Dry Eye Center of Excellence
Dry Eye Center of Excellence
The optometric physicians at Accent on Vision Santa Fe specialize on the diagnosis and treatment of ocular surface diseases causing symptoms such as:
Contact Lens Intolerance
Causes of Dry Eye
Meibomian Gland Dysfunction (MGD) and Evaporative Dry Eye (EDE)
MGD is the most common form of lid margin disease and causes 80% of dry eye cases.The oil glands along the eyelid that secrete oil to help prevent tear evaporation become blocked with thickened oil. Chronically clogged meibomian glands eventually become unable to release the necessary oil and results in permanent changes in the tear film and dry eyes. Some cases of MGD are associated with Rosacea, a chronic inflammatory condition that affects the skin on the face. The most common symptoms are dry, itchy, red eyes and is typically worse in the morning. Rosacea is likely caused by a combination of hereditary and environmental factors. A person is more likely to develop rosacea if they have light skin, are prone to flushing, are between the ages of 30 to 60, or have a family history of rosacea.
The most frequent cause of blepharitis (inflammation of the lids) is Demodex, a very common mite that has an affinity for the eye lash follicles. Demodex presents as waxy collarettes at the base of the eyelashes and is one of the causes of blocked meibomian glands. The inflammatory response can result in red, itchy eyelids. This infestation on the lids can be treated with a medicated lid wipe and in more severe cases an in-office procedure is performed that mechanically removes all debris from the lids so that the medication is more effective.
Aqueous Deficiency Dry Eye
This is a chronic, progressive disease in which the lacrimal (tear) glands fail to produce enough volume to maintain a healthy eye surface. This type of dry eye is more common in women, those with autoimmune disorders, and patients on certain medications.
Sjogren’s Syndrome is a chronic autoimmune disease in which a persons white blood cells attack their moisture producing glands. The primary symptoms are dry eyes, dry mouth, fatigue and joint pain though some may only have one or two of these symptoms. Nearly 4 milling Americans suffer from Sjogren’s syndrome with 9 out of 10 of those being women. Often this disease is overlooked or misdiagnosed. In the past, diagnosis has been limited and invasive. Our office now offers detection testing, known as the Sjo test. This is the first panel with the ability to detect the disease in its early stages. For more information on this test or Sjogren’s Syndrome, please contact our office.
Diagnosing Dry Eye
Computerized Tear Analysis
Accent on Vision uses an advanced technology called the Oculus Keratograph to examine your eyes. This instrument has a high-resolution color camera equipped with intelligent software to analyze the collected data and document the findings. It can also compare the results and show the success of the dry eye treatment. For more information view our brochure here.
Treatments for Dry Eye
Home Hot Packs and Hygiene with Avenova
The Bruder Eye Hydrating Compress improves oil gland production, stabilizes tear film, and helps slow tear evaporation. Water molecules are continuously absorbed from the air and stored inside the compress. When microwaved, the absorbed water is released as clean moist heat. There is no need to add water. Unlike other hot packs, this compress is reusable, washable, and non-allergenic.
Avenova is a gentle, refreshing, and soothing spray used for lid and lash hygiene. Avenova contains hypochlorous acid, which is produced and released by neutrophil cells, part of the bod’s natural defense mechanism against pathogens.
Thermal Eye Hydration Procedure
In more severe cases of MGD, this procedure uses heat to loosen and free the blocked oil from the Meibomian glands of the eyelid, improving the tear film’s resistance to evaporation. The glands get blocked due to a genetic tendency to produce an oil that is too thick.
The heating procedure lasts 8-10 minutes per eye and is followed by the doctor gently expressing each gland to clear obstructions. Once the glands are opened and free to secrete the oils, the tear film stabilizes and the eye is bathed with the proper amount and consistency of tear film, improving comfort, vision and eye health.
Punctal occlusion is a very safe, painless, and effective treatment option for dry eye. Plugs partially block the tear drain in the eye lids to decrease the loss of tears from the surface of the eye. There are two main types of punctal plugs, both temporary (dissolvable) and permanent. The dissolvable plugs are used for diagnostic purposes or for short term treatment post-surgery. Permanent plugs do not dissolve but can easily be removed if needed. The most common side effect is excess tearing.If the plugs are repeatedly lost, a minor surgical procedure can close the tear drain permanently.
Restasis/ Short term use of steroids
Restasis is a prescription eye drop used twice per day to stimulate tear production. Restasis is the only drop that helps increase your eyes’ natural ability to produce tears. This drop is instilled twice daily. Restasis works by treating the inflammation associated with dry eyes. It may take a few weeks to get an initial effect. Studies show most patients will begin to feel better within 4-6 weeks. Occasionally a short bust of steroid eye drops before starting restasis gives more immediate relief.
Lubricating drops are solutions specially formulated to moisten the eyes. Artificial tears should be used to supplement other dry eye treatments and do not provide long term relief. Preservative-free drops are recommended when used four or more times per day to avoid any toxic effects from the preservative use. For MGD oil-based drops are used to provide the lipid layer of the tear film that prevents rapid evaporation.
In some cases of MGD, a short course of antibiotics works to help thin the oils of the meibomian glands and reduce inflammation along the eyelid margin.