Dry Eye (Ocular Surface Disease) Treatment
Once it has been determined that you have “dry eye” and related “ocular surface disease”, a course of treatment can be developed. Depending on the severity of the dry eye, the extent of ocular tissues involved, and the underlying cause of the condition, different treatments will be indicated.
When the eyelid glands are altered by chronic infection of the eyelid margins (blepharitis), the Meibomian (oil producing) glands and water (aqueous) producing) glands don’t perform properly.
Treatment of blepharitis
To heal infection from the eyelid margins, hot moist compresses are applied over the eyes two to three times per day until the infection clears. This is done after gentle cleaning of the lids with a new eyelid cleanser called Avenova. It is not irritating to the eyes and works well. With healing comes improved gland function, and improved tears.
Restasis (cyclosporin) medicated eye drops
Restasis is a unique medication that has strong anti-inflammatory properties that combat the inflammation on the surface of the eye that leads to dry eye and discomfort. It is taken as an eye drop daily and has become a power tool to help restore tear function to a more normal level.
Xiidra medicated eye drops for chronic dry eye
Xiidra (lifitegrast ophthalmic solution) 5% is a prescription eye drop released by the FDA in 2016. It is used to treat the signs and symptoms of dry eye disease. It has the advantage, in many cases, of offering relief of symptoms sooner than other treatment options.
Meibomian gland (eyelid oil gland) treatment
Chronic inflammation the oil glands of the eyelids causes the oils produced there to convert to a pasty substance that does not flow freely from the gland. These oils form the outer layer of the tear film and prevent evaporation of tears from the eye’s surface. Heat applied to the eyelids helps convert this pasty substance back into oil. A heated mask, called the Bruder mask, held against the eyelids for about 10 minutes, two times per day, delivers the warmth required to do this. The mask is simply warmed in the microwave for about 20 seconds, and releases moist heat when applied over the eyes. These masks are reusable many times, and are available in our office.
Cleansing the eyelid margins is accomplished with a gentle, no tears shampoo, or commercially available eyelid cleansing pads. We recommend a product named Avenova lid cleanser. Avenova contains hypocholorous acid, a substance found in the white-blood-cells of the body in fighting bacterial infections. It has no toxicity to ocular tissue, but eradicates bacterial growth on the eyelid margins. Ongoing eyelid hygiene reduces the likelihood of unwanted bacteria to grow there that cause eyelid inflammation and gland dysfunction.
Additionally, use of medication, called doxycycline is shown to improve oil gland function. The medication is taken orally daily for one to two months, most typically. This medication should not be used in pregnant women and patients should avoid excessive exposure to the sun while on it. It is not indicated for all patients. A newer alternative that has proven to be equally effective is a short 5 day course of an antibiotic taken orally, called Azithromycin.
Omega Fatty Acid Supplements
Fish Oil is high in omega 3 fatty acids, and can be helpful to restore tear gland function, and has become a mainstay for dry eye therapy. We recommend Nordic Naturals products for quality and freshness.
Increased Water Intake
Being well hydrated is important to our bodies functions, particularly in tear production. Drinking adequate volumes of water daily can help dry eye significantly.
Monitor Medications that Dry the Eye
Many medications, both prescription and over-the-counter, can reduce tear production. Antihistamines, antidepressants and antipsychotics, some blood pressure medications, and hormone replacements, as well as others, can cause dry eye. When these medications are necessary to be taken, dry eye therapy may need to be increased.
Artificial Tears / Lubricant Eye Drops
Many good tear substitute drops are now available to help restore the tear layer on the eye’s surface. Drops available in a non-preserved format are best, as preservatives can aggrevate dry eye. In our office we offer a new eye formula called Oasis Tears. This highly refined formula gives immediate and more long lasting relief than more traditional drops available in stores.