"Dry eye" is a bit of misnomer. Your eyes may not feel dry with dry eye disease (DED). Do you experience any of the following symptoms?
- Dry eye
- Fluctuating/Blurry vision with your glasses on/ contact lenses in
- Must blink to see better
- Light sensitivity
- Watering or tearing
- Tired eyes/fatigue
- Stringy mucous
- Foreign body sensation
- Scratchy feeling
- Contact lens discomfort
If you answered "yes' to four or more of these questions, you may have DED. Computer work, face masks, and some medications also impact DED. Diabetes, thyroid disease, and autoimmune conditions can contribute to DED as well.
What should you do if you suspect that you have DED? If it has been over a year, come in for an eye exam. Don't rely on artificial tears or eye drops to fix the problem. They may help provide some moisture to your eyes, but they aren't actually fixing the problem. To fix the problem, we need to uncover the problem. Dry eye has multiple factors playing a role in the symptoms you are experiencing. We need to figure out what is going on with YOU. There is no cookie cutter approach to dry eye, because everyone's eyes are a little different.
We will get much deeper in the different treatment approaches to DED in future posts, but almost everyone with DED can benefit from making sure that their eyelids are healthy. Yep, that's right, your eyelids are almost always involved in DED. We have about 25 oil glands (aka meibomian glands) in each lid that produce the top layer of our tears. The oil that they produce is supposed to be clear and thin, like olive oil. When we blink, the oil distributes into our tears and ensures your tears don't evaporate too quickly. In most cases of DED, that oil is too thick (like butter at room temperature). Those glands have a harder time pushing that thick oil out, and they can eventually give up and stop working. Like muscles, if they stop working, they shrink and die. Once they are gone, there is no getting them back.
So a main focus in DED is to protect those glands. Here are some safe and simple things that you can do at home to do just that.
Blink exercises- Part of the reason those glands struggle is due to the fact that we spend a good deal of time each day on a digital screen. When we look at computers/tablets/phones we don't blink as often as we should. The oils stagnate in those glands and thicken. Blink exercises help keep the oils flowing. To do this, close your eyes focusing pressure on the junction between the eyelids. Do not scrunch your forehead. Hold for about 20 seconds and release. Repeat this several times throughout the day (4 times an hour if you can). There is a Donald Korb Blink Training app available on your app store to help you remember. Blink exercises should be done when you are doing heat masks too (more on this next).
Derm/Eyeleve heat masks- When those glands reach a certain temperature, the oils in the glands thin (think butter in a frying pan). Heat masks purchased at an eyecare professional's office can achieve this. These masks contain moisture rich beads that stay hot for several minutes (obviously a hot wash cloth cannot achieve the same results). Follow the directions on the mask to heat it and wear it for 5-10 minutes. This provides a perfect time to relax and rest your sympathetic nervous system that gets far too much stimulation on a daily basis. Doing a heat mask daily can be very effective in relieving symptoms. It takes a few weeks to notice a difference. Make sure to also do blink exercises while you are wearing the mask. Eyeleve masks are made specifically for contact lens wearers and have been proven to extend comfortable wear time.
Lid Hygiene- Another very common reason those glands struggle is due to bacterial biofilm that accumulates on the lid margin and clogs those glands up. Bacterial biofilm is exactly like the plaque that we brush off of our teeth everyday. We now think that we should be washing our lids like we brush our teeth. We carry two products for this. One is a foaming cleanser that you rub into your eyelashes with your eyes closed and rinse off (its a great make-up remover and facial cleanser). The other is a spray that you spray onto closed eyes and rub in. It does not need to be rinsed off. Do not do lid scrubs when you are wearing contacts.
If you think you have DED, please call our office and make an appointment for a dry eye evaluation. This is a detailed ocular surface examination that utilizes our Oculus 5M Keratograph and uncovers ALL the reasons for your dry eye so that we can provide the most effective treatments. This special instrument does the following:
- images your tear film
- images your meibomian glands and highlights areas of dropout
- measures how quickly your tears evaporate
- measures how much inflammation is on the ocular surface
- evaluates how well your lids function when you blink
- evaluates the topography of your ocular surface
It takes about an hour (please arrive early because there is a detailed history form and a questionnaire). If you are a contact lens wearer, please wear your glasses in and refrain from wearing any make up. The examination the doctor does is to your medical insurance. The Oculus 5M Keratograph is not covered by insurance and costs $65.