Dry Eye Syndrome (DES) or Dry Eye Disease (DED) can results in a variety of symptoms, some of which may include:
Foreign body sensation
What Causes Dry Eye Syndrome?
A problem with any of the tear film components can lead to tear instability and therefore dry eyes.
Normal tear films consist of three components:
A layer that prevents the tear film from evaporating too quickly. The meibomian glands in the eyelids produce this component.
A layer that is produced by the lacrimal gland.
A layer that helps anchor and spread the tears across the eye surface.
•DRY EYE CATEGORIES•
Meibomian Gland Dysfunction (MGD) or Evaporative Dry Eye
when the meibomian glands don’t produce or secrete enough oil
Aqueous Deficient Dry Eye
failure of the lacrimal glands to produce watery fluid (aqueous)
•DRY EYE IMAGING•
At the Kennedy Eye Clinic, we can perform a thorough assessment to determine what kind of dry eyes you are experiencing and therefore tailor a treatment specific to you for a $250.00 fee.
We will be able to show you your results in an easy to understand comprehensive analysis report. We look at:
Tear Meniscus Height (TMH) – if this is discontinuous, eyelid margins may be abnormal and need to be carefully examined.
Non-invasive Break Up Time (NIBUT) – this looks at tear film stability.
Lipid Layer Analysis – this helps diagnosis MGD more accurately.
Meibomian Gland Imaging – this allows us to see the distribution of the glands and to determine if there is gland loss.
Meibomian Gland Opening – this always for assessment of eyelid margin abnormalities as well as assessing for MGD.
Bulbar Redness Scan (R-Scan) – this will grade the level of redness on the conjunctiva (or white part) of the eyes; usually bulbar redness is associated with aqueous deficient dry eye.
Tear Osmolarity – measures the amount of inflammatory molecules in your tear film.
This is the report we can generate for all of our patients so that they can understand the nature of their dry eye disease,
as well as the reasons for recommended treatment:
ASSOCIATED WITH DRY EYE
Computer Use – when working on a computer or using a digital device, we tend to blink less frequently and less fully, which leads to greater tear evaporation and symptomatic dry eye.
Contact Lens Wear – usually dryness is the number one reason for discontinuing contact lens wear.
Aging – usually symptoms worsen later in life, especially after 50 years old.
Menopause – post-menopausal women are at a greater risk for dry eyes.
Environment – air conditioning, ceiling fans, and forced heating systems can affect humidity. Dry, wind and dust can also cause dry eye symptoms.
Health Conditions – like lupus, Sjogren’s Syndrome, rheumatoid arthritis, and thyroid problems, can exacerbate dry eye symptoms.
Medications – like certain anti-depressants, acne medications, and anti-histamines, can increase the risk of dry eyes.
Eyelid Conditions – like incomplete closure of the eyelids, especially while sleeping, can cause dryness issues.
Prior Laser Surgery – such as LASIK, PRK, or SMILE, can result in increased dryness symptoms.
•TREATING THE UNDERLYING CAUSE OF DRY EYES•
For most people with occasional or mild dry eyes symptoms, treatment involves over-the-counter eyedrops, such as artificial tears, and other home remedies. It’s always best to avoid eyedrops that reduce redness, such as Visine eye drops.
If your dry eyes symptoms are persistent and more serious, your treatment options will depend on what’s causing your dry eyes. Some conditions that cause dry eyes can be reversed or managed. Other treatments can improve your tear quality or stop your tears from quickly draining away from your eyes.
In some cases, treating an underlying health issue can help reverse dry eyes. For instance, if a medication is causing your dry eyes, your doctor may recommend a different medication that doesn’t cause that side effect. If you have an eyelid condition, such as an anatomic abnormality or a condition that makes it difficult to close your eye completely when you blink, your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids (oculoplastic surgeon).
If your signs and symptoms suggest an autoimmune condition, such as rheumatoid arthritis or Sjogren’s syndrome, your doctor may refer you to a rheumatologist for evaluation.
Treatment options depend on severity, how symptomatic the patient is, and what type of dry eye they are experiencing.
MILD TO MODERATE DRY EYE SYMPTOMS
Preservative-Free Artificial Tears
Preservative-free artificial tears are always recommended for those who are symptomatic. Preservatives in eye drops can actually lead to worsening dry eye symptoms. Regular artificial tear use can really help tear film stability and make a very big difference in how the eyes feel and also in the quality of your vision. Always avoid using tears that reduce redness, such as Visine. There are artificial tears suitable for aqueous deficient as well as lipid deficient dry eyes.
Tea Tree Products
Tea tree products that are safe for the eyes can significantly reduce inflammation and bacteria around the eyes (blepharitis). These come in foam and oil forms.
To clean the eyes and reduce bacterial buildup around the eyes.
Daily intake of 2000mg Omega 3’s can help with overall dryness long term. They are also good for your heart and brain!
Hot Compresses with a Mask
Doing this for 6-7 minutes at a time can help with expressing the oil in the meibomian glands. Using a hot cloth will NOT be effective in producing a therapeutic effect.
The 20-20-20 Rule
Every 20 minutes, take a 20 second break and look 20 feet away. This can significantly reduce eye strain and dryness symptoms.
CHRONIC DRY EYE SYMPTOMS
Prescription Eye Drops
This can range from a steroid to other medications that have immune-suppressive properties to control inflammation.
In some cases, antibiotics can be prescribed to help with dry eye symptoms.
Can be inserted in the puncta (where the tears drain on the eye) to keep the tears from leaving too quickly. We usually try temporary plugs first and if they work, permanent ones can be considered.
Scleral Contact Lenses
Can be fit by an Optometrist to help seal in the tears for added moisture.
Unblocking Clogged Oil Glands
There are a number of different devices that can do this, some of which include iLux and Lipiflow, RF (radiofrequency) and IPL (intense pulsed light). These all help with MGD, ocular rosacea and blepharitis, however here at the Kennedy Eye Clinic, we recommend using RF and IPL and have both technologies. Please see a description of each in the next section.
SEVERE DRY EYE SYMPTOMS
There are prepared from the patient’s own blood serum and plasma. This fluid contains components that are present in natural tears so that we can form tear vials for the patient to use.
A permanent procedure that causes scarring and closure of the tear duct. This is performed by an ophthalmologist.
Please consult with your Optometrist before deciding which treatment would be most effective for you.
NEW! - RF AND IPL NOW AVAILABLE!
At the Kennedy Eye Clinic, we are the first and only clinic in the entire province to have RF (radiofrequency) and IPL (intense pulsed light) to treat dry eyes and MGD (meibomian gland dysfunction)! RF and IPL work differently but are synergistic; here are some details on everything below:
RF – Tripolar vs Monopolar
RF targets the meibomian glands and gives immediate relief to clogged glands. It kills off harmful bacteria and heats up the glands so the oil can flow out easier. It’s non-invasive and works by sending radiofrequency (so electromagnetic energy) to the tissues of the skin; the natural resistance of the skin to the currents generates heat and because of this temperature increase, it promotes tissue remodeling, increased blood circulation and detoxification. The procedure works by having a thin layer of glycerin gel applied on and around the eye with constant heat applied on the upper/lower eyelids for 8 minutes per eye.
As you know from basic physics, there are 2 electric poles: plus and minus. There are 2 basic types of RF that exist: monopolar and tripolar; tripolar has 3 poles on the handpiece itself, only 2 of which are active at any given time and they alternate between plus and minus. This allows them to treat the very superficial layers of the skin which is good in dry eye treatment.
Monopolar RF only has one pole on the hand piece and the other pole is located very far away ON the patient’s back in the form of a self-adhesive pad. The current has no choice but to travel all the way from one pole to the other and this causes VERY deep tissue penetration through ALL layers of the skin (the epidermis, dermis, the hypodermis and even the subcutaneous fat deposits below the skin itself). Monopolar RF treatments are typically found in most aesthetic centres for skin tightening and rejuvenation for this exact reason.
We have had a tripolar RF for dry eyes since 2020, however we just added in a monopolar RF in 2022 in hopes of offering different treatments for different patients depending on their wants and needs.
IPL targets the blood vessels themselves and work on reducing the inflammation that is associated with meibomian gland dysfunction and it also works on unclogging the glands and improving their function. IPL has been around for over 20 years but in recent years, it’s benefits in dry eye syndrome have been established. It is actually one of the only treatments that may help regenerate the meibomian glands themselves and actually addresses treating the cause of dry eye syndrome. You need to wear UV protection and after ultrasound gel is applied on and around the eyes, 26 flashes of light (that feel like you are being flicked with an elastic band) are given around and on the eyelids. Our IPL has 3 spot sizes to get into difficult to treat places and customize the treatment for you!
Our IPL can also be used for photo-facials to reduce sun damage, as well as treat acne, pigment and vascular lesions. This can all be done as an add-on with your dry eye treatment!
What Are The Differences?
Please consult with your Optometrist before deciding which treatment would be most effective for you.