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Dry Eye Disease



More than 25 million Americans suffer from dry eye, a chronic, progressive disease that can cause tired, uncomfortable eyes, and blurred or fluctuating vision. In moderate to severe cases, it affects quality of life by making it too difficult to keep the eyes open long enough to read, drive, watch a movie, or look at a computer. In some patients, their occupation requires 8-10 hours per day on a computer. Dry eye can impact the ability to do their job. The outcomes following some dry eye surgeries can be adversely affected by dry eye.

Dry Eye is a multi-factorial disease. Risk factors include age, gender (increases in women post menopause), poor diet, (low in omega-3 fatty acids, high in bad omega-6 fatty acids), autoimmune disease (thyroid, lupus, rheumatoid arthritis, diabetes, Sjogren’s syndrome), low blink rate (due to use of digital devices or systemic disease such as Parkinson’s), medications (antihistamines, anti-depressants/anti-anxiety, diuretics, birth control pills), ocular surgery, contact lens wear, and environment (dry climate, low humidity in winter, windy conditions, flying on an airplane.)

Dry Eye Center of Excellence

Thomas Eye Group is a TearLab Accredited Dry Eye Center offering state-of-the-art diagnostic testing and management of dry eye. Stuart Newman, M.D. in our Roswell office leads the Thomas Eye Group Dry Eye Center of Excellence. Dr. Newman is a Board Certified ophthalmologist who specializes in comprehensive medical and surgical care of the eye including eye exams, contact lenses, diagnosis and treatment of dry eye disease, and refractive surgery. If you need dry eye relief, contact our Roswell office to schedule a dry eye evaluation with Dr. Newman.

Types of Dry Eye

There are 2 basic types of dry eye: evaporative (86%) and aqueous deficient (14%) or the 2 can co-exist. In aqueous deficient, the patient does not make adequate tears and in evaporative, the tears evaporate too quickly in between blinking. Tears are composed of 3 basic components: mucus, water, and oil. The oil is secreted by oil glands (Meibomian glands) in all 4 eyelids. The purpose of the oil is to act like glue to keep the tear on the ocular surface. If the oil component is not healthy, the tear evaporates too quickly. The oil component normally has the consistency of olive oil and looks watery and clear. But if abnormal it looks more like toothpaste. This toothpaste secretion blocks the openings of the glands and can lead to styes (chalazia) in the eyelid and loss of eyelashes. It also causes inflammation (chronic redness) of the ocular surface, leading to an unstable tear film that evaporates too quickly. Symptoms may include redness, burning, itching, irritation, gritty sensation, sticky discharge in the morning, a sensation of a film in vision, matting, and crusting of lashes, light sensitivity, and even watering of the eyes. Paradoxically, a dry eye can present with profuse watering. If the ocular surface is dry, it tells the brain and the brain tells the tear gland to compensate by making tears. However, these compensatory tears are abnormal reflex tears and the patient is bothered by looking through a pool of abnormal tears, blurring their vision. They have to constantly wipe away tears, which irritates the surrounding skin.

Dry eye can be mild, moderate, or severe. In mild dry eye, the patient may not even be symptomatic, but there are signs of dry eye upon examination. It is imperative to start treatment at this early stage, because one dry eye advances to severe, it can be very resistant to treatment. Severe dry eye causes extreme ocular discomfort and severe blurring of vision. Studies have shown that it can have the same impact on quality of life as chest pain from coronary artery disease and can lead to depression.

At Thomas Eye Group, we have many new advancements in diagnostic screening for dry eye as well as new treatment options. Diagnostic tests include eliciting a patient history of symptoms of dry eye, clinical findings during exam, tear break up time (rapidity at which tears evaporate between blinks), Schirmer tear test, tear osmolarity testing, and Sjogren’s syndrome test. Dry eye treatment has to be individualized depending on type of dry eye and severity. It includes artificial tears, Restasis, steroid eye drops, fish oil (omega-3 supplements), punctual occlusion with plugs or cautery, Autologous serum tears, ProKera (biologic corneal bandage), PROSE scleral contact lens, heating mask, lid hygiene with Cliradex and Ocusoft, oil gland (Meibomian  gland expression and BlephEx exfoliation of the oil glands.

Altering external variables can be helpful:

  1. Take frequent breaks from computer (we use the 20/20 rule – every 20 minutes take eyes away from computer and look far away and blink several times for 20 seconds.)
  2. Lower the level of the computer (if you look down at the computer there is less surface area for tears to evaporate).
  3. Use humidifier at bed side while sleeping.
  4. Avoid fan, heat, air conditioning, or wind blowing directly on eyes.
  5. If possible, avoid systemic medication that can exacerbate dry eye.
  6. Avoid contact lens wear.

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