Dry Eye Disease Questions
Dry eye can feel dramatic: gritty, red, burning, itchy, streaming-water-all-the-time--ugh! But often it starts with occasional blurry vision, an inability to tolerate contact lenses, tired eyes, or just a sensation that can only be described as dry. These symptoms are often irritating, but tolerable when they only happen once in a while. When they happen every day, these symptoms can limit your activities of daily living. Over longer periods of time, inflammation and surface damage can occur, and these disruptions also make a person more susceptible to infection.
During a regular eye exam, please mention your symptoms to your optometrist, even if they are only occasionally bothersome. Sometimes there are easy changes that you can do to save yourself the irritation <link to home changes>. If you find that your symptoms are affecting your ability to do what you enjoy, it’s time to book that appointment
It can be anybody, of course, but it is more likely for those who: have had laser surgery to correct their vision; eyelid surgery; have had makeup tattooed around their eyes; wear makeup on the ‘water line’ or irritating makeup; eyelash extensions; have droopy eyelids; are taking certain medications; are going through hormonal changes; are exposed to irritating environments with air conditioning/heating or airborne irritants like dust or pollen; are contact lens wearers; sleep with their eyes partly open; or, frequently use screens like computers or phones (which leads to less overall blinking). So, yeah. Basically anybody.
Many things are required for a healthy eye environment, and when everything is going well they’re hardly noticeable. From how you blink, to the tears in your eyes, to changes in your body, these all contribute to the long term comfort and health of your eyes. There’s also conditions like blepharitis and allergies in the eye that can cause similar symptoms.
One of the main things we test for in the dry eye clinic is your tears. They need to have a certain composition, from how salty they are, to how much oil is produced to keep your tears from evaporating, to work well. Inflammation in your eye can also interrupt the process of making tears or oil (properly known as meibum). Mechanical changes to your blink or eyelids (droopy eyelids, or after surgery, tiny tear ducts) might mean tears don’t stay in your eyes as long, even if they are healthy. Other factors like new medications, or the air in your home can also contribute. Finding the point of breakdown in the process of keeping your eyes happy is the reason we have our initial assessment, so that we can find the right treatment for you.
There are certain steps you can take that will help with dry eyes before any appointments with your optometrist. Some are just general good advice too, like getting enough sleep, and drinking enough water. Other things you can try would be getting a humidifier, taking breaks from screens, reducing contact lens wearing time, and reducing irritants like makeup. (Some medications can have dry eyes as a side effect, but do not stop taking medications that your doctor prescribed without speaking to them first.) The next step might be to try artificial tears which often helps with the sensation of dryness and taking an omega-3 supplement, which helps your meibomian glands produce oil for your tears. These steps should help alleviate mild to moderate symptoms, though they may not go away entirely.
Dry Eye Clinic Questions
In order to figure out why you, in particular, are experiencing dry eye symptoms, we perform a variety of tests. This is important to differentiate between the various causes of dry eye, and some other conditions that could be happening also, like allergies or blepharitis. Your first visit includes a questionnaire of symptoms and severity, an examination of the surface of the eye for dry patches or damage, a test of your tear osmolarity, a test for inflammation, a tear breakup time test, a tear meniscus test and a meibography. All within a half hour with the doctor!
None of these tests will damage your eye, though some are somewhat less pleasant. The examination of the surface of your eye will require the yellow stain some people are already familiar with, though it does go away relatively quickly. The Osmolarity test is quick and measures the ‘saltiness’ of your tears. (If your tears evaporate quickly, they leave behind the solutes, and these can be irritating to your eyes when there’s just too much!) The Inflamma-Dry test is a quick dip test which looks unfortunately like a pregnancy test. Topography, Meibography, and Tear Break Up Time time tests are done with the Oculus Keratograph which can provide us with video and analysis of the things we need to know about your dry eye.
No dilating drops are administered for these tests. We ask that you do not use artificial tears 24 hours before this initial consultation, but please continue to use glaucoma drops as normal. If you have an eye infection we may have to reschedule (but we can see you for that too!)
We will almost always book you for follow-up visits, particularly after treatments, so that we can track your progress.
After your initial consultation our doctors will advise you on things you can do at home, and will recommend treatments targeted specifically at the cause of your dry eye. These can include eye drops-- which help regulate osmolarity, help replace inadequate tears, protective gels, or anti-inflammatory drops depending on the type-- eyelid wipes for blepharitis and general eyelid hygiene (some including tea-tree oil to fight demodex), eye masks for hydrotherapy or sleeping (for those who sleep with their eyes open or use CPAP machines), punctal plugs (temporary or permanent) or scleral contact lenses. We carry many of these in our clinic, or can order them for you in short order.
I-Lux: This treatment addresses meibomian gland dysfunction. Our handheld device will heat and massage your eyelids to release any blockages in the oil glands in your eyelids. It is equivalent to Lipiflow treatments.
IPL/LLT: This treatment addresses ocular rosacea, meibomian gland dysfunction, and blepharitis. The targeted light reduces bacterial build-up, reduces inflammation in the eyes and eyelids, and increases blood flow to the oil glands.
Blephex: This treatment is a deep-clean of the eyelashes and eyelids, in order to treat blepharitis, demodex and meibomian gland dysfunction.