Diagnosis and Treatment of Dry Eye
If you are experiencing symptoms of ocular surface disease (dry eye), it is important to discuss it with an eye doctor. Dry eyes can not only make you significantly uncomfortable and cause difficulty with visual tasks but also can increase your risk of eye infections. If left untreated, severe cases can lead to corneal scarring and diminished vision.
The doctors at Barnet Dulaney Perkins Eye Center utilize all of the latest diagnostic methods and treatments for ocular surface disease. Our doctors throughout the state have extensive training in this area and can recommend an individualized management and treatment plan.
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Some of the in-office tests that can be used to diagnose ocular surface disease, determine its cause, and tailor a treatment plan include:
- Schirmer Test: Filter-paper testing strips that are placed inside the lower eyelid measure the amount of tear production.
- Staining Test: drops of dye, such as lissamine green, fluorescein, or rose Bengal, are instilled in the eye to reveal areas of uneven tear film distribution.
- TearLab Osmolarity Test: This lab-on-a-chip diagnostic device uses a tear sample to evaluate tear osmolarity, which is an accurate and objective measure of tear quality. Research shows that elevated osmolarity, which alters the stability of the tear film, is increased in both aqueous-deficient and evaporative dry eyes, making it a strong indicator of ocular surface disease. This test is also helpful for monitoring the effectiveness of treatment over time.
- LipiView Ocular Surface Interferometer: This imaging device measures the absolute thickness of the tear film lipid layer by analyzing more than one billion data points. It also helps the doctor to evaluate the blinking pattern.
The treatment of the ocular surface disease depends on the underlying cause and includes many strategies. Mild symptoms can often be alleviated with over-the-counter artificial tears (preservative-free is usually best) or longer-acting gels or ointments. If these remedies do not sufficiently reduce the signs and symptoms of ocular surface disease, or have to be used constantly, other treatments or a combination of treatments may be necessary.
Depending on the cause and severity of ocular surface disease, treatment beyond artificial tears may include:
- Restasis: This prescription eyedrop contains the immune-suppressing medication cyclosporine for controlling inflammation and increasing tear production.
- Prescription Eyedrops: Steroid or antibiotic drops or ointments help to control inflammation.
- Punctal Plugs: These tiny devices (about the size of a grain of rice), typically made of silicone or dissolvable collagen, can be placed in the tear ducts to prevent tears from draining out of the eye too quickly.
- LipiFlow Thermal Pulsation System: Designed to treat evaporative dry eye, the in-office LipiFlow treatment uses an eyepiece to apply precisely controlled heat and gentle pressure to the eyelids to unblock clogged meibomian glands. It takes approximately 12 minutes and most patients describe the experience as a soothing eye massage.
- Warm Compresses: Some patients with evaporative dry eye find that applying warm compresses to the eyelids helps to unclog meibomian glands and relieve symptoms.
- Lid Scrubs: Pre-moistened pads and specialized solutions, many available over-the-counter, can be used to remove debris and bacteria from the eyelids and improve meibomian gland lipid secretion. (Using shampoo or soap for this purpose is not recommended.)
- Nutrients: Some evidence suggests that increasing the amount of Omega-3 fatty acids in the diet can improve the signs and symptoms of ocular surface disease. Omega-3s are found in foods such as fish, vegetable oils, and flaxseed and are also available as supplements.
- Oculoplastic Surgery: When the eyelids or other structures near the eye are the cause of ocular surface disease, a corrective procedure may be recommended. For example, when eyelids are turned in (entropion) or out (ectropion), surgery can be done to restore normal functioning.