Modern Dry Eye Therapy
Dry Eye affects people of all ages, but more women than men are affected. Causes can include genetics, hormonal changes, prescription medications and systemic diseases like diabetes or autoimmune conditions. Symptoms of dry eye disease range widely from the occasional use of artificial tears to the inability to function in everyday life. The disease typically worsens as we get older so seeking treatment earlier can prevent the need for more aggressive treatments down the road.
So what can we do about it? Luckily, a flood of new and effective treatment options have been released over the past two decades that have allowed for the relief of dry eye symptoms. Artificial tears and topical lubricants can offer temporary relief but are only palliative and do not actually treat the underlying cause of the disease.
The first step in selecting the proper treatment is to understand the cause of the dry eye. Some cases are caused by an inability to produce tears (aqueous deficient dry eye) and others lack the crucial oil layer of the tear film that protects the tears from evaporation (evaporative dry eye). Simple examination and testing can help to determine which type of dry eye is causing symptoms.
To treat aqueous deficient dry eye we focus on reducing the inflammation that causes the tear glands to not function properly. Prescription medications like Restates and Xiidra help to reduce the inflammation on the surface of the eye, relieving the discomfort and allowing the tear glands to work normally. For some people, more severe treatments are needed including topical corticosteroids or amniotic membrane treatments. Once inflammation is under control, punctual plugs, a safe, easy and painless procedure done in office, can act to slow the drainage of tears off the surface of the eye, allowing more natural tear to remain for longer periods of time.
For those with evaporative dry eye, treatments tend to focus on the eyelids. Oil glands located in the lids secreted oil onto the surface of the eye to prevent the evaporation of tears between blinks. If these glands become blocked or the oil becomes unhealthy, the tears will not protect the ocular surface properly. Treatment typically begins with warm compresses, foaming lid cleansers and oral supplements to improve the function of the oil glands and remove any blockages. If this is not sufficient, oral pharmaceuticals may be needed along with in office procedures to clear out the glands such as the Lipiflow Thermal Pulsation System.
These two types of dry eye are not mutually exclusive and many patients may need both types of treatments. Over-the-counter drops will only offer short term relief and will not stop the progression of the disease. While we cannot cure dry eye disease, we now have the tools to treat it effectively in a way that allows patients to live pain free and without fluctuating vision and/or irritation throughout the day.
Image courtesy of Mayo Clinic and Google Images.
Andrew Biondo, OD, FSLS is the Primary Medical Director at Kirkwood Eye Associates in Kirkwood, MO. Serving the greater St. Louis area, Dr. Biondo has 12 years of experience as an eye care provider, health educator & consultant to the specialty contact lens industry. His special interests include contact lenses, dry eye disease, glaucoma, macular degeneration, laser eye surgery & preventive vision care.