Dry Eye Center

Dry Eye Disease Overview

Dry eye symptoms affect millions around the world. Left untreated, they progress to the disease state and start affecting people’s vision, quality of life and work productivity.

Common Dry Eye Symptoms

Red, dry, burning and itchy eyes
Light sensitivity
Blurred or fluctuating vision
Overly watery eyes
Discomfort or pain with contact lenses
Discomfort when wearing eye makeup

Our Dry Eye Clinic specializes in identifying and treating the root causes of your dry eye disease (DED) using the most advanced technology. We follow evidence-based treatment protocols to manage and treat all ocular surface disease conditions. All patients scheduled for refractive and corneal surgeries (LASIK, cataract, corneal cross-linking, and others) receive a comprehensive dry eye evaluation prior to their surgeries. Come see the doctors at Vision Optique to design a personalized treatment plan just for you.

Book Appointment

Dry Eye Quiz

Homework Before Your Dry Eye Exam

A comprehensive dry eye exam is necessary to determine the causes of your various symptoms, and to test how well your current tear film is functioning in protecting your ocular surface. Many technology advancements have occurred in both diagnosing and treating dry eye disease, therefore it is important for patients to understand why each treatment is prescribed. A customized treatment plan is formulated for each dry eye patient. Please read the homework below prior to your dry eye exam.

Pre-Exam Homework

Before your exam, we encourage you to please watch this YouTube playlist to familiarize yourself with the basics of dry eye disease and treatment options. Additionally, ensure you read through our dry eye content to best understand the complexity and progressive nature of this disease.

On the day of your exam, please do not use any eye drops and do not wear eye makeup.

Medical Diagnostic Tests

Our diagnostic tests help to detect and diagnose signs of dry eye. These include:

Lipid (Oil) Layer Tests: LipiView, lipid layer thickness (LLT), blink test, meibomian gland function score
Aqueous (Tear) Layer Tests: Tear osmolarity, non-invasive tear break up time (NITBUT)
Mucin (Cells) Layer Tests: Fluorescein eye stain test, eyelid margins and conjunctiva (lissamine green)
Presence of blepharitis and demodex along eyelid margin
Patient ocular surface disease index (OSDI) and lifestyle questionnaire

Treatment Plan

Each dry eye patient will receive a detailed treatment and management plan after their initial comprehensive dry eye examination. We recommend that you follow the prescribed treatment plan. We offer more detailed explanations on the non-invasive and effective procedures available to you below.

Dry Eye Disease Prevalence & Treatment (TFOS DEWS II)

“Dry Eye is a multi-factorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

– TFOS DEWS II, 2017 [Official definition of the Dry Eye Disease according to the Tear Film and Ocular Surface (TFOS) Dry Eye Workshop II (DEWS II) Report]

In epidemiological studies performed globally, the prevalence of dry eye disease is common and affects millions around the world. In the U.S, the National Health and Wellness Survey found that 6.8% of the adult population have been diagnosed with dry eye disease (DED), and more than 40 million adults suffer from various symptoms. The prevalence of DED increased with age and was higher in women than men.

If left untreated, patients with DED may suffer from a reduced quality of life due to discomfort and poor vision. Today’s digital lifestyle, eye cosmetics and beauty trends, environmental factors and other medical conditions can contribute to DED. One of the leading causes is meibomian gland dysfunction (MGD). The doctors at Vision Optique provide several treatment options to help patients that suffer from MGD. Our Dry Eye Clinic follows the evidence-based recommendations from the TFOS DEWS II Report.

The Tear Film & Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Report outlines a four-step approach based on a patient’s disease severity. The TFOS DEWS II recommendations provide evidence-based protocols for managing this complex and variable disease. It is followed by dry eye disease experts around the world. Our doctors will provide each dry eye patient with an individualized treatment plan after the comprehensive dry eye exam.

1

Step 1 of the TFOS DEWS II recommendations includes patient education, dietary modification, lid hygiene, use of lubricating eye drops, and modification of environmental factors.

2

If Step 1 strategies are inadequate, progression to step 2 strategies is recommended and includes nonpharmacologic and pharmacological management.

3

Step 3 involves the use of oral secretagogues and autologous or allogeneic serum eye drops.

4

Step 4 includes topical corticosteroids for longer durations, amniotic membrane grafts, surgical punctal occlusion, and more complex surgical approaches.

TFOS DEWS II Recommendations for Staged Management & Treatment of DED

Step 1

Education regarding DED and its management, treatment, and prognosis
Modification of local environment
Education regarding potential dietary modifications (including oral essential fatty acid supplementation)
Identification and potential modification/elimination of offending systemic and topical medications
Ocular lubricants of various types (if MGD is present, then consider lipid-containing supplements)
Lid hygiene and warm compresses of various types

Step 2

If options in Step 1 are inadequate consider:

Non-preserved ocular lubricants to minimize preservative-induced toxicity
Tea tree oil treatment for Demodex (if present)
Tear conservation (eg, punctal occlusion, moisture chamber spectacles/goggles)
Overnight treatments (eg, ointment or moisture chamber devices)
In-office, physical heating and expression of meibomian glands (eg, device-assisted therapies)
In-office intense pulsed light therapy for MGD
Prescription drugs to manage DED

Step 3

If options in Steps 1 and 2 are inadequate:

Oral secretagogues
Autologous/allogeneic serum eye drops
Therapeutic contact lens options
Soft bandage lenses
Rigid scleral lenses

Step 4

If options in previous steps are inadequate:

Topical corticosteroid for longer duration
Amniotic membrane grafts
Surgical punctal occlusion
Other surgical approaches (eg tarsorrhaphy, salivary gland transplantation)

Dr. Bridgitte Shen Lee, is a global educator on Dry Eye Disease. Since 2018, she has served as a Global Ambassador for the Tear Film & Ocular Surface Society (TFOS).

Meibomian Gland Dysfunction (MGD)

“Meibomian gland dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion. This may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease.”

– TFOS MGD Report, 2011 (Official definition of the Meibomian Gland Dysfunction according to the Tear Film and Ocular Surface MGD Report)

Meibomian gland dysfunction (MGD) is among the leading causes of dry eye disease and it affects millions of people around the world. Often reported symptoms are watery and burning eyes, fluctuating or blurry vision, and inability to wear contact lens or eye makeup. The most common type of MGD is obstructive MGD, which occurs when the glands become clogged, stopping the meibum from reaching the eye’s surface. The doctors at Vision Optique use the LipiFlow treatment, it is an FDA approved procedure to treat MGD.

The meibomian glands secrete an oil called meibum. Meibum (oil), aqueous tear (watery layer), and mucin (mucus) make up the three layers of the tear film. The meibum/oil stabilizes the tear film and prevents it from evaporating too quickly. A healthy tear film is required to keep your eyes moist and comfortable.

Spending long hours on digital devices (not blinking enough), wearing contact lenses, and using eyelash extensions or false eyelashes can all contribute to developing MGD.

Certain medical conditions can also cause MGD, such as:

High cholesterol levels
Conjunctivitis
Eyelid infections
Eyelid inflammation (blepharitis, Demodex)
Skin disease (acne, rosacea, atopic and seborrhoeic dermatitis)

Additionally, some medications can cause a reduction in meibum production, such as glaucoma medications, estrogen replacement therapies, and retinoids commonly found in acne medication and anti-aging creams.

In-Office Dry Eye Disease Treatments

Microblepharoexfoliation (MBE) Treatment

Anterior blepharitis is an inflammatory disease that involves the anterior eyelid margin and eyelashes. This condition can cause eye irritation, burning sensation, tearing and itchiness. It is common to find sticky eyelids, crusty and flaky discharge in the mornings. The disease is commonly associated with staphylococcal bacterial infection or Demodex mite infestations. Left untreated, it can lead to dry eye disease.

Removing any flaky buildup along eyelids and Demodex nits around the eyelashes will reduce the possibility of bacterial infection and increase the proper working function of the meibomian glands. The most effective procedure is called microblepharoexfoliation (MBE). MBE is a Step 1 DED treatment procedure to eliminate anterior blepharitis debris and Demodex nits. For most dry eye patients, having the MBE done early can help achieve better long term outcome of other treatments.

The doctors at Vision Optique use the AB Max™ microblepharoexfoliation (MBE) device. It involves a 10-minute in-office deep cleaning treatment that gently exfoliates the outer eyelids while cleaning away any crust, debris, and Demodex nits. It is performed using topical anesthetic drops and it is a non-invasive and well-tolerated procedure. This procedure can be repeated quarterly or as needed.

Meibomian Gland Expression (MGX) Treatment: LipiFlow

LipiFlow is a FDA approved thermal pulsation and meibomian gland expression (MGX) procedure to treat MGD. It is a Step 2 DED treatment, and it is a non-invasive 12 minute procedure performed with topical anesthetic drops. It uses gentle heat to liquefy and loosen clogs in the meibomian glands.

The lids are then gently massaged to improve the flow of meibum (oil) through the glands, followed by the expression of the melted meibum. LipiFlow procedure improves the function of meibomian glands and protects them long term.

For contact lens wearers, each LipiFlow procedure often improves wearing time by at least four additional hours. For many of our patients, they report improvement in longer computer work hours and more stable vision. For women patients who wear eye makeup, they report less makeup smearing and watery eyes.

For patients with more severe symptoms, LipiFlow can be done semi-annually. The procedure is often combined with MBE and/or IPL for patients presenting with multiple ocular surface disease (OSD) conditions, including the dry eye disease (DED).

Dry Eye Online Store

Our doctors have studied the evidence-based research and tested the performance of each of the dry eye products recommended to our patients. Now you can purchase them directly from our Dry Eye Online Store.

If you are interested in a dry eye evaluation at our Dry Eye Clinic, please contact us (call, email, messaging on social media platforms). We would love to hear from you and begin to help provide solutions for all of your dry eye needs.

Shop Online