Eyecare Focus & Specialties has designed a specialty dry eye program that gets to the root of the disease in order to effectively treat the disease. Dry eye disease is a chronic inflammatory condition of the ocular surface brought about by tear hyperosmolarity and usually accompanied by ocular surface symptoms. In other words, persistent eye irritation and inflammation from our eyelids and other surfaces in and around our eyes leads to poor tear quality, quick evaporation of our tears, and ultimately dry eyes. Our eyes can then burn, itch, excessively tear, discharge, become light sensitive, or even have reduced vision. If left untreated, a downward spiral begins with inflammation causing dryness, dryness then causing more inflammation, and a continual worsening of the condition.
Common ocular conditions that lead to dry eye disease:
Inflammation of the eyelids. Blepharitis affects the outside front of the eyelid, where the eyelashes are attached. Common causes of blepharitis are bacteria (Staphylococcus), scalp dandruff and demodex. Demodex is a type of small parasitic mite which lives in or around the hair follicles of any mammal, including humans. These mites survive by feeding off of dead skin cells and bacteria.
Meibomian Gland Dysfunction (MGD)
Meibomian glands in both the upper and lower eyelids secrete oils that are essential to high quality tears, allowing them to lubricate the eye rather than evaporate away. MGD occurs when these glands stop working properly. This is usually due to the openings of the glands being blocked by bacteria, skin cells, mites or environmental debris. It can also occur due to inflammation from other conditions such as Rosacea and acne. Over time, these glands can become damaged to the point of complete loss of function.
How do we treat these conditions?
Blephex Eyelid Cleansing Treatment
Blephex is an in-office cleansing of the eyelid margin using a small rotating sponge. During this 6-8 minute procedure, the rotating tip removes bacteria, skin and environmental debris, and any other material that has collected. By removing this material, the meibomian glands are able to more easily release the oils that are required for high quality tears. Along with this, the procedure is removing the food source for demodex mites. Demodex feed off of bacteria and skin debris and if not available, they cannot survive in the follicles of the lashes.
Mibo Thermoflo Treatment
Mibo Thermoflo is a directly applied heat treatment to the eyelids and is actually quite relaxing. The direct heat softens the material that has built up and blocked oil release within the meibomian glands. Many times, after years of being clogged, the meibomian oils become thick with the consistency of toothpaste. This treatment allows this material to be expressed out, allowing the meibomian glands to begin working properly. The end result is a higher quality of tears and a decrease in dry eye symptoms.
During your Advanced Dry Eye Disease consult, there are several procedures that will be performed that allow us to diagnose whether or not dry eye disease is present, and if so, what is the severity. The testing begins with a questionaire called the Ocular Surface Disease Index (OSDI). This questionnaire is a subjective measurement of your dry eye symptoms and their affect on your daily life. Then the doctor will perform an in-depth evaluation of the ocular surface and eyelids to determine the presence of blepharitis, meibomian gland dysfunction, demodex or any signs of damage caused by years of dryness. Photos will be taken to compare against treatment progress in the future. Our technicians will perform the TearLab Osmolarity test, which analyzes the tears to determine a numerical value for the severity of the dry eye disease. The InflammaDry test will also be performed, which tests the tears for a specific protein that is commonly found in dry eyes as a result of chronic inflammation.
After the initial Dry Eye Disease consult, if you are found to have moderate to severe dry eye disease, you may begin the treatment program. The Advanced Dry Eye Program is an intense 1 year program designed to get to the root of the problem. It requires many office visits along with at-home personal maintenance. There is a standard protocol, however the program may be altered slightly by the doctor to fit your specific needs. The Dry Eye Disease is attacked from every angle to ensure the highest probability of reduced symptoms and highest success.
A typical program will consist of the Dry Eye Consult to determine the cause and severity of the condition. Most patients will begin with a minimum of at-home treatment consisting of artificial tears, lid hygiene, heat treatment, and omega-3 supplementation. Those with more advanced disease will begin topical and oral anti-inflammation medications, some of which are short-term and some long-term, along with in-office treatment with Blephex and MiboThermoflo. As every patient responds differently to treatment, some patients may later require punctual occlusion to increase ocular tear quantity, amniotic membranes or scleral lenses for severe corneal inflammation.