If you are experiencing itching, red, irritated, and/or burning eyes, you may have Dry Eye Disease. Dry Eye Disease occurs when normal tears are not sufficient to keep the front surface of the eye moist and well lubricated. At The Eye Associates we have a profound understanding of the causes of dry eyes and can customize a treatment plan for you. We have two Fellowship-Trained Dry Eye Specialists, Richard Hector, MD and Brian Foster, MD.

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More About Dry Eye Disease

Dry Eye Disease is a common problem for all ages, but it is more common as we get older. It occurs when your tears are not sufficient to keep the front surface of the eye, your cornea, well lubricated. The cornea needs constant lubrication by tears to stay healthy. "Tears are made up of three components: an outer layer of oil, a middle layer of water, and an inner layer of mucus." explains Dr. Foster "If you do not produce enough tears, or if the composition of your tears is not balanced, your eyes will not be properly lubricated. The result may be blurry vision, scratchy, itchy eyes, and pain."

Tears and Dry Eyes

Patients often feel their problem cannot be dry eyes, because their eyes overflow with tears. It may sound odd, but watery eyes are sometimes part of Dry Eye Disease. Dr. Richard Hector, our Fellowship Trained Dry Eye Specialist explains, “When the cornea becomes too dry, tear glands over stimulate the production of the watery component of your eye's tears. Unfortunately, these reflex tears do not lubricate well and may actually aggravate the problem.”

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If you have any of the following symptoms, ask your doctor if you have Dry Eye Disease.

  • stinging and itching
  • excessive tearing
  • burning sensation
  • inflammation and redness
  • sandy/gritty feeling
  • sensitivity to light

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Causes of Dry Eye Disease

  • Aging: Aging is one of the most common causes of dry eyes because tear production tends to diminish as you get older.
  • Environment: Hot, dry, and windy weather; heaters and air conditioners; and high altitudes increase the evaporation of tears. Ceiling fans are another common factor.
  • Computer Use: Computer users have a tendency to “stare” at a screen for long periods without blinking. This insufficient blinking pattern is often the cause for dry eyes in increasingly younger people.
  • Poor Lid Function: As you blink, your eyelids continuously spread a thin film of tears over the surface of your eye. Problems with eyelids, such as out-turning of the lids (ectropion) or an in-turning of the lids (entropion) contribute to dry eyes. Eyelid function can be addressed by our Fellowship-Trained Cosmetic Surgeon.
  • Contact Lenses: Long term contact lens wear can negatively affect your tear production.
  • Medical Conditions: Hormonal changes, especially in women, can cause problems with dryness. Also, patients suffering from thyroid disease, rheumatoid arthritis, psoriasis, eczema, Sjogren's syndrome, lupus, scleroderma, and other systemic conditions often experience dry eye disease. In addition, blepharitis, an inflammation of the eyelids, may be a cause.
  • Medications: Diuretics, allergy medication, antihistamines, and many other common medications may all produce dry eye symptoms. Also, a lack of some vitamins can increase dryness.

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Dry Eye Treatment

Dry Eye Disease is generally a condition that is not cured (depending on the cause), but it can be managed. Treatment options usually fall in four categories: increasing the amount of tears kept in the eyes, decreasing tear evaporation, treating inflammation and/or addressing eyelid function.

Mild dry eye symptoms are usually addressed with artificial tears to lubricate the cornea. There are many over-the-counter drops and ointments designed to replenish natural tears. Ointments are best for night use because they will blur your vision. We suggest that you try different brands of tears to see which one is best for your eyes. We do want to warn you against choosing an eye drop that 'takes the red out.' These eye drops tend to irritate the eye even more. Also, because some people are allergic to drops with preservatives, we recommend single-use drops.

Some other treatment options include Restasis prescription eye drops, autologous serum tears, punctal plugs, scleral lenses, Bruder Eye Hydrating Compress, vitamin therapy, lid scrubs, eyelid function surgery, and nutritional therapy.

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However, artificial tears only offer temporary symptom relief and do not address the underlying problem, which often is inflammation. There is a FDA approved prescription eye drop, called Restasis, designed to decrease inflammation, thereby helping to make tears that are more efficient in lubricating the eye. This not only increases the patient’s comfort, but also prevents more serious damage from occurring.

Autologous Serum Tears

The Eye Associates is one of the few practices that are equipped to offer serum tear treatment for patients with severe dry eye disease. Since artificial tears lack the biologically active elements found in our natural tears, eye drops made from components derived from one's own body have been found to be very beneficial. These eye drops, called autologous serum tears, are made by separating components of a patient's own blood. The benefit is that these man-made tears possess the biological nutrients naturally found in our own tears. It should be noted that this treatment is normally not covered by insurance.

Punctal Plugs

When eye drops are not able to offer relief of dry eye symptoms, another option is punctal plugs. They are tiny devices that are inserted into the tear ducts in order to retain the tears in the eye and increase the moisture and tear film. They are very easy and painless to insert and can be done during a routine office visit. Also, they are easily removed if necessary.

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Scleral Lenses

Some people find that they can improve their eye comfort with the use of scleral lenses. Scleral lenses are oversized gas permeable contact lenses that basically trap fluids behind the lens to add moisture to the eye. Many times this lens is used in conjunction with other dry eye treatments.

Bruder Eye Hydrating Compress

At any location of The Optical Gallery locations, the Bruder Eye Hydrating Compress are offered for sale. The Bruder compress is placed in a clean microwave for no longer than 20 to 30 seconds. Once it has been heated, it is placed over your closed eyes for several minutes. The moist heat works to improve oil gland production to expel bacteria, stabilize tear film and slow tear evaporation. Those with a mild to moderate dry eye condition find this natural treatment to be soothing and helpful.

Vitamin Therapy - HydroEye by ScienceBased Health

HydroEye softgel capsules are another product sold at The Optical Gallery that have been shown to decrease inflammation and significantly improve symptoms in moderate to severe dry eye patients. This daily supplement provides a proprietary blend of omega fatty acids [gamma linolenic acid (GLA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)], antioxidants and other key nutrients that work together to support a healthy tear film and dampen inflammation.

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Omega Cure Fish Oil

The Eye Associates also offers patients the ultra-fresh Omega Cure fish oil. This full spectrum fish oil is a liquid product that, because of the level of freshness, is virtually tasteless. Omega Cure owes its potency and superior freshness to meticulous handling from the catch of wild cod to its delivery to you. This liquid form is especially popular with patients that have problems swallowing the seven+ large capsules that would be needed to provide the dosage required to improve dry eyes as well as offer many other benefits for the entire body. Just two teaspoons daily provides 2000 mg of EPA/DHA, and it can be taken straight or it can be combined with juices, smoothies and other food products.

Lid Scrubs

Lid hygiene is very important in the management of Dry Eye Disease, and lid scrubs are often recommended. By using lid scrubs, patients are able to better remove debris and bacteria, and stimulate meibomian gland secretions; all of which help with Dry Eye Disease. There are many brands available over the counter so it's important to try a few out to see which type works best for you.

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Avenova by NovaBay Pharmaceuticals

There is also a new prescription lid scrub called Avenova that appears to be a major breakthrough in good lid hygiene. One of the main ingredients is hypochlorous acid (HOCL). HOCL is one of the chemicals that is naturally produced by your own white blood cells to kill germs. It is used in Avenova to kill bacteria and fungi while still being gentle enough to be soothing to the eye. Daily use of Avenova has shown to help dry eye patients as well as those with blepharitis and meibomitis within 2 weeks of use.

Maybe it's not Dry Eyes?

Conjunctivochalasis or CCH is often misdiagnosed or overlooked because the symptoms are very similar to Dry Eyes. Between the eye and the eyelid is a thin clear layer of tissue called conjunctiva. The conjunctiva extends from the edge of your cornea to the inside of the eyelid and acts like a pocket that holds a reservoir of tears, keeping the eyes lubricated and comfortable. For some people, this tissue can loosen and wrinkle with age disrupting the normal process of keeping the eyes healthy with tears. This condition is called conjunctivochalasis. Due to the wrinkling and loosening of the tissue, tears are forced out and the eyes become dry, irritated, and vision can decline.

Drops, ointments, and even prescription medications that are effective for Dry Eye do not resolve CCH. Your doctor may recommend surgical treatment of CCH. The procedure involves removing excess conjunctival tissue and replacing it with an amniotic membrane tissue graft that adheres without stitches. Amniotic membrane has natural anti-inflammatory and anti-scarring properties that actively promotes the healing process and reducing discomfort after surgery. Smooth, healthy conjunctiva replaces the amniotic membrane graft in a few days. After the ocular surface is restored patients can expect improvement in dryness and irritation.

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A consultation is highly recommended to determine the nature of your dry eye symptoms and to develop a treatment plan. We recognize that dry eye disease is a very frustrating and complex medical problem and we treat our dry eye patients with compassion and understanding, in addition to using the best medical and surgical therapy available. There are no quick fixes, but our doctors will do their best to improve your vision and ocular comfort.

The only way to know what treatment option is right for you is to make an appointment for a dry eye evaluation. Call (941) 792-2020 or toll free 1-866-865-2020 or contact The Eye Associates for an appointment.

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