In Office Treatment for Dry Eyes
It’s no secret that most of us spend too much time in front of a screen. Many people spend all day at work staring at a computer monitor, only to come home and spend hours on a phone or tablet. This kind of extended near work takes a toll on our tear film, the protective layer of hydration on the surface of our eye.
Our pre-corneal tear film is an extremely complex and important component of our visual system. It protects our sensitive ocular surface from the environment and any disruption in this layer leads to symptoms ranging from tired eyes to burning, tearing and itching. The tear layer also serves a very important optical function. The surface of our eye is rough and uneven… not ideal for focusing light precisely on the retina. Our pre-corneal tear film fills in these irregularities and creates a smooth and uniform surface for refraction. This is the reason that the majority of dry eye sufferers present with complaints of blurred and variable vision, not eyes that feel dry or uncomfortable.
So why does screen time lead to tear film instability and dry eye? This mainly is due to our lack of full and complete blinks while focusing on our near work. Any extended near focusing (even a book) causes us to blink one-third as much as we normally would, but screens make it even worse. Images on digital devices change and refresh so quickly, we not only blink less, we have incomplete blinks because. A full and complete blink may mean that we miss something on our facebook timeline!
This issue is that a lack of blinking (and complete blinking) leads to blocked up tear glands. Our eyelids contain glands that make up two of the three layers of our tear film. Accessory lacrimal glands secrete the watery part of our tears and (most importantly) meibomian glands secret oils that cover and protect our tears, holding the system together between blinks. In order for these glands to properly express their contents, one must achieve a full blink that causes small muscles around the glands to contract, expressing their contents. When we chronically fail to do this, the oils and tears start to coagulate in the glands and lead to blockages, causing dry eye.
Another cause of dry eye symptoms (blurred vision included) is an accumulation of microorganisms along the eyelash line (blepharitis). These can include bacteria (mainly the staph that typically inhabits our skin surface) and parasites like the demodex mite. Our lashes provide the shelter, oils and moisture to promote microbial growth. Combine that with the fact that most people fail to wash their lashes on a daily basis and you have a recipe for infestation.
These microorganisms do more that just gross us out… they release exotoxins, oil destructive enzymes and other byproducts that irritate our ocular surface and inflame our eyelid margins. They can even cause more direct damage by infesting our glands leading to improper tear production and styes. If you suffer from chronic styes, we can help!
So what can be done? If you are not experiencing any symptoms, its still worth getting check out. Early detection of lid disease through examination and gland imaging is paramount in preventing dry eye symptoms. This is also the best time to begin lid hygiene with doctor recommended lid scrubs to prevent blockages and infestations. It is also important to remember to take frequent breaks from digital device and BLINK!!
If you’re already experiencing ocular fatigue, discomfort or blurred/variable vision, it may be time to consider in-office treatment. These treatments can be tailored to treat your specific lid disease. Treatments often include blepharo-exfoliation that removes dirt, metabolic debris, bacteria and parasites from the eyelid margin. This helps allow the tear producing glands in the lids to function optimally. Additionally, meibomian gland expression ( iLux ) is a new and extremely effective method of instantly and painlessly improving tear quality and reducing dry eye symptoms through the unclogging of blocked glands. These treatments have shown a success rate of over 85% in our practice.
While treatment like these are not covered by insurance, they are far more effective than over-the-counter or prescription eye drops and tend to be far cheaper when extrapolated over a years time.
At Kirkwood Eye Associates, we remain committed to being at the forefront of dry eye therapy, most of which is now done in the office, reducing or removing the need for daily home therapy that is less effective and more time consuming (and typically more expensive). In office treatments include blepharo-exfoliation, iLux meibomian gland expression (replacing lipiflow), amniotic membrane therapy, punctal plugs, bandage contact lenses and more.
Call us today if you’re tired of tired eyes!
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.