Dry Eye Treatment
Dry eyes can rapidly become the bane of a patient’s existence. Relief can be difficult to find and patients often travel from doctor to doctor seeking help. Our Doctors are dedicated to finding a personalized approach to target the specific cause or causes of your dry eye.
Nutritional Supplements and Dietary Considerations
Nutritional supplementation has become a well-accepted therapy for dry eye. Numerous studies have found that omega-3 fatty acids can containing supplements decrease dry eye symptoms, positively impact meibomian gland secretion, and possess anti-inflammatory effects.
There are a variety of natural sources for omega-3s including cold-water fish, such as herring, sardines and salmon. Supplements containing fish oil are often recommended. Flaxseed oil is recommended but has little beneficial effect. O3 + Maqui is our most frequent recommendation as a product formulated specifically for dry eye as it delivers Omega-3 fish oil and increases tear production. Some patients choose more common, but far less potent or effective Omega-3 supplements available from health food stores. Virtually all “store brands” and heavily promoted products like Krill Oil do not reach
therapeutic levels and are ineffective.
Many clinicians recommend that patients consume sufficient water. Dividing your body weight by 16 yields the recommended number of cups of water you should be consuming per day – although that should be taken as a general recommendation. In general, consuming more water, but not excessive amounts of water can’t hurt and may
help.
Medications for Dry Eye
Currently the only medication indicated and approved by the FDA for treating the signs and symptoms of dry eye in the United States is Shire’s Xiidra™. Allergan’s RESTASIS® is approved for increasing tear production.
An ophthalmic emulsion containing the immunomodulator cyclosporine, Restasis® has been found to increase tear production in clinical trials. Restasis® is appropriate for some patients who have inflammatory dry eye. Clinical trials failed to demonstrate any increased tear production in patients who were using anti-inflammatory eye drops or
had punctal plugs. Restasis® is taken twice daily and may take months or longer for any effect to be observed.
Recently introduced, Xiidra™ represents a true breakthrough in dry eye treatment. The first and only medication approved by the US FDA for the treatment of both signs and symptoms of dry eye, this novel eyedrop was developed specifically for the eye by Shire, a global leader in pharmaceuticals. Used twice daily and rapidly acting, most patients experience relief within days of starting this medication.
Xiidra™ safely and effectively blocks inflammatory T-cells cells from attaching to the eye’s surface, thereby shutting down the inflammatory response that causes much of the misery of dry eye. Many of our patients have experienced rapid and substantial relief including those who failed with other treatments.
While Xiidra™ alone may be an appropriate and effective treatment for many patients, dry eye is a complex, chronic and progressive condition. So, for some Xiidra™ will be an important addition or adjunctive part of an overall long term therapeutic approach. Topical steroid medications are often prescribed either alone or in conjunction with initiating Restasis® therapy. Dry eye is often accompanied by inflammation and steroids are the most effective way to squelch inflammation. Lotemax is referred to as a “soft steroid” and does not have the serious side effects of other steroids. Steroids are typically used either for intermittent pulse therapy or for a limited time. A doctor must closely supervise steroid use.
Intense Pulse Light Therapy (IPL)
Intense pulsed light (IPL) therapy can help treat meibomian gland dysfunction, a common cause of most chronic dry eye symptoms. Originally designed for cosmetic purposes, this treatment can benefit your eyes. IPL releases wavelengths of light to warm the meibomian glands and remove blockages to restore tear functionality. A previous study on IPL discovered it improves tear breakup time in 87% of patients. IPL uses a scattered pulse of light to treat inflammation within the eye. This pulsing light warms the eyelids to treat clogged or blocked glands. The release of these blockages helps prevent your tears from evaporating as quickly.
IPL has been used successfully to treat patients with rosacea, a skin disorder that often is associated with ocular problems such as MGD and early trials are promising for treatment of MGD.
There are several benefits to IPL. The treatment is anti-inflammatory and can effectively remove the blockages in your meibomian glands. Its effects are long-lasting, and the treatment is relatively painless. The safety profile is also extremely high with the newer devices. The treatment is very comfortable and any discomfort following the treatment is rare and temporary.
IPL requires 4 sessions to reach optimal results. Following this, the meibomian glands will be functioning much more efficiently, and patients usually report a marked improvement in their dry eye symptoms.
Scleral Contact Lenses
All too often, people find themselves unable to wear contact lenses due to dry eye disease. While traditional soft contact lenses are not suitable for patients with dry eye disease, Scleral Contact Lenses are therapeutic for dry eyes. For patients suffering significant discomfort and ocular pain due to dry eye disease, a properly designed and fit scleral lenses can eliminate most, if not all, of the symptoms. This is because a scleral lens will vault over the cornea and rest on the white portion (the sclera) of the eye. The lenses create a moisture chamber of preservative free saline solution that the
ocular surface constantly bathes in. In other words, the chronically dry ocular surface is always in a moist environment.
Comfort and vision with Scleral Lenses are almost always excellent. Scleral Lenses are an especially attractive option for patients suffering chronic ocular pain due to refractive surgeries such as Radial Keratotomy and LASIK surgery.
Punctal Plugs
In healthy people, the rate of tear production, evaporation and drainage remain in good balance regardless of environmental or other challenges.
One strategy to retain more tears in the eye for longer involves restricting drainage using plugs that occlude the drainage system. Despite years of use, punctal plugs remain somewhat controversial. Some dry eye experts believe that tear stagnation and complications associated with plugs often outweigh their benefits. With advances in pharmacologic management and new understanding of the role played by meibomian gland dysfunction in dry eye, use of punctal plugs has generally diminished. Plugs are never used if inflammation is detected in the tear film. If punctal occlusion is appropriate for you, we can insert plugs in the office and it is a quick and painless procedure.
Amniotic Membranes
Amniotic membranes are ocular grafts that are derived from ethically sourced placental tissue. This tissue is rich in stem cells, which can provide a damaged ocular surface with important regenerative properties.
The process of applying and removing an amniotic membrane is quick and pain free. It is an in-office procedure done by an eye care professional within minutes. Within a few days, the graft beings to dissolve and the regenerative properties of the stem-cell abundant tissue is absorbed within the ocular surface so tissue healing can begin to occur.
Amniotic membranes can be used in the treatment and management of many ocular surface diseases. For patients who experience painful recurrent corneal erosions, amniotic membranes may be a method of not only reducing symptoms of a current episode, but also providing the eye with healing properties to avoid another incident. They can be used in cases of long-term ocular inflammation in which the front surface of the eye is negatively affected. They may also be useful in treating moderate to severe dry eye disease, in which traditional treatment methods have proven to be ineffective. These powerful tissues have proved to be widely useful in promoting a healthy ocular surface.
