eye, your eye waters. That’s normal. So, if your eyes dry out to the point that those cells are irritated, inflamed and unhappy, that you’re sitting there in this dry environment, they’re gonna send a signal to your lacrimal gland, that is the big gland that produces the water part of your tears, that is sort of the crying gland, so it tells the gland, “We need help, we are in an irritating environment, we need help”. So, that gland just pours out water, but not necessarily in a controlled manner. So people with dry eyes, typically come in and complain that their eyes are scratchy, burning and watery. Actually the treatment for that, at least initially, is to put in artificial tears to calm your eye down.
In basic terms, that’s what dry eyes are. So we go back to the LipiView and LipiFlow which this lady first came in for. We now have the capability of telling you more about your dry eyes. It used to, in the old days or previously there is still a few of these machines still in the US at this time. “Your eyes were dry, we can tell by looking at your eyes that they were dry and here’s some tear drops and that will sort it out.”
Now we can actually tell you what part of your tear film is not correct. So we now have a test called a tear osmolarity which measures the salt level in your tear film. So if you don’t have enough of the liquid layer part of your tears, then the normal amount of salt and minerals and components of your tears that are produced, still are there but the tear part has evaporated off your eye. And so that then causes the salt level to go up, and therefore that is one of the leading reasons why people’s eyes are irritated as there is an increase in the salt level on the surface of their eye. And just like there is no fish that live in the dead sea, because it’s too salty, your body has to have a normal salt level in order for the cells to be normal. Because of evaporation off the surface of your eye, the salt level can increase on the surface of your eye and lead to irritation and dry eyes.
There’s two main reasons for people to have dry eyes. One is that they’re not producing enough of the liquid layer of their tear film, and two is meibomian gland dysfunction. So it’s a big medical term but basically what that is, is that you have glands in your lid, upper and lower lid, and those glands are called the meibomian glands and they are responsible for producing that outer lipid layer of your tear film.
Probably the most common cause of dry eyes that we found out recently is that, maybe 75 to 80 percent of people who have dry eyes, is due to meibomian gland dysfunction, that is the glands in your lid are not producing the proper amount of lipid or oil that goes on the front outside surface of your tear. That oily layer is responsible for, just like oil rises on top of water, it’s responsible for covering over the water part of your tear film and protecting it from evaporating off your eye, and of course, the oil lubricates your eye as well.
Seventy-five to 80 percent of people who have dry eyes, may have meibomian gland dysfunction. So we now have ways we can treat that, one of those is LipiFlow, and that is actually one of the first FDA approved treatment for dry eyes and it actually treats the meibomian glands. So what happens is an apparatus is put on your eye and part of it slips inside your eyelid and part of it goes on the outside of your eyelids. The inside part heats the lid up, to a few degrees above body temperature. Just like when you put grease in a pan and you heat it up that gets more liquid, so the same thing in your lid. So we heat the lids up inside where the glands are located, and that makes the oil or lipid layer more liquified, and then on the outside there’s a balloon that gradually pumps up and down and it presses and tries to clean out the glands in your lid so that they function better. In the study that was done for the FDA, 80 percent of the people who had this treatment felt their eyes are better after the treatment.
We are going into more treatment because there is now a long list of things that we can do to treat dry eyes so in the near future we come back and discuss some of the other treatments for dry eyes.
So have a great day, if you have any questions you can try to reach us through the website and may God bless you and your eyes and have great vision.