A Step-Wise Approach to Dry Eye Disease

Dry Eye Disease is a chronic condition that affects millions of Americans.  The disease exists along a spectrum that starts at mild (often asymptomatic) to severe and debilitating.  At Kirkwood Eye Associates, we follow a progression in treatment options to meet the need of any dry eye patient.  While dry eye is not curable and in many cases requires life-long treatment, it can be controlled effectively.


Mild/Moderate dry eye can manifest with no symptoms at all, or can cause mild symptoms of blurred vision, itching, redness, tearing, and grittiness.  When we see this stage, we first must determine the type of dry eye and whether the symptoms are caused by the tear glands (the main lacrimal gland and accessory lacrimal glands) or the eyelid oil glands (the meibomian glands).  While eyelid glands are more often to blame, it’s typically a combination of the two systems.  Initial treatments include warm compresses, omega 3 supplements, lid cleansers and tear supplements (artificial tears).


Severe dry eye can range from the constant need of drops or other supportive therapy, to severe pain and depression.  Treatment options here are plentiful, mainly because there is no perfect treatment.  Which treatment is best for an individual patient depends on a multitude of factors.  Here is a list of dry eye therapies offered at Kirkwood Eye Associates:


Medical Therapy:  Prescription eye drops including corticosteroids, Restasis and Xiidra are commonly used to reduce inflammation and improve the ocular surface environment, allowing some patients to produce more tears.


Punctal Occlusion:  The watery part of our tears is secreted onto the surface of the eye from the lacrimal gland and then drains off of the eye through the puncta (one on the upper and one on the lower lid near the nose) into the nasal cavity.  Punctal plugs are small, painless devices that slow the drainage of tears off of the surface of the eye.  This allows your own natural tears to stay on the eye longer, reducing surface dryness.


LipiFlow:  This unique in office procedure utilizes a device that is placed on the eyes and uses a combination of heat and pressure to clean out the meibomian glands that are crucial for producing the oil layer of our tear film.  This oil layer protects the tears from evaporating and helps distribute them evenly over the surface.  Chronic inflammation can cause these glands to clog, eventually leading to gland atrophy (death), making regular expression extremely important to the long term health of the eye.


Serum Tears:  A newer technique gaining popularity is the utilization of your own blood serum as a healing agent for the ocular surface.  This process involves drawing blood and spinning it down to a serum that is put in drop bottles.  They are then used as eye drops to promote comfort and healing of the ocular surface


Scleral Shell:  This technique is reserved for individuals with severe tear deficiencies, but it can be highly effective and life changing.  A scleral shell is a large rigid contact lens that fits over the cornea, trapping behind it a layer of hydrating saline.  Comfortable and easy to wear, these devices bathe the cornea in hydration, alleviating the symptoms of dry eye throughout the day.  The also have an added benefit of vision correction, as they can be powered to allow you to see without the need for glasses.