The Basics - Dry Eye Explained and Dry Eye Treatment

'Dry Eye' refers more to an imbalance in tear chemistry vs. a total lack of tears

The thin film of fluid on the surface of the eyes is quite a complex recipe.  If this is not produced by your body properly, unstable vision and discomfort and sometimes permanent damage to the ocular tissue can ensue.

Type of Dry Eye

For the purposes of creating a treatment strategy and communicating status, I break down DRY EYE into two main forms

• Suspected lipid deficiency
• Suspected aqueous deficiency

These can occur concurrently and are listed as ‘suspected’ as they are sometimes hard to distinguish clinically but are treated differently.  Dry eye treatment options for progressing severity for both forms of dry eye will be highlighted below.

If not treated, eyes that are chronically dry can progress to having an inflammatory condition that generally requires prescription drops or oral medications to manage. Chronic, advancing Dry Eye is not only uncomfortable but can cause unstable vision and irreparable damage to ocular tissue.

Concurrent with any treatment, four easy changes that you can make to help both forms of Dry Eye

• Hydration – drink lots of water!
• Humidity – consider a humidifier in house or work environment for winter or dry environments
• Screen use use – try to limit and take breaks of 5 minutes minimum each hour
• Make-Up – consider hypoallergenic make-up and be sure not to line eye lid margins (tissue between lashes and eyeball)

How do I know what form of Dry Eye that I have?

The best way to determine what form of dry eye that you have is an eye exam by an Optometrist.  Special dyes and tests are used to identify your type of dry eye (Aqueous vs. Lipid Deficiency) and the best treatment course.   If this this is not possible, start with recommendations on Lipid deficiency based dry eye as it is much more common.

 Recommendations for Lipid Deficiency Dry Eye (most common form)

The goal of treating lipid deficiency dry eye is to reduce the evaporation of tears from the ocular surface as low moisture causes irritation and damage to the ocular tissue.  This condition may also be referred to as 'Meibomian Gland Dysfunction' by your eye doctor.

Acute dry eye treatment strategies involve drops and and ongoing strategies involve drops and getting your body to produce better tears.

Phase ONE (Acute): Use non-preserved rewetting drops designed for Lipid Deficiency - i.e. Anti evaporative Drops.  Recommended 2-6 times per day.

These are not your Grandmothers lubrication drops!  These are drops specialized designed to keep you tears from evaporating.  It is very important that you use these drops proactively.  i.e.  Put a drop in before your long day at the computer

Keeping any lingering blepharitis (lid issues) in check is important in getting relief as well.   See more information on Blepharitis here

Phase TWO (ongoing): All level ONE recommendations but to an enhanced vigilance also add:

5min of Bruder Mask or Blepha EyeBag in morning and at bedtime

Adding Omega-3 Supplements as part of chronic dry eye management is extremely effective in clinic (when the correct dose is used)

For overnight irritation -  Add a non-preserved eye gel at bedtime -  Recommended: Ocunox or I-Defence 

Recommendations based on an Aqueous Deficiency Dry Eye

The goal of treating aqueous deficiency dry eye is to dilute the tears so that they are less salty and irritating to the ocular tissue.

Phase One: Use non-preserved rewetting drops designed for Aqueous Deficiency.  Recommended 2-6 times per day.

 

For overnight irritation -  Add a non-preserved eye gel at bedtime -  Recommended: Ocunox or I-Defence 

Either form of dry eye can become ADVANCED DRY EYE (hyper acute inflammatory)

Typically in clinic, these phase is managed with a pulse of prescription topical steroid and/or oral medications would be discussed by Optometrist for inflammatory dry eye disease.  There are also non-steroidal medications that can be prescribed for ongoing use to battle inflammatory dry eye.

This video does a good job to explain Inflammatory Dry Eye

There are also Advanced Dry Eye Treatment Options

These would include eyelid heat therapy, light therapy, plasma energy therapy, punctual plugs.  These should be discussed with your eye doctor.

Recommendations for Contact Lens Related Dry Eye

Despite dramatic advancements in contact lens material wet-ability and breath-ability, contact lens sometimes cause dry eye symptoms that reduce wear time and increase blur.

Contact lens material/fit/design, care solution, ocular and handling hygiene and natural tear quality are the main considerations for poor contact lens comfort.  This guide only covers improving tear quality.

I use two strategies in clinic (once any inflammatory issues treated):

1] Improve natural tear quality with Omega 3 supplementation and warm compresses

2] Contact lens safe eye drops to immediately extend comfort and clarity

 

Continue Reading more Dry Eye Information on mEYEspa

References

NIH National Library of Medicine - Dry Eye Classifications

DEWS II study: TFOS DEWS II Definition and Classification Report