Dry Eye Disease

Dry Eye Disease

Dry eye does not necessarily mean your eyes are "dry," but that there are signs and/or symptoms of dryness. Many people who suffer from "dry eye" have chronically watery eyes because of an imbalance in the systems that maintain the ocular surface. Dry eye disease is often associated and exacerbated by other conditions such as blepharitis, meibomian gland disease, and rosacea.

Dr Xu is bringing cutting edge dry eye treatments to Staten Island. We have the newest, and the only FDA approved IPL treatment for dry eye in Staten Island.

Dry eye symptoms can be some of the most frustrating and uncomfortable day-to-day feelings. They can severely impact your quality of life. If you often suffer from dry, irritated, burning, or gritty eyes, you may have dry eyes.

Dry eye disease is very common especially in today's world when we are all involved in electronics, whether it is at work or at home in entertainment. Additionally, in patients with glaucoma or with environmental allergies, the glaucoma or allergy eye drops tend to contribute to additional dryness. It is a chronic condition.

Our tear film is made up of three layers; they together to help maintain the health of our eyes and ward off infection.

Oil (Lipid) Layer:

In combating dry eye, the outer layer of our tear film plays a crucial role as it consists of an oil or lipid-based layer. Its primary function is to safeguard the tear film, effectively reducing the evaporation of our essential natural tears, providing relief for dry eye symptoms.

Water (Aqueous) Layer:

The middle layer primarily consists of water, dedicated to hydrating the eye, rinsing away particles, and serving as a protective barrier against infections.

Mucin Layer:

The innermost layer is the mucin layer, pivotal in enabling the even spread of the watery layer across the eye's surface. This vital layer ensures the eye stays consistently moist and lubricated, offering nourishment to the underlying cornea. Moreover, it plays a crucial role in helping tears adhere to the eye's surface.

Causes of Dry Eye Disease

Tear Film and Ocular Surface Society (TFOS) defined "Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage and neurosensory abnormalities play etiological roles."

The causes of dry eyes are multifactorial:

1. Age: As our eyes go through natural changes, tear production become less and the tear film may become less stable causing faster evaporation. For this reason, dry eyes are more common in those over 65. However, nowadays, we see many younger 20-30 years old with dry eyes too (see other causes below).
2. Hormone related: Post menopausal women are more likely to develop dry eyes caused by a decrease in estrogen. Studies shown that women over 50 have a 50% greater risk of dry eye disease than men of the same age.
3. Medications: Antihistamines for allergies, decongestants for cold, oral contraceptives, diuretics for blood pressure or weight loss, antidepressants, and many other medication have side effects in reducing tear production and causing dry eyes.
4. Medical conditions: Patients with an autoimmune disease such as Lupus, rheumatoid arthritis, Hashimoto thyroiditis are more likely to develop lacrimal gland inflammation. The Lacrimal gland is the tear-production powerhouse. Thus, patients with these conditions are more likely to suffer dry eyes.
5. Eyelid Malposition/inflammation: Inflammation of the eyelids (from blepharitis or rosacea) or inward/outward turning of the eyelid (entropion/ectropion) cause tear film instability.
6. Environmental factors: Windy and dry climates increase tear evaporation. Digital eye strain: when we focus on a screen (computer, cellphone, iPads) or when reading for prolonged period, we naturally reduce our blinking rate, causing evaporative dry eyes. Air conditioners or heaters are associated with tear insufficiency.
7. Other factors: Contact lens use. LASIK surgery. Eyelid surgery like upper lid blepharoplasty. Bell's palsy.

What We Do

Insight Ophthalmology takes dry eye treatments very seriously. We combine the latest know-how with the absolute latest technology. We offer a trifold approach, treating dry eye, and the associated ocular/skin issues of blepharitis and rosacea. We are one of the only area clinics that offer in-office IPL with the only FDA approved IPL in treating dry eyes. Dr. Xu will create a personalized regimen that improves vision, comfort and quality of life, without being overly burdensome.

Dry eyes develops when the amount of tears produced is not sufficient to maintain the moisture balance in your eye. Ironically in an effort to fight off the condition, dry eyes can cause you to produce excessive tears, which is why some people experience watery eyes.

"Doc, I am tearing. How can I have dry eyes?!" — MANY PATIENTS

Symptoms of Dry Eye Disease

Symptoms of dry eye syndrome can vary depending on the severity of the condition but can include:

• Dry, itchy eyes
• Burning or stinging
• Irritation
• Watery eyes
• Blurred vision
• Pain
• Foreign body sensation

Did You Know?

Dry eye disease frequently co-exists with

• Meibomian gland disease
• Blepharitis
• Rosacea

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We take an individualized step-wise approach, to give our patients the most relief of symptoms with the least amount of to-do items.

Diagnostic Modalities

• Fluorescein and Vital Dye staining
• Tear Break Up Time
• Schirmer Testing
• SPEED questionnaire
• Sjogren antibody blood test
• Corneal Topography

In recent years, new advanced diagnostic and treatment devices have been developed and can make a substantial difference in the treatment of this condition. Our goal is to make you "forget" about your eyes. If you are not thinking about your eyes, that means they are not bothering you. You should be enjoying your vision not reminded of any discomfort.

Treatment Options

• Holistic dietary adjustment and supplements
• Tear Substitutes, drops, gels
• Lid warming eye masks
• Tea Tree Oil based lid cleanser
• Omega 3 – triglyceride form, Oral supplement
• Prescription eyedrops (Restasis, Cequa, Klarity-C, Xiidra drops)
• Punctal plugs
• Debridement of lid margin
• Intense Pulsed Light (IPL)
• Autologous Serum Eye Drops (ASED)
• Protopic ointment
• Doxycycline
• Azithromycin drops
• Environmental modifications such as humidifier, moisture goggles

To start, make an appointment for dry eye consultation with Dr Xu. A comprehensive exam helps to define the problems and area of focus.

ZEST (Zocular Eyelid System Treatment)

ZEST (Zocular Eyelid System Treatment) is an exciting new treatment developed by Zocular® to treat dry eye, demodex and blepharitis. Dry eye and blepharitis are often associated with poor hygiene of the eye area.

ZEST is an in-office lid cleaning and debridement system using a natural okra-based gel. It is an effective treatment for killing demodex mites, removing dirt and debris and relieving associated inflammation.