Dry Eye Institute

What is dry eye?

Your eyes need enough tears to stay comfortable and provide you with the clearest vision, and dry eye is one of the most common reasons that people see an eye doctor. Dry eye occurs when your eyes do not produce enough tears or the tears produced do not have the right mix of ingredients, leading to rapid tear evaporation from the surface of the eye. It is important to treat dry eye because if it is not properly managed, dry eye can not only cause discomfort affecting your quality of life but can also cause scarring and infections that may result in loss of vision.

What are the symptoms of dry eye?

Some of the most common symptoms of dry eye include:

Stinging and burning of your eyes
Sandy or gritty feeling like there is something in your eye
Red or irritated eyes
Light sensitivity
Episodes of blurred vision
Eye fatigue after reading or at the end of the day
Discomfort when wearing contact lenses
Discharge or mucous in or around your eyes
Occasional or constant tearing (watery eyes)

Having tearing in the setting of dry eye may sound counterintuitive, but when your eye is dry, it sends a signal to the tear gland to produce more tears to address the dryness, which can lead to tearing.

What causes dry eye?

The most common causes and risk factors of dry eye include:

Increasing age
Contact lens wear
Environmental factors such as wind, dust, smoke, air conditioning, fan, or a dry climate
Decreased blinking when reading or watching screens
Medications such as antihistamines, antidepressants, hormones, blood pressure medications, diuretics, and even some over-the-counter medications
Medical conditions such as rosacea, diabetes, Sjogren’s syndrome, rheumatoid arthritis, thyroid disease, and lupus
History of Accutane use, chemotherapy or radiation
Hormonal changes such as menopause
Having refractive eye surgery such as LASIK
Meibomitis causing oil glands along the eyelid margin to become clogged so that they no longer add sufficient oil to the tear film, accelerating tear evaporation
Blepharitis causing inflammation along the base of the eyelashes and lid margin adding debris to the tear film.
Incomplete eyelid closure following eyelid surgery, bell’s palsy, or occurring naturally with larger eyes
Eyelids being in the wrong position such as with ectropion or entropion or in floppy eyelid syndrome

How is Dr. Liu uniquely qualified to treat my dry eye?

Dr. Liu is a board certified Ophthalmologist and completed an additional fellowship in Ophthalmic Plastic and Reconstructive Surgery specializing in the eyelids and the complete pathway from where tears enter the eye to where they leave the eye. Other Ophthalmologists look to Dr. Liu’s specialized knowledge and treatment protocols to address dry eye in their patients, from the most common problems to the most complex.

Many people have tried artificial tear drops or even medicated eye drops and experienced limited improvement in their dry eye symptoms. This is typically because the cause of dry eye can be complex and vary from person to person. Dr. Liu provides a suite of treatment options unique to her office, including:

Intense Pulsed Light (IPL) – a revolutionary in-office treatment technology to treat one of the most common causes of dry eyes, meibomian gland dysfunction
Punctal plugs – a procedure to keep your natural or artificial tears around for longer, when punctal plugs keep falling out or are not tolerated, punctal cautery can be performed
Eyelid surgery – occasionally, eyelid surgery may need to be performed if your eyelids are not sitting in the right position

During your consultation with Dr. Liu, she will perform a complete assessment of your dry eye and all of the contributing factors. Dr. Liu will then recommend a customized management protocol that addresses your particular causes of dry eye.

What are the treatment options for dry eye?

There are a number of treatment options for dry eye, since the underlying cause of the condition can be attributed to many different factors. Dr. Liu has extensive experience diagnosing dry eye and its causes, which enables her to guide patients to the appropriate treatment regimen.

Lifestyle Modifications

Lifestyle modifications are usually the first line of treatment and may include:

Limiting screen time
Wearing sunglasses
Avoiding windy conditions
Using a humidifier at home
Taking a break from contact lens wear
Being meticulous about makeup removal
Placing warm compresses on your eyes to stimulate oil gland function
Scrubbing the eyelid margins to thoroughly remove debris at the eyelash root
Adding an Omega-3 supplement to help fight inflammation and provide essential fatty acids that aid the function of your eyelid oil glands

Dry Eye Medications

If lifestyle modifications are ineffective or impractical, the next step for many patients is non-prescription medications:

Artificial tears can be used as often as needed to replace your natural tears
Artificial tear gels are thicker and remain on the surface of the eye longer
Artificial tear ointments are best used to lubricate the eyes overnight when vision is less important since these medications tend to blur your vision

When required, prescription medications can also be added:

Restasis to help increase your eyes’ natural ability to produce tears
Xiidra to target a source of underlying inflammation that may fuel dry eye disease
Cequa is the highest FDA approved concentration of immunosuppressant to increase tear production
Oral Doxycycline is an antibiotic that when used in low doses can improve the function of the meibomian oil glands

Intense Pulsed Light (IPL)

Intense pulsed light (IPL) technology is a broad-spectrum light treatment used to improve the function of the meibomian glands that release oil into your tear film to prevent your tears from evaporating too quickly. IPL is able to kill bacteria and mites that live on the eyelids, melt the thick gland secretions to allow for easier oil release, and close abnormal blood vessels to decrease inflammation. A hand-held applicator is used to deliver a strategic level of light pulses to the skin surface across the cheeks, nose, and on the eyelids. After the light therapy is administered, an eyelid massage is performed to help break up the oil and encourage oil flow from the meibomian glands. Most patients achieve optimal results from four treatment sessions lasting 15 to 20 minutes each, spaced one month apart . There is little to no downtime after each treatment and since the IPL treatment uses the same light wavelength that is used for photofacials, you have the added benefit of improved skin texture and coloration in the areas treated.

Punctal Plugs / Punctal Cautery

Punctal plugs are tiny devices that are placed in the eye’s tear drains (called puncta) to slow the drainage of your tears so they can lubricate your eye for longer. There are two types of punctal plugs, temporary and permanent. The temporary punctal plugs usually are absorbed in 3 to 4 months and the permanent punctal plugs do not absorb. Both types of punctal plugs can be placed in the office under the microscope quickly and painlessly. If there is improvement in dry eye with punctal plugs but they keep falling out or if they cause eye irritation, punctal cautery can be performed to permanently close the tear drain. Punctal cautery can be performed in the office by administering a little local anesthetic and applying heat to the tear drain to close it.

Eyelid Surgery

Although often overlooked, your eyelids can be a critical contributor to dry eye. When the eyelids are not in the right position and functioning properly, all of the other treatment options are usually not sufficient to alleviate the dry eye. Based off of her specialized training in the eyelids, Dr. Liu is able to assess the contribution of your eyelids to the dry eye and discuss with you what type of procedure may be needed to improve the intimate relationship between the eyelids and the eye.

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