There are many sub-specialties of optometry. One of them is Dry Eye Syndrome (DES). DES can affect anyone from children to adults. The symptoms range from redness, irritation, gritty feeling, fluctuating vision, burning, itching and tearing. Patients can present with one of the above, or all of the above. There are also many different levels of dryness and different treatments depending on whether the condition is mild, moderate, or severe.
The tear film is the outermost layer on the surface of the eye which is composed of three parts. Ocular irritation is usually due to one or more of the following tear film components (aqueous, lipid or mucin). These three layers also work together to maintain the health of the front of our eyes and to ward off infection. The aqueous and mucin layer form the bulk of the tears. If the tear film has an abnormality, the issues are usually decreased tear production or increased tear evaporation.
Treatments range from something as simple as artificial tear drops to IPL laser therapy. There are many prescription dry eye medications such as Restasis, Xiiadra, and Cequa. Serum autologous tears can also be used. This is a blood derived eye drop that has been proven successful in many patients where other options have failed. Punctal plugs can also be used to treat dry eye, along with steroid drops to help with the inflammation. In some situations, punctual plugs, steroid drops and I lux are combined. Each doctor has his/her own way of treating dry eye, depending on what they have found to be successful. One newer piece of technology to treat DES that involves punctate keratitis (inflammation on the cornea) is a Prokera contact lens. This contact is used as a tissue bandage to heal the front surface of the eye. It can be used for many other conditions besides dry eye as well. It contains a piece of amniotic membrane which comes from the human placenta.
Blepharitis is very commonly associated with DES. Blepharitis results from inflammation of the eyelid margins. Inspissation of the oil producing glands of the eyelid is called meibomitis and also is commonly associated with dry eye and blepharitis. The symptoms are very similar to those of dry eye (itching, redness, burning, tearing, mild pain). Treatments range from warm compresses, bruder masks, avenova eyelid cleanser, doxycycline, bleph x, I Lux, to IPL therapy, depending on the severity.
The technology to treat DES is ever-changing and it’s important to maintain continuing education to keep up to date with all the changes to help give patients the best care possible.
