Dry Eye occurs most often when the meibomian glands on the eyelids become inflamed or clogged (meibomian gland dysfunction, or MGD). Meibomian glands produce the lipid, or oil, that stabilize the tear film and prevent it from immediately evaporating. When the lipid layer is not present, tears will evaporate too quickly. Dry eye can also develop when the eyelids do not close properly or when the lacrimal glands of the eye fail to produce enough lubricating tears.
Patients at risk include women experiencing age-related hormonal changes, those eating a diet that is low on vitamin A or low in omega-3 fatty acids, individuals with certain allergies, on medication for allergies or being on other drugs where dry eye may be a side effect, like birth control pills or antidepressants. The prevalence of dry eye also increases with age, more than 25 million people in the U.S. suffer from dry eye.
Symptoms can range from mild to severe and include: eye discomfort or irritation, grittiness, the feeling of a foreign body in the eye, a burning or stinging sensation, continuous tearing, redness, discharge, itchiness, sensitivity to light, difficulty reading or being on a computer, inability to wear contact lenses, or a constant need for lubricating eye drops.
Artificial tear lubricating drops are recommended and may very well suffice for relatively mild cases. Artificial tears are non-prescription and available in preservative and preservative-free variants. There are any number of manufacturers. The products range from those that are very runny to drops that are much more viscous. Some patients may prefer one particular variant over another. Patients that will have to use lubricating drops frequently or for a prolonged period however, are encouraged to avoid drops with preservatives.
Omega-3 Fatty Acids like fish oil or flax oil are good for the mucous membranes and also for the eyes. These are readily available over-the-counter and are taken orally. Flax seed oil is reported to be more effective in most cases and has the added advantage of being somewhat more palatable than fish oil.
Steroidal Drops may be used for more moderate cases but they do not offer a permanent solution as they cannot be taken in perpetuity. Restasis is another anti-inflammatory medicated drop that may provide some relief and help restore the meibomian glands to a more proper function.
Moisture Goggles may be used at night time, especially for patients whose eyelids are not shutting properly. The goggles slow down the evaporation of the tear film, creating a moisture barrier that protects the eyes while sleeping. Their benefits can provide comfort to patients that will last right through the next day.
Punctal Plugs placed on the corner of the eyelids, on the tiny drainage ports where tears are syphoned from the eye’s surface, are very efficient in slowing down the rate at which the tear film is syphoned off and can provide much relief in more severe cases.
An in-office procedure that clears and unclogs blocked glands, allowing them to heal and return to a more healthy state can provide much assistance and benefit to patients suffering from MGD (meibomian gland dysfunction).
Lipiflow is another relatively new, in-office procedure for patients suffering from dry eye as a consequence of meibomian gland dysfunction (MGD). The twelve minute, in-office procedure, stimulates, gently heats and massages the lids and glands directly. Lipiflow is a much more immediate approach vs. gradual benefits that may be derived from a protracted and labor intensive use of warm compresses. It cleans out and clears blocked meibomian glands in order to restore a more adequate function.
Testosterone Cream is recommended for chronic sufferers to address the imbalance of too much estrogen and not enough testosterone that is at the root of meibomian gland dysfunction. The cream, which has been used quite successfully, is applied topically on the lids themselves, at bedtime, to restore the glands to a healthy state and provide much needed relief.
The management and treatment of dry eye and meibomian gland dysfunction may call for one or more of these approaches to be applied simultaneously. Doctor Belmont evaluates each patient to assess the severity of the condition and select the most effective therapy for each individual.