DRY EYE CLINIC
If you have dry eyes, WE can help! At The Kennedy Eye Clinic, we have a ton of in-office dry eye treatment options so trust us when we say we can customize a treatment plan for you. Let's go over some basics first.
What is Dry Eye Syndrome?
Dry eye syndrome results when either the eye does not produce enough tears or when the tears evaporate too quickly. Certain medications, medical conditions and environments can make dry eyes worse. Symptoms can include: redness, burning, irritation, soreness, itchiness, heavy eyes, fatigued eyes, fluctuating vision, and blurry vision. There are at-home treatments that you can do to help with your dry eye symptoms and after those options are exhausted, there are multiple in-office treatments that we can do at Kennedy Eye Clinic.
Tear Film Components:
There are 3 main components to a normal tear film:
1. Lipid Layer: Produced by the meibomian gland and prevents the tear film from evaporating too quickly.
2. Liquid Layer: Produced by the lacrimal gland and it lubricates and protects the eyes surface.
3. Mucin Layer: Produced by goblet cells and it helps anchor and spread the tears across the eye surface.
DRY EYE CATEGORIES
1. Evaporative Dry Eye or Meibomian Gland Dysfunction (MGD). This results when the meibomian glands do not produce enough oil to keep the tear film from evaporating. Over 86% of people in Saskatchewan suffer from MGD.
2. Aqueous Deficient Dry Eye: This results when the lacrimal gland does not produce the watery fluid that lubricates the eye.
3. Mixed Dry Eye: a combination of MGD and aqueous deficient dry eye.
DRY EYE ASSESSMENTS
At the Kennedy Eye Clinic, we offer various dry eye assessments with a valid SK health care card:
Dry Eye Consult: you meet with one of our doctors for a consult to determine what at-home and/or in office treatments would be most beneficial for you. There is no imaging done at this appointment and the visit is $50.
Dry Eye Assessment: is the dry eye consult + imaging to determine which type of dry eye disease you have so a customized treatment plan can be created. We will take images of the meibomian glands to look for gland atrophy, we will measure how fast your tear film evaporates, and we will also tell you the amount of tear volume you have. This assessment is $200 (or $50 for each individual test if you don’t want to have them all done).
Dry Eye Assessment + Tear Osmolarity: is the dry eye assessment with a measurement of your tear osmolarity, which is essentially measuring the amount of salt you have in your tears. If there is too much salt in your tears, it leads to improper tear production, distribution and elimination. This assessment is $250.
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:
RISK FACTORS ASSOCIATED WITH DRY EYES
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.
Smoking
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 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.
AT-HOME TREATMENTS
For most people with mild to moderate dry eyes, we start with at-home remedies. Your Doctor of Optometry will let you know which of the following will help. Options include:
Artificial Tears: preservative free artificial tears are always recommended for people who suffer from dry eye syndrome as the preservatives themselves can cause more dryness overall. There are a lot of options for artificial tears, so please ask your doctor which is the best option for you.
Omega 3 Fatty Acids: 2000-3000mg a day. Not all Omega’s are created equal so we recommend that you buy the dry eye formula that is sold in optometry clinics. Omega 3’s particularly help people suffering with MGD but take a few months to kick in.
Hot Compresses with a Bruder Mask: for at least 8-10 minutes at a time, and once or more daily. This helps treat the symptoms associated with MGD.
Lid Hygiene: keeping the eyes clean on a daily basis is very important for people suffering with dry eye syndrome. We recommend either lid wipes with or without tea tree oil; please consult your doctor on which product would be better suited for you.
Sleeping With A Humidifier: this can help create a more humid environment for your eyes. Some people also put small ones at their desk at work to help too.
Moisture Release Eyewear: there are certain goggles that you can wear during the day as well as to sleep to help retain moisture around your eyes.
20-20-20 Rule: just a friendly reminder for every 20 minutes of screen time, take a 20 second break, and look 20 feet away. This helps you blink more frequently and prevents your eyes from drying out from prolonged screen time.
CHRONIC TREATMENTS
Prescription Medications: your doctor can sometimes write a prescription for medication to help with your dry eyes. These include steroids, antibiotics, and dry eye specific drops.
Punctal Plugs: these are plugs inserted into the puncta (where the tears drain) to help pool the tears so they don’t dissipate as fast. There are temporary as well as permanent plugs.
Scleral Contact Lenses: these are a hard type of contact lens that can be worn that causes the tears to be pooled and give relief for serious and chronic dry eye patients.
Serum Tears: these are special artificial tears made from your own blood plasma and serum and are typically used in patients with severe symptoms.
Amniotic Membranes: these are put in place on your eye to heal damaged corneal tissue.
Heat Therapy: these are in office treatments that help unclog the meibomian glands. These include Radiofrequency (RF) as well as Lipiflow treatments.
Inflammation Treatment: this is done in-office and through a procedure called Intense Pulsed Light (IPL). Please read below for further information.
Thermal Cautery: permanent procedure that causes scarring and closure of the tear duct. This is performed by an ophthalmologist.
IN OFFICE TREATMENTS AT Kennedy Eye Clinic - RF, IPL & LIPIFLOW!
If dry eye symptoms are more serious and persistent after doing at-home therapies, then in-office treatments are considered. Treatment options will depend on what type of dry eye the patient is experiencing and its severity. At the Kennedy Eye Clinic, we have RF, Lipiflow, and IPL to treat dry eyes and MGD. Ideally, a combination of RF and/or Lipiflow with IPL treatments will have maximum efficacy to unclog the glands while also simultaneously treating the associated inflammation.
LIPIFLOW
Lipiflow uses thermal heat to treat chronic and severe symptoms of MGD; the machine uses thermal pulsation to unclog and express the glands rather than a doctor doing it for you manually. After the treatment, the meibomian glands gradually start to re-produce their own oil again except this time, the quality is much higher since all the cloggages were removed; it takes about 4-8 weeks before you start noticing the effects of the procedure.
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Treatment Time: 15 minutes total.
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Downtime: None.
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Level of Discomfort: None.
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Procedure: An anaesthetic drop is put in the eye and then a cornea shield is put in place.
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Skin Types: All.
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Frequency: Once a year.
There are essentially no contra-indications for someone to get Lipiflow as it is super safe and non-invasive.
RADIOFREQUENCY (RF) TREATMENTS
RF heats up the meibomian glands and gives immediate relief to clogged glands and improves their function. It is non-invasive and works by sending radiofrequency 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. RF is also great for people who also want to tighten skin and reduce fine lines, wrinkles and dark spots around the eyes. We can add on other parts of the face and/or neck for an additional fee.
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Treatment Time: 20-25 minutes total.
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Downtime: None except some redness around treatment area for an hour after.
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Level of Discomfort: None during but post-procedure, there is gland expression done by the doctor which can be found to be uncomfortable but not painful.
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Procedure: a gel is placed on and around your eyes. If the upper lids require treating, an anaesthetic drop is used before a corneal shield is put onto the eye.
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Skin Types: All.
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Frequency: 5-7 spaced 2-3 weeks apart to start then 2-3 visits a year after for maintenance. Frequency may be less if coupled with IPL treatments.
Lipiflow and RF have essentially the same outcome; the main differences are that Lipiflow is only 1 visit a year whereas RF is multiple, and RF can tighten the skin and address fine lines and wrinkles.
INTENSE PULSED LIGHT (IPL) TREATMENTS
IPL targets the blood vessels themselves and work on reducing the inflammation that is associated with MGD as well as unclogging the glands and improving their function. 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. IPL can also reduce the look of fine lines and wrinkles, treat dark circles around the eyes and can stimulate collagen production. As such, IPL can also be used to reduce the appearance of acne and acne scars, sun damage, melasma, chalazions, and rosacea; if you would like to treat other areas of your face/neck with IPL in addition to your dry eye treatment, we can do this for an additional fee.
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Treatment Time: 15-20 minutes total.
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Downtime: Some redness around treatment area for an hour after.
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Level of Discomfort: it feels like you are being flicked by an elastic band 26 times. Post-procedure, there is gland expression done by the doctor which can be found to be uncomfortable but not painful.
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Procedure: Ultrasound gel is put on and around the treatment area and UV protection is given. Sometimes an anaesthetic drop is put in the eye and then a cornea shield is put in place.
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Skin Types: 1-3, sometimes 4.
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Frequency: 4 spaced 2-3 weeks apart to start then 1-2 maintenance visits per year.
More side effects can occur with IPL than RF and Lipiflow, most of which include burning, redness and some bruising.
COST OF IN-OFFICE TREATMENTS
Single Treatments:
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Lipiflow: $900 per session
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RF (monopolar): $250 per session
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IPL: $250 per session
Bundle Pricing To Save You Money:
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Lipiflow/IPL Bundle: $1710 for 1 Lipiflow and 4 IPL sessions (10% off)
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RF (monopolar)/IPL Bundle: $1800 for 4 RF sessions and 4 IPL sessions (10% off)
If you want to take advantage of the aesthetic benefits of IPL and RF and add those to the dry eye treatments, we will offer a 10% discount on those too!
To help offset the bundle cost, we are offering PayBright so you can buy now, and pay later! See clinic for details.
WHAT ARE THE NEXT STEPS?
Consult your Doctor of Optometry to see what you should be doing and what procedures you would be a candidate for. We can start with a dry eye assessment and go from there. We are here to answer all of your questions and we want to help you feel better!