Dry Eye Syndrome
Tears are more than just an expression of joy or sorrow. Tears are an essential part of the eyes’ ability to see. With every blink tears are distributed across the surface of the eye – lubricating and cleansing the surface and washing away foreign objects. The tear film covers and protects the cornea, forming a tear “lens” responsible for two thirds of the eye’s refractive power (ability to see). When the tear film is dysfunctional or there is an imbalance between tear production and tear drainage, vision quality can be greatly affected causing blurriness and or decreased vision. A stable tear film is not only necessary in maintaining a healthy ocular surface, it is fundamental in achieving optimal visual outcomes for LASIK and refractive cataract surgeries, proper contact lens fittings and glasses correction.
“A healthy, stable tear film is crucial to the outcome of your cataract and LASIK surgery and in fact is so essential that any surgery, contact lens fitting or glasses corrections should be delayed until your tear film has been treated and optimized.”
–David R. Pernelli, MD
Tear film deficiencies have become so prevalent that 50% of adults over the age of 40 have Dry Eye Syndrome with numbers increasing yearly. 30% of individuals under the age of 30 are known to have Dry Eye attributable to use of handheld computerized devices.
Dry Eye Symptoms
Frequently Dry Eye can be present with few or no symptoms initially and is often ignored or not recognized until symptoms worsen. Those suffering with Dry Eye commonly complain of:
- Blurry or fluctuating vision
- Excess tearing
- Light sensitivity
- Contact Lens discomfort
- Foreign body sensation
Causes of Dry Eye
Dry Eye Syndrome (DES) can occur in people who are otherwise healthy. The following can be contributing factors to Dry Eye Syndrome:
- Hormonal changes
- Sun exposure
- Environmental factors such as wind, air conditioning and heating
- Decreased blink rate due to reading and computer usage
- C-Pap or Bi-Pap usage
- Handheld computerized device usage
- Autoimmune disorders such as Sjogren’s Syndrome
Dry eyes occur when the meibomian glands, which are responsible for maintaining your eyes’ tear film, become compromised and are unable to produce the quantity or the quality of tears necessary to lubricate the eye. Often undiagnosed, Meibomian Gland Dysfunction (MGF) continues to degrade the quality of your tears until symptoms become intolerable. Untreated Dry Eye can lead to damage to the ocular surface and corneas and can result in poor visual outcomes following cataract and LASIK surgeries.
Tear Film 101
Your tears are made up of three components:
- Lipid Layer is the outermost layer which acts as a sealant to keep tears from evaporating.
- Aqueous Layer is the middle layer that carries salt, vitamins and minerals to the cornea.
- Mucin Layer is the innermost layer providing nourishment and ensuring the even spread of tears over the corneal surface.
When the meibomian and lacrimal glands that produce these components of your tear film are not working in tandem or are compromised, the volume of tears and or diminished quality of tears can result in Dry Eye.
Types of Dry Eye
- Evaporative Dry Eye (most common): is caused by decreased function of the meibomian gland resulting in poor tear film quality and rapid evaporation.
- Aqueous Dry Eye: is a result of the lacrimal glands not producing enough tears.
When Dry Eye goes undiagnosed or is left untreated, daily activities can be frustrating and activities such as reading, driving, watching TV or using a computer can be difficult.
Diagnosing Dry Eye
In order to properly diagnose Dry Eye, Dr. David R. Pernelli, MD, and Dr. Terrance K. Heacox, Jr., OD, will ask you to complete a Dry Eye questionnaire and may perform a combination of several tests to determine the level of dysfunction or deficiency of your tears.
- Tear Osmolarity testing utilizes the Tear Lab collection and a testing device which collects a small amount of your tears and then analyzes the tears to determine the level of dryness. It ranks the level of your tears on a measurable scale which, when repeated, can show improvement or decline in the quality of your tears.
- Corneal and conjunctival staining involves placing a drop of flourescein in the eye and evaluating the eye under a slit lamp for meibomian dysfunction and corneal surface.
- Corneal typography maps the ocular surface outlining areas of change due to Dry Eye.
- Ocular Coherence Tomography (OCT) provides a reliable, more precise comparison and evaluation of tear retention pre and post punctal plug placement.
- Sjo testing panel is a blood test which can detect Sjogren’s Syndrome early in the course of the disease. This is particularly beneficial because individuals with Sjogren’s have an increased risk of developing lymphoma or complications of the liver, thyroid or lungs.
- Doctor’s Allergy testing is a three minute, in-office testing system that tests for 58 common ocular allergens. Results can be determined in as little as 10-15 minutes leading to quick, appropriate treatment and can help to differentiate between Dry Eye, ocular allergies and blepharitis, all of which have symptoms in common.
Treatment for Dry Eye
Over-the-counter eye drops and artificial tears rarely provide effective relief of Dry Eye symptoms. The only way to diagnose and treat Dry Eye, blepharitis, Sjogren’s syndrome or any of the related ocular conditions is by having an examination and testing performed by a dry eye specialist at a recognized eye center. At the Eye Institute of South Jersey, PC, a nationally recognized and designated Dry Eye Center of Excellence, Dr. David R. Pernelli, MD and Dr. Terrance K. Heacox, Jr., OD can assess your condition and may recommend treatment options to include:
- Lid hygiene regimen
- Oral supplements to increase tear production and quality
- Punctal plugs to reduce tear drainage from the eyes
- RESTASIS® or Xiidra® eye drops to increase tear production
- Intense Pulsed Light treatments to unblock the eyelid glands
- BlephEx© lid and lash cleansing and exfoliating
- Eyelid surgery
- Protective eyewear for sleeping
If you are suffering with dry eye symptoms such as excessive eye watering, itching, stinging, redness, pain, blurry or decreased vision or an inability to wear contact lenses – or if you are considering LASIK or an advanced technology IOL for cataract surgery – contact the Eye Institute of South Jersey, PC, at (856) 205-1100 to request an eye exam and learn about your options for relief.