Dry Eye Clinic

Nuvision centers

Dry eye clinic

Since dry eye can be related to many different conditions and is often chronic, we recommend you seek care from our doctors that specialize in dry eye treatment. Schedule an appointment with the clinic at our Ironwood location, and we can help determine the root cause of your symptoms and recommend the best treatment options for you.

Checkup Eye Exam

Dry eye clinic

About dry eye

What is dry eye?

Dry eye, also known as ocular surface disease or keratoconjunctivitis sicca, occurs when the tears aren’t able to provide adequate lubrication to the eyes. Oftentimes, dry eye is not related to a lack of tear production but instead is caused by an unstable tear film.

Do I have dry eye? How can I tell if I have dry eye? What are the symptoms of dry eye?

Many patients suffer the symptoms of dry eye without realizing it.
Common symptoms of dry eye are:

  • Red eyes
  • Contact lens discomfort
  • A feeling of sand or grit in the eyes
  • Fluctuating vision
  • Burning or stinging
  • Itchiness
  • Excessive tearing
  • Light sensitivity

Two or more of the above symptoms may indicate dry eye disease. For further evaluation, take the dry eye test below or schedule a dry eye examination with our office:

Dry eye severity quiz: http://www.supereyecare.com/resources/OSDI.pdf

Dry eye clinic

What causes dry eye?

Dry eye disease can have many different causes. Prolonged computer use, inflammation, clogged tear and oil glands of the eyes, certain cosmetics, medications, and medical conditions all play a role in dry eye.

The most common classifications of dry eye are listed below:

  • Meibomian gland dysfunction is the clogging of the meibomian glands that help produce thick and stable tears. (Very Common)
  • Aqueous Tear Deficiency is when the tear duct is not producing enough aqueous, also known as the watery component of the tears. (Uncommon)
  • Blepharitis is inflammation and build-up along the lash margins that lead to inflammation within the eyes. (Common)
  • Elevated Tear Osmolarity is when the eye has a loss of homeostasis.
  • Demodex are eye mites that can live at the base of lashes and increase inflammation within the eyes.
  • Computer Vision Syndrome – We blink an average of 30% less when staring at our computer screens and digital devices. Not only does this lead to dryer eyes, but it is also a major cause of meibomian gland dysfunction. (Very Common)
  • Nocturnal Lagophthalmos – Some patients sleep with their lids open, leading to dry eyes. (Less Common)
  • Sjogren’s Syndrome, Rheumatoid Arthritis, Acne Rosacea, and other systemic inflammatory conditions can lead to increased inflammation within the eyes. (Less Common)
  • Prescription and non-prescription medications such as antihistamine allergy drops, acne medications, and birth control can all be associated with increased dry eye. (Less Common)

Dry eye clinic

Dry eye evaluation

Dry eye evaluations are medical office visits designed to diagnose your dry eye and design a custom treatment plan tailored to your specific causes. While we have a variety of diagnostic tools and treatments available in our clinic, all dry eye evaluations start with the same two tools:

tear lab

Tear Lab is a diagnostic tool used to test for tear osmolarity. This allows us to determine how large of a role inflammation plays in causing a patient’s dry eye symptoms.

 

Oculus keratograph

The OCULUS keratograph is an advanced imaging machine that allows us to measure dry eye factors such as clogged meibomian glands, level of tear production, and tear evaporation rate. Not only is the Keratograph vital for determining the root causes of a patient’s dry eye symptoms, but it is also a fantastic tool for tracking and measuring the improvement of symptoms over time

NIKBUT ASSESSMENT OF THE TEAR FILM BREAK-UP TIME

The tear film break-up time is measured non-invasively and fully automatically. This scan is done by recording the way tears break up over the course of a few seconds without blinking. The infrared illumination is not visible to the human eye and prevents glare during the examination.

R-SCAN AUTOMATIC CLASSIFICATION OF REDNESS

The R-Scan is the first module that automatically and objectively documents and classifies the bulbar and limbal degree of redness. The R-Scan detects the blood vessels in the conjunctiva and evaluates the degree of redness.

MEIBOGRAPHY OF THE EYELID

One of the leading causes of dry eye is the clogging of meibomian glands (the glands that produce the oily component of tears). Over time, clogging can lead to atrophy and irreversible loss of the meibomian glands. The keratography allows us to view the health of a patient’s meibomian glands and design treatment plans that are tailored to counteract and prevent further changes.

Dry eye clinic

Treatments for dry eye

INTENSE PULSED LIGHT THERAPY

Lumenis Intense Pulsed Light (IPL) Therapy is among the more groundbreaking treatments for dry eye and styes. This in-office treatment uses specific wavelengths of light to reduce inflammation around the eyes, enabling oil-producing meibomian glands to better lubricate the eyes and significantly reduce unpleasant dry eye symptoms. This treatment is most effective for patients with a condition called telangiectasia. Telangiectasia are dilated small blood vessels that, when present around the eye, lead to excess inflammation and unstable tear film. Our doctors can help diagnose telangiectasia and evaluate whether this is the correct treatment for you.

Tempsure envi

Using safe, powerful, and highly effective radiofrequency energy, our treatment gently delivers a therapeutic level of heat to the delicate tissue surrounding the eye. This heat signals your body to reboot its natural healing processes, which in turn helps to boost collagen to tighten the skin around the eyes, reducing fine lines, wrinkles, drooping eyelids, and under-eye bags while providing relief from your dry eye symptoms.

Blephex for blepharitis

BlephEx is a painless in-office procedure performed by our doctors. This treatment removes excess bacteria and toxins that live along the lash margins and is an excellent remedy for patients with blepharitis-related dry eye.

Blepharitis is a common eyelid condition. Inflammation occurs when buildup around the lashes causes tiny oil glands located near the base of the lashes to become clogged, leading to red, swollen, and irritated eyes. Our doctors can help diagnose blepharitis and evaluate whether this is the right treatment for you.

Amniotic Membranes

Amniotic membranes are thin buttons of amniotic tissue preserved using cryotherapy. Amniotic tissue has long been used as a form of stem cell therapy to help with inflammation and healing. This treatment is best for patients who have long-term, chronic dry eye and can provide significant relief for patients suffering from corneal dystrophies or other related systemic conditions.

Punctual Plugs

Punctal plugs are an effective and simple solution for patients who are suffering from aqueous deficiency or contact lens related dry eye. Punctal plugs can be used to cover the puncta (the drainage system of the eyes). A punctal plug can help increase the quantity of tears in a patient’s eyes and relieve symptoms of dry eye.

OVER THE COUNTER LID CLEANSERS & ARTIFICIAL TEARS

Avenova is a lid cleanser that helps reduce and prevent blepharitis, meibomian gland dysfunction, and inflammation. Avenova is an excellent way to treat mild dry eye symptoms and prevent the progression of dry eye. Our doctors recommend it for all patients, not just patients with dry eyes.

Artificial tears are formulated to mimic healthy natural tears and can soothe and protect your eyes. We often describe artificial tears as a “Chapstick” for the eyes, as they do not prevent or treat dry eye; however, they do help soothe the eyes and reduce discomfort in patients with dry eye.

Brands we like at our office include Blink Tears, Systane Complete, Retain MGD, TheraTears, Refresh Tears, Oasis Tears, and Ivizia.

Brands and ingredients to AVOID:

Many drops that are advertised as redness reducers contain an ingredient called tetrahydrozoline, which tends to increase redness and dryness over time. The most common brands to avoid are Visine and Clear Eyes. For reducing redness, try Lumify drops instead. Another ingredient to avoid is belladonna, which is often found in medications advertised as homeopathic remedies. Belladonna is derived from a poisonous flower and is an archaic method of pupil dilation that is sometimes still used for cosmetic effects. Generally speaking, the brand Similasan is one to avoid, although their Ivizia drop is the exception to this rule as it is a safe and effective natural eye drop that we recommend to our patients.

PRESCRIPTION DROPS & SPRAYS

Restasis, Xiidra, and Cequa are medicated drops that reduce the production of T-cells in our eyes (one of the major inflammatory cells involved in dry eye). These medications are an excellent treatment for dry eye.

Tyrvaya is a nasal spray that is used to stimulate the production of “good quality” basal tears.

Eyesuvis, Lotemax, and Pred Forte are steroid drops that provide dramatic but temporary relief from dry eye symptoms. While steroids cannot be used long-term, they are often a first step towards making our patients more comfortable and providing immediate relief from inflammatory dry eye.

DIET, SUPPLEMENTS, AND LIFESTYLE CHANGES

Omega Fatty Acids have been shown to improve the production of the stabilizing oil layer of the tear film.

Foods high in Omega fatty acids include:

  • Fish: salmon, cod, mackerel, trout
  • Meat: red meats and pork liver
  • Oils: canola oil, sunflower oil, walnut oil
  • Cheese and eggs

Vitamins for dry eye:

  • Vitamin A (retinol) helps protect the surface of the eye. Vitamin A deficiency, which usually occurs in developing countries, can cause an increase in dry eye. By adding foods rich in Vitamin A, like carrots, pumpkins, apricots, spinach, tomatoes, dairy products, and liver, you can prevent the development of this condition.
  • Vitamin B2 protects your eyes from cell damage. It is found in broccoli, avocados, dairy products, and whole-grain products.
  • Vitamin B6 is needed for a healthy tear film. Foods such as kale, potatoes, goose, mackerel, salmon, and sardines contain high doses of vitamin B6.
  • Vitamin B12 is also important for lubricating the eyes. It’s typically found in mackerel, beef liver, calf’s liver, and pork liver. It is also found in dairy products and eggs, though in smaller amounts.
  • Vitamin C protects against oxidative stress and plays an important role in maintaining a functioning tear film. It can be found in peppers, broccoli, rosehip, acerola berries, and brussels sprouts.
  • Vitamin E is necessary to protect your eyes against cell damage and dry eye. This vitamin is prominently found in sunflower oil, mackerel, wheat germ oil, peppers, spinach, mangos, and redcurrants.

Lutine and Zeaxanthin are antioxidants that help prevent chronic eye diseases from macular degeneration to dry eye syndrome.

Foods high in these antioxidants include:

  • Romaine lettuce
  • Kale
  • Spinach
  • Egg yolk
  • Peppers
  • Grapes