Category: Blog

Dry Eye Disease (aka Ocular surface disease) is extremely common- especially in Colorado! It is a chronic and progressive disease that if left untreated may cause severe discomfort. Patients may or may not have symptoms in early stages of the disease, but the degenerative process that causes you to have symptoms later in life can begin at any age. We evaluate your eyes for signs of DED at each and every comprehensive annual exam to ensure we catch it as early as possible. Early intervention is the key to long lasting comfort, and our goal is to keep you comfortable for life.

Over 80% of chronic DED is caused by Meibomian Gland Dysfunction (MGD). Meibomian glands are in your eyelid and produce the oily protective layer of your tears. Normally, this protective layer prevents your tears from evaporating. In MGD, these glands do not produce the oily layer of your tear film properly. Glands progressively become inflamed and their oily secretions become thick like butter.

Unfortunately, in many patients, these glands stay chronically inflamed which can lead to gland dropout or atrophy. Once a gland has died, it is gone for good. We have a limited number of these Meibomian glands, which makes it especially important to identify and treat this condition early.

The trend over the past five years has shifted toward office based treatments that can restore proper function of the meibomian glands.  The first instrument designed to treat Meibomian Gland Dysfunction, LipiFlow, was introduced five years ago. This instrument is inserted behind the eyelids and gently applies heat and pressure to release the build up of oils in each meibomian gland.  This treatment has been clinically proven to provide relief and restore proper function of the meibomian glands.

ILUX: THE EQUAL ALTERNATIVE

This brings us to our exciting news. Over the past year, clinical trials of a new device have been taking place. When compared to LipiFlow, iLux provided equal improvement in comfort to the patient at 2 and 4 weeks, as well as an equal improvement in clinical signs.

We are thrilled to be one of the first practices in Colorado to offer the iLux treatment to our patients.  Our doctors believe this treatment has many advantages over previous technology.  The device itself is handheld, so we have direct control of the area of each eyelid to be treated. We are also able to view the output from the oil glands as heat and pressure are applied. This allows for specialized treatment as different areas of the eyelid may require more or less treatment to ensure the blockages have been sufficiently cleared.  In addition, the iLux treatment is more affordable, making it available to more patients.

BlephEx® is an FDA approved, in-office procedure to treat blepharitis and reduce dry eye symptoms. Blepharitis is a chronic inflammatory disease caused by an overgrowth of natural bacteria along the base of your eyelashes. It often leaves patients suffering from red, sore eyelids with crusty debris at the base of their eyelashes. The Blephex treatment uses cleanser and a highly specialized device to gently scrub the base of your eyelashes.

Our own Dr. Jennifer Redmond recently received a Blephex treatment to help her own dry eye symptoms. She let us photograph her experience and also answered a few questions that some of our patients may have about the procedure.

Q: Do you suffer from dry eye?
A: Yes! Which is why I’m such a believer in treating dry eye for my patients as well.

Q: What else do you do to treat your dry eye?
A: I take PRN Omega 3. I do the liquid because I do not do well swallowing pills.

Q: Why did you decide to try Blephex?
A: I have dry eyes, myself, but I also wanted to experience what my patients experience as well.

Q: Was the Blephex treatment painful?
A: It was not painful, but it did tickle… a lot!

Q: How long did it take?
A: It took about 20 minutes for the treatment.

Q: How did you feel afterwards?
A: Within 1 hour I could feel a sensation of more moisture on my eyes. I was able to continue working shortly after the treatment.

Q: What do you want patients to know about Blephex?
A: That it removes a “bio film” from your eyelid margins, like an ultrasonic cleaning. I would also like for them to know that there are so many treatments for dry eye that you do not need suffer with it!

WHAT CAUSES DRY EYE DISEASE?

Many Coloradoans suffer from dry eye due to our arid environment and other causes such as

• Digital device use
• Air Pollution
• Environment: wind, cold, dry air, altitude
• Aging
• Contact lens wear
• Hormonal changes in women
• Medications
• Laser vision corrective surgeries as well as cataract surgery
• Sjogren’s Syndrome

Highline Vision Center offers a number of treatments available for patients who suffer from Dry Eye Disease (DED), also known as Ocular Surface Disease (OSD). In its early stages, more than 50% of those with the condition do not report any symptoms. When DED is identified early while in its mildest forms, it is easier to treat. Early treatment also helps slow the progression of the disease.

Learn more about Blephex here.

If you are concerned about your own dry eye symptoms, call us today to schedule a comprehensive eye health examination. Your Highline Optometrist can discuss what treatments might work best for you.

The following are treatments generally preferred by our Highline Vision Center Optometrists for Dry Eye Disease. If you suffer symptoms of DED, talk to your Highline Optometrist about which treatment will be best for you.

ARTIFICIAL TEARS

Drops that can be used 4-6 times per day or as otherwise directed:

• Retaine MGD
• Refresh Advanced – preservative free

Drops that can be used with contact lenses:

• Refresh Optive – preservative free single use containers
• Refresh Plus
• Blink Tears – preservative free

Drops and gels to use before bed:

• Refresh Celluvisc
• Blink Gel

Ointments to use before bed:

• Retaine PM
• Refresh PM

OMEGA-3S

PRN Dry Eye Omega Benefits: This is a high potency omega 3 fatty acid supplement that has been proven to maintain the lipid (oily) layer of your tear film. This improves the overall health of your tears and decreases the rate at which they evaporate. Our doctors have carefully chosen this product based on its high quality and specific dry eye targeted formula of omega 3’s. This supplement is available in either a liquid or softgel form.

WARM COMPRESSES & LID HYGIENE

Your doctor may prescribe warm compresses and good eyelid hygiene. The heat helps the oils in your eyelid glands liquify so they can flow properly to hold the moisture on your eyes. Warm compresses are most effective when using one of the following devices:

WARM COMPRESSES

• Derm mask: place in microwave for 20 seconds, add 10 second intervals as needed to find the best temperature for you. Use 5 minutes daily prior to lid massage.
• Tranquileyes: use 3-5 minutes daily with lid massage. Follow microwave instructions in the product manual. Beads can be used up to 60 times. Refill beads are available.

LID MASSAGE

After the warm compress it is helpful to massage the lids in order to try and mobilize the oily secretions from the Meibomian glands. This is done by placing your finger gently on the lower lid and using a rolling motion toward the top of the lid where the eyelashes are. Repeat this for 30-60 seconds on each eye.

After warm compresses and lid massage, follow with one of the following foams prescribed by your doctor to cleanse your eyelids.

LID CLEANSERS

• Ocusoft lid scrub: use a quarter pump on a clean washcloth and wash along lid margins. Rinse thoroughly.
• Ocusoft Platinum: use a quarter pump on a clean washcloth and wash along  lid margins. Leave on overnight.
• Tea Tree Foam: use a quarter pump on a clean washcloth and wash along lid margins. Rinse thoroughly.

INCREASE TEAR VOLUME

It is also important to increase the volume or quantity of tears on your eyes. Punctal occlusion is a painless in office procedure that helps to do this by blocking one of the tear drainage areas on the upper or lower eyelid with a tiny device called a punctal plug. This reversible process often offers patients more immediate relief as we help to treat Dry Eye Disease.

BLEPHEX

Blephex is the first approved in-office procedure that allows the doctor to treat blepharitis, thereby reducing your dry eye symptoms. Blepharitis is a chronic inflammatory disease that is caused by an overgrowth of natural bacteria along the base of your eyelashes.  This procedure is FDA approved but not yet covered by your insurance. There will be a fee for this test in addition to any co-pay required by your medical insurance for the office visit. It is between you and your doctor to decide how often this testing is needed. Learn more here about Blephex from our own Dr. Redmond!

PRESCRIPTION MEDICATION RELIEF

The items below are various options that may be selected based on your individual needs:

• Lotemax Gel: steroid gel drop to help reduce inflammation. Instill 1 drop into both eyes 4x per day for 2 weeks, then twice a day for 6 weeks. Return for a pressure check with a technician 2 weeks after you’ve started the drops. Schedule a 1 month dry eye follow up with your doctor.
• FML: steroid drop to help reduce inflammation. Use 1 drop 4x per day for 1 month, then twice a day for 1 month. Return for a pressure check with a technician 2 weeks after you’ve started the drops.  Schedule a 1 month dry eye follow up with your doctor.
• Doxycyline Hyclate: antibiotic with anti-inflammatory properties. Take with food as directed by your doctor. Do not take within 2 hours of consuming any milk-based product or calcium supplement.
• Restasis: instill 1 drop twice a day. Maximum results will be realized approximately 3-6 months after beginning treatment.
• Xiidra: instill 1 drop twice a day. Maximum results will be realized approximately 1-3 months after beginning treatment.
• Lacrisert: place 1 Lacrisert in both eyes inside lower lids before bed.
• Azasite: use 1 drop twice a day for 2 days, then once per day for 28 days. Press on bottom of bottle to release drop. Rub excess medication along lashes.

Dry Eye Disease (DED), also known as Ocular Surface Disease (OSD) is a very complex condition that is chronic and progressive. More than 50% of those having the condition do not report symptoms, especially in the early stages. If dry eye disease is identified early, when mild, it is easier to treat, helping to slow the progression.

You may also download this document by clicking here.

The composition of the human tear layer is very complex with more than 500 unique proteins. For simplicity’s sake, let’s discuss the three main layers of the tears. There is the mucin layer which is the thinnest and helps to hold the tears on the cornea. It is important for the viscosity of the tears. The middle layer is the aqueous layer, which is the thickest layer, containing important nutrients for keeping your cornea healthy. The outer layer is the lipid or oily layer of the tears. The lipid layer is responsible for protecting the tear layer from evaporation, which is crucial in our high altitude and arid environment. This layer is produced by the meibomian glands, the openings of which line the lid margin just inside the lashes on the upper and lower lids.

There are two primary types of dry eye disease: evaporative and aqueous deficient. Evaporative DED is caused by Meibomian gland dysfunction and is present in over 80% of cases. Cases of purely aqueous deficient DED are fairly rare, occurring about 10% of the time. Many people have a combination of the two. Our testing protocol is designed to get to the base cause of the condition so that we can treat your DED more efficiently and effectively.

CAUSES OF DRY EYE DISEASE:

• Digital device use: screen time has increased exponentially and is probably the main reason the latest studies on dry eye show a significant increase in the condition in younger populations.
• Environmental factors: people tend to have dry eye symptoms when they are exposed to smoke, air pollution, high altitude, sunny, windy, cold or dry air conditions.
• Aging: tear flow normally decreases with age. About 75% of individuals over the age of 65 suffer from dry eye symptoms.
• Contact lens wear: contact lens wear can dramatically increase tear evaporation, causing dry eye discomfort.
• Hormonal changes in women: various hormonal changes associated with pregnancy, oral contraceptives and menopause can contribute to dry eye symptoms.
• Certain diseases: dry eyes are a problem with several diseases. Thyroid disease, arthritis, and lupus, are examples.
• Medications: the list of medications having dry eyes as a side effect is too extensive to list here. Check the package insert for any medications you are taking.
• Laser vision corrective surgeries and/or cataract surgery: following various ophthalmic surgical procedures patients can develop dry eye.
• Sjogren’s syndrome: an immune system disorder characterized by inflammation and dryness of the mouth, eyes and other mucous membranes. This disorder damages the lacrimal glands and affects tear production.

LIFESTYLE RECOMMENDATIONS

• 20/20 focusing breaks: every 20 minutes look 20 feet away for 20 seconds. This is recommended for patients who do a lot of reading or computer work. When we are doing concentrated activities we blink two to five times less frequently than normal, reducing tear production.
• Avoid direct air flow on your eyes: it is important to point all airflow including heating/AC vents, fans and defrosters away from your eyes. Avoid sitting under or sleeping with ceiling fans running.
• Remove makeup nightly: we all have glands in our eyelids that produce oil to help keep the moisture on our eyes. It’s important to clean the makeup off your eyes every night to make sure these glands can release the oil properly.
• Humidifier: keeping a humidifier in your house or next to your bed at night helps keep your eyes hydrated.

ADVANCED DIAGNOSTIC EQUIPMENT

DRY EYE SYMPTOM CHECKLIST:

• Blurry/fluctuating vision
• Red eyes
• Burning
• Itching
• Foreign body sensation, gritty, sandy feeling
• Light sensitivity
• Excessive tearing
• Pain or soreness in or around eyes
• Tired eyes
• Contact lens discomfort or intolerance
• Seasonal allergies