What is dry eyes?

Dry eye is a very common and often chronic problem. It can be found in people of all ages but typically worsens as we age. It is condition in which a person doesn't have enough quality tears to lubricate and nourish the eye. Good quality tears are absolutely necessary for maintaining the health of the cornea (the front surface of the eye) and for providing clear vision. Dry eye symptoms can include eye discomfort and sensitivity to light as well as red, burning, tearing, gritty, and/or itchy eyes. Dry eye can be caused by a wide range of factors including environmental factors (air conditioning, seasonal allergies and dust). Prolonged computer use as well as certain conditions, like Sjogren's syndrome and rheumatoid arthritis, can cause or exacerbate dry eye symptoms.

In a healthy eye, with each blink tears spread across the front surface of the eye. Tears are essential in providing lubrication, reduce the risk of eye infections, wash away foreign matter in the eye and keep the surface of the eyes smooth and clear. Excess tears in the eyes flow into small drainage ducts in the inner corners of the eyelids, which drain into the back of the nose. Dry eyes can occur when tear production and drainage is not in balance.

People with dry eyes either do not produce enough tears or their tears are of a poor quality:

• Inadequate amount of tears. Tears are produced by several glands in and around the eyelids. Tear production tends to diminish with age, with various medical conditions or as a side effect of certain medicines. Environmental conditions, such as wind and dry climates, can also decrease tear volume due to increased tear evaporation. When the normal amount of tear production decreases or tears evaporate too quickly from the eyes, symptoms of dry eye can develop.
• Poor quality of tears. Tears can be thought of as a soufflé. The tear film is composed of essentially three layers (mucus, water and oil) each in a very specific quantity. Each component has a different function which collectively protect and nourishe the front surface of the eye. The mucin layer spreads the tears evenly over the surface of the eye which the water layer bonds to. The smooth oil layer comes from glands found in your eyelids that is released with each blink. This oil layer helps prevent evaporation of the water layer. If the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers our tear film soufflé collapses and dry eye symptoms can develop.

The most common form of dry eyes occurs when the smooth oil layer is inadequate. This condition is found called Meibomian Gland Dysfunction.

People with dry eyes may experience irritated, gritty, scratchy or burning eyes; a feeling of something in their eyes; excess watering; and blurred vision. Advanced dry eyes may damage the front surface of the eye and impair vision.

Depending on your personalized in-office treatment plan, Dr. Rubinfeld might recommend additional at-home treatments which may include artificial tears, prescription eye drops, lid scrubs, warm compresses and nutritional supplements like Omega-3's.

Treatments for dry eyes aim to restore or maintain the normal amount of tears in the eye to minimize dryness and related discomfort and to maintain eye health.

What causes dry eyes?

Dry eyes can develop for many reasons, including:

• Age. Dry eyes are a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes.
• Gender. Women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives and menopause.
• Medications. Certain medicines, including antihistamines, decongestants, blood pressure medications and antidepressants, can reduce tear production.
• Medical conditions. People with rheumatoid arthritis, diabetes and thyroid problems are more likely to have symptoms of dry eyes. Also, problems with inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye, or the inward or outward turning of eyelids can cause dry eyes to develop.
• Environmental conditions. Exposure to smoke, wind and dry climates can increase tear evaporation resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to drying of the eyes.
• Other factors. Long-term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries, such as LASIK, can decrease tear production and contribute to dry eyes.

How are dry eyes diagnosed?

Dry eyes can be diagnosed through a comprehensive eye examination. Testing, with emphasis on the evaluation of the quantity and quality of tears produced by the eyes, may include:

• Patient history to determine the patient's symptoms and to note any general health problems, medications or environmental factors that may be contributing to the dry eye problem.
• External examination of the eye, including lid structure and blink dynamics.
• Evaluation of the eyelids and cornea using bright light and magnification.
• Measurement of the quantity and quality of tears for any abnormalities. Special dyes may be put in the eyes to better observe tear flow and to highlight any changes to the outer surface of the eye caused by insufficient tears.

With the information obtained from testing, Dr. Rubinfeld can determine if you have dry eyes and advise you on treatment options.

How are dry eyes treated?

The Way We Treat Dry Eye

Dr. Rubinfeld can conquer & manage blepharitis, Meibomian Gland Dystrophy and Dry Eye disease with LidPro Eye Exfoliator and MiBoFlo Thermoelectric technology, Blephasteam or IPL Technology.

Lidpro is a handheld device used to gently exfoliate the upper and lower eyelid as a treatment for Blepharitis. Blepharitis is a condition where an overgrowth of the bacteria in the eyelids and eyelashes causes a biofilm layer that prevents healthy tear production, leading to dry, painful, gritty, and watery eyes.

The exfoliation is very gentle using ultra soft cleaning discs with less friction at an increased speed means the process is faster and results in less irritation. Normally after the initial series of treatments a patient will be seen for this procedure every 4-6 months in order to maintain healthy eyelids and lashes.

The MiBo Thermoflo and Blephasteam are therapeutic medical devices that provide safe and effective alternative therapy for dry eyes. Both use thermoelectric heat to break down the hardened meibum clogging the glands, thus allowing natural oils to be secreted and improving the preservation and function of the evaporative component of the tear film.

Over time and with a specific prescribed therapy regimen, the ducts of the meibomian glands will secrete thinner and clearer lipids which will allow for a healthier tear film. Most patients benefit from four treatments but subsequent maintenance ensures long-lasting results.

Even after just one treatment, most patients experience a noticeable improvement. The sandy, gritty feeling often associated with dry eye is replaced by a smooth and silky sensation on the eyes' surface. More importantly, the newly lubricated eye surface will lead to improved eye health and vision clarity.

No one treatment method works for all patients. The right treatment course would be developed by Dr. Rubinfeld for your unique situation.

Patient happiness - priceless

Key points: healthier eyelids, immediate reduced inflammation of upper and lower lids, patient comfort. - many patients return to comfortable contact lens tolerance -patients resume normal activities same day -quick treatment yields 95% patient satisfaction.