Dry eye disease is a disease that has many factors contributing to it. There are three main categories of dry eye syndrome.
- Meibomian Gland Dysfunction
- Aqueous Deficient Dry Eye
- Sjogren’s Syndrome
Meibomian Gland Dysfunction
Dry eye secondary to meibomian gland dysfunction is caused by inflammation in the meibomian glands. Miebomian glands are glands that line both the upper and lower eye-lid margins and secrete oils onto the surface of the eyes. Inflammation causes these oils to thicken and to no longer be able to properly coat the surface of the eyes. This leads to dryness, watering, itching and/or fluctuations in the vision. This is by far the most common cause of dry eyes.
Aqueous Deficient Dry Eye
Aqueous deficient dry eye is caused by poor production of fluid by a gland called the lacrimal gland. The lacrimal gland is a small structure located below the brow bone. It is responsible for our “crying” tears. It is also responsible for the production of the “aqueous” layer in our tear film. Therefore, aqueous deficient dry eye is caused by the lack of production of “aqueous” from these glands. This, in turn, creates a low amount of moisture on the surface of the eyes.
Sjogren's Syndrome
Dry eye secondary to Sjogren’s syndrome is caused by the immune system attacking the mucous membranes of the entire body including the eyes. The two most common symptoms are dry eye and dry mouth. This is because those are the two organs in the body that are first effected by Sjogren’s. This is the least common form of dry eye.
Factors
There are many factors that contribute to inflammation in the eyes. These factors include bacteria buildup on the eyelids, computer use, aging changes, hormonal changes, medications, contact lenses, and different environments, i.e. air conditioning, dry heat during the winter and fans indoors and cold or hot dry air, dusty, windy conditions outdoors.
Treatments
There is no cure for dry eye. There are, however, treatments that can help reduce the inflammation and relieve discomfort. Consistency is key, though. Let’s review these treatment options below.
Environment Adjustments
Avoid dusty and windy environments, when possible. In addition, humidify indoor spaces. When using the computer, make sure you do “blinking exercises” every 30-40 minutes.
Omega-3 Supplements
Take omega-3 fatty acids by mouth. Omega 3 fatty acids have anti-inflammatory properties that decrease inflammation in the glands. Foods such as salmon, tuna, mackerel and lake trout are rich in omega-3 fatty acids. When choosing Omega-3 supplements it is important to check on the EPA/DHA levels. You want the EPA and DHA to add up to ~2000 mg at a ratio of 2-3:1. It is also important that the omega-3 is processed as a triglyceride and NOT an ethyl ester. Two recommended omega-3 brands are PRN De 3 Omega Benefits and Nordic Naturals Ultimate Omega 2x.
Warm Compresses
Apply warm compresses to melt and release the meibum that builds up in the meibomian glands. The melted oils will allow more protection of the surface of your eyes. This is good to do daily. A recommended product is Ocusci warm compress.
Eyelid Cleansers
Use an eyelid cleanser on your eyelids. Bacteria build-up is normal. Too much build up, however, leads to an increase in inflammation and irritation. It is good to remove the bacteria at least once a day. Two recommended products are WeLoveEyes Tea Tree Oil foaming cleanser and Oasis hypochlorous cleansing spray.
Artificial Tears
Use artificial tears to keep the eyes moistened and lubricated. Keep in mind artificial tears are simply a relieving drop. They do nothing to reduce the inflammation. A recommended product is Refresh Optive Mega-3.
Anti-inflammatory Drops
Use anti-inflammatory drops to reduce inflammation. Anti-inflammatory drops include Restasis, Xiidra, Cequa, Vevye and sometimes steroids. This is something that your doctor can prescribe for you.
Punctal Plugs
Have punctal plugs inserted into your punctas. Your punctas are tiny openings in the eyelids that drain the tears from your eyes. By putting plugs in the openings, more moisture stays on the surface of your eyes. This is also something that can be discussed with you doctor.
Intense Pulsed Light (IPL)
Intense Pulsed Light (IPL) is a new exciting treatment available for treatment of meibomian gland dysfunction. It improves signs and symptoms by:
- Improving the function of the meibomian glands.
- Unclogging the meibomian glands.
- Significantly reducing inflammation.
- Improving the quality and stabilizing the tear film.
It is also the only treatment available that’s been shown to regenerate atrophied glands.
Ask your doctor if this treatment is right for you.
