What is Dry Eye Disease?
DRY EYE DISEASE (aka keratoconjunctivitis sicca) occurs when the eyes become inflamed due to an inadequate tear supply or poor-quality tears. The two forms of dry eyes are evaporative dry eye and aqueous deficient dry eye. Most people suffer from a combination of the two forms.
EVAPORATIVE DRY EYE occurs when the meibomian glands in the eyelids are not functioning properly. The meibomian glands secrete oils which prevent the tears from evaporating too quickly. Meibomian Gland Dysfunction (MGD) is when the glands become obstructed and inflamed, thereby diminishing the quality and effectiveness of the oils and causes the tears to evaporate rapidly.
AQUEOUS DEFICIENT DRY EYE occurs when the lacrimal glands produce an insufficient amount of water for the tears. This results in tear hyperosmolarity, an increase in salt to water ratio, and causes inflammation to the surface of the eyes.
– Low blink rate
– Decreased function of the lacrimal glands
– Meibomian gland dysfunction
– Lagophthalmos (incomplete eyelid closure)
– Contact lens abuse
– Medications (antihistamines, decongestants, antidepressants)
– Environmental conditions (smoke and wind)
– Red eyes
– Contact lens intolerance
– Excessive tearing
– Gritty sensation
– Blurred vision
– Light sensitivity
Equipment and tests used to diagnose Dry Eye Disease
Medmont Meridia PRO
The latest state-of-the-art equipment in diagnosing dry eyes.
The Medmont Meridia with enhanced Medmont Studio software v7 has the capability to measure various components of dry eye through:
- Meibomian gland imaging
- Fluorescein imaging
- Noninvasive tear breakup time
- Tear meniscus measurements
- Corneal staining and fluid dynamics
Meibomian gland dysfunction (MGD) is the leading cause of dry eyes. Meibography utilizes infrared light to capture images of the meibomian glands. Meibomian gland truncation and drop out are signs of severe MGD.
Hyperosmolarity of the tear film is one of the key diagnosing factors of dry eye. This means the tears have a higher-than-normal salt to water ratio.
- 302 mOsm/L = Normal mean osmolarity value
- 315 mOsm/L = Mild/Moderate Dry Eye mean value
- 336 mOsm/L = Severe Dry Eye mean value
Hyperosmolarity of the tears contributes to an inflammatory cascade, resulting in increased levels of cytokines and matrix metalloproteinase-9 (MMP-9). Increased levels of MMP-9 can contribute to damaged corneal epithelial barrier function and corneal surface irregularity.
Diagnostic Dyes (NaFl & Lissamine Green)
Dry eyes cause inflammation to the surface of the eyes. The inflammation can be clinically measured with diagnostic dyes. Sodium Fluorescein (NaFl) permeates into intracellular spaces and reveals epithelial defects on the cornea while Lissamine Green stains dead and devitalized cells on the bulbar conjunctiva.
Latest treatments for Dry Eye Disease
Low-level Light Therapy (LLLT)
Marco Equinox is an FDA-approved medical device used to treat MGD. It is a safe, pain-free procedure that utilizes low-level light therapy (LLLT) to stimulate and heat the meibomian glands.
The primary mechanism of action for LLLT is photobiomodulation. The low-level light targets the mitochondria and stimulates the production of ATP – the energy that powers the cell. This increases intracellular activity and heats the glands from the inside out.
There are currently three Equinox Masks used to treat various conditions:
RED LIGHT – stimulates production of collagen and elastin by activating ATP and increasing cellular action.
BLUE LIGHT – purifies the skin by destroying demodex and bacteria.
YELLOW LIGHT – relieves swelling by stimulating cellular metabolism and promoting a detoxifying action.
Blepharitis is an inflammation of the eyelids caused by bacterial overgrowth. It plays a major role in the development of MGD.
In-office treatments for blepharitis include Microblepharoexfoliation (MBE) and Zocular Eyelid System Treatment (ZEST). The ZEST deep cleaning is like a “power wash” for the eyelids. It contains okra-infused Zocusome micelles that remove bacteria and parasites (demodex) while decreasing inflammation.
Biologic treatments are becoming increasingly popular in the dry eye community. They are natural treatments derived from living organisms and cheaper than dry eye medications such as Restasis and Xiidra.
Examples of biologics include:
Regener-Eyes – a sterile biologic eye drop made of anti-inflammatory cytokines and growth factors that have been proven to decrease inflammation. It can repair and regenerate the ocular surface and meibomian glands.
Autologous Serum Eye Drop (ASED) – customized drops made from the patient’s own blood. ASEDs have antibodies, albumin and special growth factors that promote healing.
Dry eye medications are very useful in decreasing inflammation of the ocular surface and tears. Commonly used prescription drugs include steroids, antibiotics, Restasis, Xiidra, and Cequa.
Omega 3 has been shown to reduce inflammation and improve the quality of the tear film. Unfortunately, many store-bought omega-3s are in a synthetic (ester) or unpurified form, which is difficult to absorb and leaves a fishy aftertaste. We recommend high quality omega-3s in the re-esterified triglyceride form (rTg). We recommend PRN De 3 and Nordic Naturals to our patients.