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Dry Eye Syndrome



What is Dry Eye Syndrome?

Dry Eye Syndrome (DES) is the most common eye condition worldwide. DES is a chronic condition where the eyes do not produce the proper tears or enough tears necessary to maintain healthy moisture in the eyes. The most crucial components to examine are the tear film and the Meibomian glands. Your tear film has three layers: lipid, aqueous and mucin. The Meibomian glands in the eyelids produce the oils needed for the tear layers. The lacrimal glands and conjunctiva also play a key role in balancing the tears. When these layers are not balanced, DES occurs. While dry eyes typically occur as we age, there are other factors that come into play that can cause DES. Symptoms of Dry Eye can range from mild to severe and can be present occasionally or continuously. Dry eyes can not only affect your vision but also your quality of life.

At Thomas Eye Group, we have a great team of experts to help from the diagnosis to treatment of all Dry Eye symptoms. Dr. Stuart Newman has specialized in the treatment of DES for over 10 years and leads the Thomas Eye Group Dry Eye Center of Excellence. He and his team are located at our Roswell location. Our Cornea specialist, Dr. David Sackel, also treats dry eyes for his patients. Dr. Sackel travels between our Roswell and Sandy Springs locations.

Common Causes of DES:

Dry Eye can present differently for each patient. Identifying the cause will help the specialist to determine the best treatment plan. The most common causes of DES can include:

  • Tear insufficiency or poor tear quality
  • Staring too long while reading or at the computer/phone
  • Allergies and your environment (wind, smoke or dry air)
  • Hormonal changes in women including pregnancy and menopause
  • Systemic disorders including auto-immune diseases, endocrine disorders, diabetes and rheumatoid arthritis
  • Aging; more common in women than men
  • Certain medications like antihistamines, acne medications, hormonal medications and depression/anxiety medications
  • Poor lid closure (Lagophthalmos aka “lid lag”)
  • Some refractive surgeries most commonly including LASIK®

Common Symptoms of DES:

  • Excess tearing
  • Discomfort such as itching, burning or light sensitivity
  • Blurred vision or fluctuation in vision when blinking
  • A foreign body sensation or feeling of “stringiness” in the eyes
  • Tired or fatigued eyes, especially at the end of the day
  • Contact lens discomfort
  • Redness

If you have any of these symptoms or believe you may have Dry Eye Syndrome, call Thomas Eye Group today to schedule an appointment for an evaluation. You can also go to the link at the top right of the page to access our Dry Eye Questionnaire.

Types of Dry Eyes and Diagnostic Testing

There are two types of Dry Eye: Evaporative Dry Eye and Aqueous Dry Eye. Evaporative Dry Eye is the most common form of Dry Eye affecting about 86% of all dry eye cases. Evaporative Dry Eye results when there is a blockage in the Meibomian glands (on your upper and lower eyelids) and cause a shortage of oil in your tears resulting in faster evaporation on the eye’s surface. This blockage is commonly known as Meibomian Gland Dysfunction (MGD). Less common among patients is Aqueous Dry Eye; when the lacrimal glands fail to produce enough fluid to keep the eyes moist. This type of Dry Eye can point to an autoimmune disorder. While there are a few autoimmune disorders that can cause Dry Eye, the most common is Sjögrens. Any family history of this disease or others should be recorded by the technician as well as any complaints of dry mouth, joint pain and fatigue.

During your work-up, a technician will conduct a few simple tests for the doctors; this includes the Schirmer Tear Test to measure the amount of tearing is in each eye, a TearLab® to determine the tear osmolarity (salt content) and lastly, the technician will perform a LipiScan® to see any dropout in the meibomian glands.

While you are with the doctor, they will do a slit lamp exam to look at the tear break-up time, look for any inflammation in the lids and may conduct a conjunctival staining using Lissamine Green to look at the surface of the eye. This staining helps your doctor determine the severity of the Dry Eye as it shows spots where devitalized cells are present. After your examination, the doctor may order an allergy test to further investigate the symptoms you are experiencing. One of our Dry Eye technicians will perform this in-office test, usually taking only 12 minutes. We test for 60 local environmental allergens and can measure the severity to each if any come up as “positive”. Instructions will be given before the allergy test on any medications to avoid before your appointment.

What Are My Treatment Options?

Since there are different individual factors that contribute to Dry Eyes, each treatment plan is specialized for YOUR eyes. At Thomas Eye Group, our Dry Eye Specialists, Dr. Stuart Newman uses specific methods in diagnosing Dry Eye. To best manage your symptoms and treat your DES, our specialists identify how and why the tears may be imbalanced. From there, the proper treatment plan can be determined, and you can begin to get relief!

Tears and Warm Compresses

The most common treatment is using artificial tears and preservative-free artificial tears to help keep the eye surface lubricated. Our specialists may also recommend the use of a lid scrub and lid cleanser as well as warm compresses using the Bruder® Heat Mask. A good alternative to using a lid scrub or lid cleanser is to use a small amount of baby shampoo. You can lather the shampoo and diluted water in your hands or on the fingers or with a cotton pad and gently scrub the lid margins with the eyes closed then rinse with warm water and dry with a clean towel.

If artificial tears are not enough to maintain the lubrication on the ocular surface, your specialist may add a Restasis® or Xiidra® regimen. These are prescription eye drops specially formulated to help increase the natural tear production in the eyes. Xiidra is also the only drop approved to treat BOTH types of Dry Eyes. These drops are approved for contact lens wearers, but it is advised to remove contacts and give the drops at least 15 minutes before re-inserting your contacts.

Autologous Serum Tears are also a treatment option for more severe cases where artificial and prescription tears are not adequate. These tears are made in a compounding lab using your own blood. The red blood cells and clotting factors are removed. The serum left over is then diluted with a sterile, preservative-free solution. You now have your own customized tears that have shown to give relief in the first few weeks of use. Just like Restasis® and Xiidra®, results will vary per patient in response to the tears.

In-office Treatments and Procedures

In some cases, a more invasive option will be used. For treatment of any lid dysfunctions, your specialist will offer the LipiFlow® or BlephEx® treatments. These are performed by certified technicians. Following each treatment, the doctor will do a quick check immediately after and one again in about 2 months to see how the eyes reacted to the treatment. A Meibomian Gland Expression may also be used. This procedure is done by the doctor and helps to express any clogged oil glands in the eyelids.

Other procedures include insertion of punctal plugs and a P&I procedure (probing and irrigation). Punctal plugs are placed in the tear ducts to help maintain moisture in the eyes by blocking the tears from draining into the ducts. P&I’s are performed when there is a blockage in the nasolacrimal ducts. The doctor will dilate the punctum and insert a tiny metal tube to flush out the blocked drain with a sterile solution.

PROKERA® is an alternate treatment for the cornea. Stated on www.biotissue.com: “PROKERA is made from amniotic membrane which has natural anti-inflammatory and anti-scarring properties. It is the only FDA cleared therapeutic device used by eye care practitioners to provide quick symptom relief and reduce inflammation associated with ocular surface disease. It helps restore your cornea and return your eye to a normal, healthy state.” This is commonly used to treat other symptoms of the cornea, but because DES can cause cornea issues, this is a viable option to help the eyes heal.

Ways to Help Prevent DES

  • Keeping a diet with anti-inflammatory foods and the use of vitamins, like Omega-3 or fish oil and keeping well-hydrated throughout the day.
  • Wearing sunglasses while outside or driving can help with light sensitivity.
  • Avoiding direct exposure to fans or vents can help prevent the eyes from drying too quickly.
  • Using the 20/20/20 rule while using the computer for hours at a time while at work. Every 20 minutes, take a 20 second break from your work, focusing on something in the distance about 20 feet away and blink.
  • Doing “blink exercises” throughout the day.

Daily Maintenance

After many of our in-office treatments, it is recommended to add a few simple tasks to your day to ensure your eyes continue to feel relief (just as you would brush and floss your teeth between dental check-ups). Adding warm compresses a few times a day for about 10-15 minutes, using lid scrubs and cleansers every morning and night and using artificial or preservative-free tears throughout the day will help prolong your results. If you are a contact lens wearer, the doctor may suggest you change the type of lens you use or take breaks from wear on occasion to increase oxygen flow to the cornea.

Dry Eye Syndrome

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