What is Dry Eye or Dry Eye Syndrome?
Dry eye syndrome or dry eye is a deficiency in one or more layers of the tear film. These deficiencies result from a variety of causes. There are two main types of dry eyes:
- Evaporative Dry Eyes
- Non-Evaporative Dry Eye or Decreased Tear (liquid layer) Production
Layers of the Normal Tear Film
There are three layers that compose the tear film.
Inner Mucous Layer
This layer is produced by the Goblet cells that are located in the conjunctiva (tissue overlying the white portion of the eye called the sclera and contains many blood vessels).
Middle Liquid Layer
This layer is the liquid layer that is produced by the Lacrimal gland and contains many nutrients and other tear components.
Outer Lipid Layer or Oily Layer
This layer is produced by the Meibomian glands located in the upper and lower eyelids. The openings of these glands are located on the eyelid margin or edge just inside of where the eyelashes are located.
Normal Tear Film
The normal tear film contains the proper amount of all three layers. Any decrease in one or more of the layers results in a breakdown of the tear film. The increase in the osmolarity due to the breakdown of the tear film causes a reaction or inflammation around and on the surface of the eye leading to the development of the dry eye syndrome.
Symptoms of Dry Eyes
- Foreign body sensation
- Scratchy sensation
- Eyes stuck together in the morning
- Blurred vision
Diagnosing Dry Eyes
In the past, the eye doctor would use the history, examine the eye with the slit lamp (microscope used to examine the eye), use a variety of stains to look for damaged cells and evaluate the quality of the tear film, measure the breakup time of the tear film, and Shirmer’s test to diagnose dry eyes. These methods do not diagnose the cause or type of dry eye syndrome.
New Dry Eye Tests for Diagnosing Dry Eyes
Tear Osmolarity is an instrument that is able to measure the salt levels or osmolarity of the tear film. If the liquid layer does not contain enough liquid, the minerals in the tear film become concentrated and the osmolarity increases above what the body normally maintains. This increased slats levels causes inflammation which leads to the development and progression of dry eyes. This test is useful for not only diagnosing dry eyes but also in monitoring the progress of the treatment for dry eyes.
LipiView is an instrument that utilizes a high resolution camera and takes a movie of the tear film on the surface of the eye. Using an inferometer, the instrument measures the outer lipid layer to microns of resolution. If the lipid layer in thin or decreased, the liquid layer will evaporate from the eye. Using the LipiView, the eye doctor is able to evaluate the blinking patterns of a person. Many people do not blink in a proper manner.
Evaporative Dry Eye
Evaporative dry eye may comprise as much as seventy five percent of dry cases. The Meibomian glands become plugged and are unable to secrete their lipid material secondary to infection and/or inflammation. The lipid material in the glands loses its normal character and becomes thickened or solid. The longer the glands remain blocked, the more damage that is done to the glands. Many will atrophy over time and never function again. Therefore, if you are diagnosed with Meibomian Gland Dysfunction, Meibomianitis, or Meibomian Gland Disease, it is important that it be treated to improve the dry eye syndrome and restore as many glands as possible.
New Treatment Regimens for Evaporative Dry Eyes
Baseline Maintenance Treatment
If you have evaporative dry eyes, treatment designed to help improve Meibomian gland production and function is essential in improving the levels of the tear film.
Lipid Containing Artificial Tears
There are several different brands of lipid containing artificial tears:
- Thera Tears
- Retaine MGD
- Bausch and Lomb
Retaine MGD is the only lipid containing artificial tear that is preservative free. Many patients have to use their tear from a couple times a day to as often as every twenty minutes a day. Using a preservative artificial tear can make it less irritating to the eye because it is preservative free.
HydroEye is a supplement that its main ingredient is Gamma Linolenic Acid (GLA). This is an omega-6 fatty acid derived from black currant seed oil. The GLA in HydroEye has a strong anti-inflammatory effect. HydroEye and GLA has been shown in several studies to significantly reduce the inflammation in the eye.
Hot compresses in the morning help to stimulate the Meibomian glands to secrete their lipid material. The person can use a hot wash cloth dipped in hot water (not so hot as to burn the skin) for ten to fifteen minutes first thing in the morning. You can also use Tranquileyes which uses gel beads that can be microwaved in a cup of water and placed in the Tranquileyes goggles that keep the eyes warm for ten to fifteen minutes.
New and Only FDA Approved Treatment for Meibomian Gland Dysfunction
LipiFlow is the only FDA approved treatment for Meibomian gland dysfunction or disease. LipiFlow gives the patient the opportunity to restore as many glands as possible. The LipiFlow apparatus is placed inside the eyelids and outside the eyelids. The inner portion heats up to 106 degrees to thin or liquefy the lipid material so that it can be more easily expressed from the glands. The outer portion contains a balloon-like apparatus that compresses the eyelids to clean out the Meibomian glands. In the FDA study, eighty percent of patients reported a significant improvement in their dry eye symptoms.
Today, eye doctors are able to diagnose the cause of the dry eye syndrome. The doctors are now able to customize a treatment for the cause of their dry eyes.