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The tear film is composed of three intermingling layers:
Oily (Lipid) Layer
Outermost layer prevents evaporation
Watery (Aqueous) Layer
Middle layer moisturizes the eye
Inner layer allows adherence between
the eye and the watery layer
Since the tear film is exposed directly to the air, the protective lipid layer is essential for maintaining a healthy film on the eye. When the protective lipid layer of the tear film is lacking, often caused by a blockage or obstruction of the eyelids meibomian glands, the result can cause a variety of problems including the following:
According to research, over 16 million Americans have dry eyes. However, this number may be significantly higher. Those who develop the disease can experience problems with daily activities like reading, watching television, using the computer and mobile phones, dealing with work, and driving.
The aqueous layer makes up the bulk of your tear film, however your lacrimal gland may not be functioning properly enough to supply enough water within your tears.
The oily (lipid) component of your tear film is critical for protecting your tears from evaporating between blinks. Meibomian gland dysfunction (MGD) accounts for most cases of dry eye syndrome.
Inflammation plays a key role in diagnosis and treatment of dry eye disease. Recognized as both a cause and consequence of dry eye, inflammation is a primary target in assessing the type of dry eye that you may have, along with determining a treatment plan.
Dry eyes are often accompanied with a condition called blepharitis or eyelid inflammation. This inflammation causes the tips of the eyelid to swell up, appear red and inflamed, and produce infected debris called scurf.
Demodex are tiny mites that live in your eyelash follicles and the glands of your eyelids. Regardless of whether the culprit is bacteria or Demodex parasites), both release toxins into the tear film, causing additional inflammation and irritation.
Dry eye disease (DED) poses a significant public health concern, given its increasing prevalence and impact on patient quality of life. In addition, digital screen use is on the rise, which is known to decrease a patient’s blink frequency and completeness.
This can have the biggest environmental impact on dry eye disease. An estimated 40% of the world’s garbage ends up in the air after burning, filling it with millions of invisible toxins, contributing to poor air quality which can exacerbate the effects of dry eyes,
Ocular hypersensitivities due to allergies can cause your eyes to be red, watery, itchy, or filmy. Seasonal changes, particularly in the spring, summer, and fall— cause there to be a high number of pollens and allergens in the air.
Many systemic health conditions impact the structures and the health of the eyes. Autoimmune diseases (i.e., Lupus, Crohn’s Disease, Rheumatoid Arthritis, Sjogren’s Syndrome, and many more), metabolic diseases (i.e., Thyroid disorders), stress, lack of sleep, and poorly balanced diet drive inflammation in the body and contribute to your ocular surface issues, including Dry Eye Disease.
Several medications may cause a reduction in the functionality of the tear ducts and lead to dry eyes. These include:
Lortab (acetaminophen and hydrocodone)
Certain Birth Control pills
Contact lens wearers are at a higher risk of developing dry eye. Whether your contact lens is blocking oxygen from entering the eye, or the tear film breaks up, both cause the contact lens to irritate the surface of the eye.
While dry eye syndrome (DES) is very common among both contact lens wearers and non-wearers alike, the symptoms can be more severe and uncomfortable if you wear contact lenses. Typically, DES symptoms include irritated, red and itchy eyes.
Blurred vision, itchiness, burning, or discomfort when wearing contact lenses, as well as sensitivity to light may occur during the early stages of pregnancy, when hormones are most active. These hormones have also been shown to adversely impact meibomian glands, located within the upper and lower eyelid margins.
Complications from certain medical procedures, including eye surgery and radiation therapy, will very often result in Dry Eye Disease. Radiation therapy to treat head and neck cancers, cancer of the eye socket or whole brain radiation for brain cancer, often damages the lacrimal glands. The glands may decrease tear production and cause dry eye symptoms.
This is also true for laser eye surgery, such as LASIK, where symptoms may develop due to an increased corneal sensitivity following the surgery.
Working in very dry or dusty environments has been shown to worsen the effects of dry eyes. Dry climates tend to have high winds and little moisture in the air, which can cause the tears to evaporate quickly. Furthermore, cold weather may lead you to spend most of your time indoors, exposed to dry heat. This can evaporate your tears, leading to inflamed, itchy eyes.
Spending long periods of time using digital devices can cause significant strain on the eyes. We also automatically blink less when we are concentrating on visual tasks. Regular breaks can counteract this effect.
As we know, any sort of smoke can irritate the eyes and exacerbate the symptoms of dry eyes, including tobacco smoke. When our eyes are exposed to smoke, microscopic particles get stuck inside them, remaining in place long after the visible smoke has cleared.
There is no single test to reliably diagnose dry eye, as there are always several factors involved, and sufferers may report a variety of symptoms. The key to proper analysis of the various factors involved in eye wetting disorders and determination of their causes lies in a broad-based diagnostic approach.
Some patients have an inflammatory marker, called MMP-9 (Matrix Metalloproteinase-9) present in their tears. By taking a sample of tears from the inner lining of your lower eyelid, we diagnose a “positive” or “negative” reading in 10 minutes. This is a crucial piece of information that can point your doctor in the proper direction for follow up therapy.
There is a certain amount of salt found in your tear film, called osmolarity. As tears evaporate, the salt becomes more concentrated. This hyperosmolarity is why many patients experience classic dry eye symptoms. We take a small sample of your tears to measure the salt content. Regular testing is a great way to monitor dryness changes over time and determine which treatment methods are successful.
The Dry Eye Center at B-Town Eyecare has the most current diagnostic technologies as well as up-to-date knowledge on all treatment options available. We provide cutting-edge treatment for dry eyes that’s fully tailored to your specific situation. Here are some of the questions we will likely ask on your first visit:
Our Doctor will also conduct an in-depth assessment of indicators for other diseases and health problems which might be contributing factors to your dry eyes. We then develop a personalized treatment plan based on what we find, and ongoing based on what’s working for you.
On every patient questionnaire, we ask if you are suffering from any of the typical symptoms of dry eyes. Do your eyes feel gritty? Sore? Do you feel like something is in your eye or that you just don’t seem to have any tears?
Given the chronic nature of Dry Eye Disease, it’s often helpful to track symptoms over time using standardized questionnaires. We use the DEQ-5 Questionnaire to assess and track your subjective symptoms of Dry Eye Disease.
If you report symptoms of dry eye, or appear to exhibit those symptoms, then we recommend beginning the dry eye exam process, which is quick, easy, and painless.
Your first visit will include the following:
Suffering from dry eye syndrome not only diminishes your quality of life but also makes daily activities such as reading, doing sports, or even driving a struggle. We aim to restore or maintain the normal amount of tears in the eye to minimize dryness and discomfort.
Many patients have tried multiple over the counter drops and remedies. Some have tried prescription drops or other professional therapies. Having a detailed list of your treatment history along with any drops or medications used previously or currently will be very helpful. Please note if you have had any adverse reactions or allergies to medications. A current list of diagnosis and systemic medications is necessary as sometimes these can be contributory to the disease process. It is also helpful to avoid using any drops at least 2 hours before the evaluation, and to arrive with glasses versus contact lenses.
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