Dry Eye is the most prevalent eye disease in the world. In fact, approximately 30 million people in the United States have dry eye, which is about 10% of US population. However, only a small percentage have actually been diagnosed and treated. Why? This is because most patients don’t realize their eye discomforts are actually symptoms of a legitimate medical disease. We often attribute our itchy, dry eyes to “too much time on the computer,” or we simply think our contact lenses aren’t working. In reality, Dry Eye is a more serious – and treatable – medical condition known as Dry Eye Disease.
Do I Have Dry Eye?
Common symptoms of Dry Eye Disease include:
- Blurred vision
- Fluctuating vision
- Burning Foreign body sensation (eyelash in the eye or sandy/gritty feeling)
- Tired Eyes
- Inability to wear contacts comfortably (or reduced wear time)
- Light sensitivity
- Watery eyes (Paradoxical Dry Eye)
Symptoms vary greatly from person to person, depending on the type and the severity of dry eye. You may only have one of the above symptoms, or you could experience all of them. If you are experiencing any of these symptoms, you may have Dry Eye Disease.
What Causes Dry Eye?
Dry Eye Disease occurs when the tear film within our eyes becomes unstable. In a healthy eye, tear film is a balanced combination of three layers: the inner mucin layer, the middle water layer, and the outer oil layer. Dry Eye Disease starts when one of these layers is affected.
Most dry eye sufferers experience problems with the oil layer due to a condition called Meibomian Gland Dysfunction, or MGD. Imagine having a cup of water outside in the Texas heat. In time, the water evaporates. This is exactly what happens to your tear film. Remember, the middle layer of tear film is water, and the layer on top of it is comprised of oils. If MGD is causing reduced oil production, the water in the middle layer remains exposed and will evaporate, leaving you with dry eyes. This is known as Evaporative Dry Eye.
Another type of Dry Eye is called Aqueous Deficiency. In this case, the outer oil layer is sufficient, but the middle layer of tear film actually lacks water. This can be caused by many things such as systemic diseases (Sjogren’s, Arthritis, Thyroid, Lupus or any other inflammatory condition) or secondary to medications (allergy medications, anti-depressants, or oral contraceptives).
In either case, Dry Eye Disease is caused by unstable tear film. The two keys to an effective Dry Eye treatment are:
- Figure out why the tear film is unstable.
- Start treatment early.
Can Dry Eye Actually Cause Damage?
Dry Eye Disease is more than discomfort. It is a chronic and progressive disease, which means without treatment, it will get worse with age. When the tear film on the surface of your eye becomes unstable, whether it is from a lack of oil or a lack of water, our tears become salty, or hyperosmolar. The hyperosmolar tears then cause damage to the front of the eye.
This video provides a great overview of the effects of hyperosmolarity on the eye:
How do we Diagnose Dry Eye?
In order to determine if you have Dry Eye Disease, as well as the underlying causes of the condition, we offer the NuVision Dry Eye Evaluation.
This is an extensive check if your entire tear system, which includes the following tests and scans:
- To start, we utilize a technology called TearLab to measure osmolarity, or the saltiness, of your tears.
- Then we take images of the Meibomian Glands on your lower eyelids to determine if there has been damage that has created an Evaporative Dry Eye condition (lack of oil).
- If we suspect Aqueous Deficient Dry Eye, we have a simple test that helps us understand how much water your tears are producing (tear production).
- We conduct a scan called Corneal Topography that allows us to detect any subtle irregularities due to the tear film.
- And finally a Slit Lamp Examination will allow us to evaluate meibomian gland structure and function, observation of both the oil and water layers, and check for any damage to the front of the eye.
These tests are non-invasive, and the entire process takes only about 60 minutes to complete. At the conclusion of your NuVision Dry Eye Evaluation, your doctor will be able to diagnose the cause of your Dry Eye Disease and recommend appropriate treatments for your needs.
How is Dry Eye Treated?
During your NuVision Dry Eye Evaluation, we evaluate your tear film stability, tear osmolarity, the amount of inflammation in the tears and corneal damage. Based on these factors, along with evaluating your lifestyle and daily routine, we will be able to prescribe a treatment plan that is tailored to your needs.
Lubricants (Artificial Tears)
Artificial tears can be used to help refresh the eye. Some patients need liquid tears, and others need tears to be a little more oily, so they last longer throughout the day. We will recommend an artificial tear based on your type of dry eye.
Once tears are produced, they can do one of two things:
- They can drain from your eye through an area called the punctum.
- They can evaporate.
Punctal plugs reduce the amount of tears being drained, thus, more tears are left on the front of the eye. This procedure is usually combined with other treatments, such as anti-inflammatory treatments, and only takes a matter of seconds.
Restasis/Xiidra/Klarity C Drops/Cequa
Any of these specialty drops can be used to decrease the amount of inflammation:
- Klarity C Drops
We know that dry eye is a chronic and progressive disease, which means that if left untreated, it will only get worse.
If you have dry eye now, just imagine it five times worse. That’s your potential future if left untreated.
LipiFlow Plus is one of the best and most comfortable treatments we have to treat MGD, the leading root cause of dry eye. LipiFlow is performed in our office, and it lasts 12 minutes. We can combine Lipiflow with IPL and we call this Lipiflow Plus. Patients describe LipiFlow as a spa-like experience. Using the LipiFlow device, we warm the oil glands of the eye, followed by a massage of the glands. The heat and massage help re-open the oil glands, stabilizing the tear film, decreasing inflammation, and increasing the lubrication to the front of the eye. This treatment can last anywhere from six months to three years.
Intense Pulsed Light (IPL)
Intense Pulsed Light (IPL) is another great option for treating Meibomian Gland Dysfunction, the leading root cause of dry eye. The use of IPL is gaining popularity in the treatment of MGD. In fact, our very own Dr. Saenz was the first eye doctor in San Antonio to use the IPL for MGD, and has even had the treatment himself.
PROKERA® Ocular Surface Treatment
Parkhurst NuVision is pleased to offer our patients PROKERA®, a new treatment for chronic Dry Eye that heals the surface of your eye (the cornea) and returns your eye to a normal, healthy state. PROKERA is similar to a contact lens and is made of FDA-regulated amniotic tissue, which is known for its natural therapeutic actions and heals your eye faster with less pain, scarring, and inflammation. Clinical studies have shown PROKERA reduces the sign and symptoms of Dry Eye, and helps soothe pain, heal the eye, and improve vision. PROKERA is a simple procedure and is easily inserted and removed in our office. Once removed, your cornea is rejuvenated so you can see and feel better. In a recent patient survey, 93% of patients with Dry Eye said they felt better after treatment with PROKERA.
PROKERA is the only FDA-cleared therapeutic device that reduces inflammation and promotes healing.
TearCare is a software-controlled, wearable eyelid technology designed to provide targeted and adjustable thermal energy to the meibomian glands of the eyelid. Designed to mimic the functionality of the blinking eye, proprietary SmartLid™ technology facilitates natural meibum expression during this comfortable, in-office treatment.
With the TrueTear® Intranasal Tear Neurostimulator (TrueTear® device), patients are able to achieve a temporary increase in tear production during neurostimulation to improve dry eye symptoms.
This prescription device causes your eyes to produce their own tears via tiny pulses of energy. TrueTear is simple to use, with only 2 buttons, and it’s completely portable. TrueTear even has a smartphone app that allows you to track the device’s battery level, use and intensity levels.
Severe ocular surface diseases involving severe inflammation, such as Dry Eye Disease, can often be difficult to treat solely with conventional methods like artificial tears and topical steroids. The use of Autologous Serum Administration (AS) provides an effective and alternative method for severe inflammation. AS involves using a component (serum) from a patient’s own blood to replenish his or her natural tears, nourish the ocular surface, and decrease inflammation.
If you’re a doctor and are interested in serum tears for your patients, please call our office to speak with your Optometric Liaison for further details – (210) 585-2020.
Inflammation of the eyelid can come from bacteria or mites, or it can just happen to people who are prone to inflammation on their skin. Blephex is a treatment that can be used to clean the eyelid and help decrease eyelid inflammation, which in turn decreases the amount of inflammation in the eye. Additional options include scrubs and hypochlor.
Nutritional Supplements and Other Remedies
During your NuVision Dry Eye Evaluation, we will discuss nutritional supplements and other remedies which might be beneficial to you. For example, if you are a computer user, having your computer below your line of sight (or below eye level), can help decrease the amount of eye exposure, which can decrease symptoms related to computer use. Try it out!
HydroEye is a patented nutritional formulation that works from the inside out to deliver ongoing support for dry eyes. HydroEye delivers a proprietary blend of omega fatty acids (GLA, EPA and DHA), antioxidants and other important nutrients that work in harmony to support a healthy tear film and soothe the ocular surface.
HydroEye is much more powerful than flaxseed oil or fish oil alone. It provides the unique omega fatty acid, GLA, from black currant seed oil (not easily obtained from the diet), along with Omega-3 EPA and DHA from highly pure USP®-verified fish oil.
When Parkhurst NuVision treats my dry eye, can you also prescribe glasses or contacts?
In order to focus our efforts in our vision correction and dry eye patients, we have made a conscious decision not to offer glasses and contacts at Parkhurst NuVision. We rely on optometrists in our community who specialize in this. If you are looking for an optometrist, please don’t hesitate to give us a call so we can recommend a doctor for you! If you are tired of your Dry Eye symptoms, please contact us for your NuVision Dry Eye Evaluation now.
If I have dry eyes, can I get LASIK?
Yes! We have helped many patients who were experiencing dry eyes with their contact lenses. If we remove the contacts (which cause the dryness) and start treatment for dryness, we are able to help patients enjoy clear, crisp vision after Modern LASIK.