Published: Feb. 24, 2012
Updated: June 13, 2012
Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly.
Inflammation on the surface of the eye often occurs with dry eye.
Untreated, dry eye leads to blurry vision, burning or gritty feeling, red eyes, corneal pain, scars, or ulcers and occasionally some loss of vision. Permanent vision loss from dry eye is uncommon.
Dry eye can make it difficult to perform daily activities such as reading, driving, working at a computer station for long periods of time, or being in a very dry environment such as the cabin of an airplane or office environment.
Dry eye can be associated with:
Dry eye symptoms may include any of the following:
Dry eye can be a temporary or chronic condition. It can be associated with a number of other systemic conditions or environmental factors:
Dry eye can affect anyone and at any age, however it is much more common as we get older.
Nearly five million Americans 50 years of age and older are estimated to have dry eye. Of these, more than three million are women and more than 1.5 million are men. It is suspected that there are tens of millions more who have not been yet diagnosed with dry eye but suffer from dry eye symptoms.
Dry eye is more common after menopause. Women who experience menopause prematurely are more likely to have signs of dry eye. It is also associated with chronic use of certain medications and those that suffer from abnormal thyroid function.
This novel treatment improves meibomian gland function in patients with evaporative dry eye. The most common cause of meibomian gland dysfunction is obstruction and blockage of the ducts and orifices of these glands.
By restoring or improving the lipid layer, the rate of evaporation is decreased and relief from the dry eye state can be achieved.
The lipiflow device single-use eyepiece allows controlled application of warmth and massage to the eyelids, treating the affected meibomian glands in the upper and lower lids simultaneously.
The device is designed to facilitate removal of the meibomian gland blockage without damage to glands or negative impact to delicate structures of the eye. The device is approved by the FDA and, in a randomized controlled trial, the device showed significant improvement on average in the gland secretions and the time that the tears remained on the eye before evaporating.
We offer this treatment at Duke, and you can find out if you are a candidate for this procedure by scheduling an evaluation with one of our dry eye specialists.
The procedure is done in the office and takes 12 minutes per eye. The eye is briefly anesthetized with topical eye drops. The eyepiece is securely placed between the eyelids. Most patients describe a warming sensation across the eyelids, in addition to a massaging or compression sensation along the eyelids.
Both the warming and compressing sensations gradually increase in intensity over the course of the 12-minute treatment to maximally express the meibomian glands. Afterwards, patients commonly experience temporary eyelid redness which lasts less than 24 hours.
Most patients start to notice benefits and dry eye relief over the next four-to-six weeks after the procedure -- many report using tears less often and having less overall ocular discomfort. Others have reported being able to wear contact lenses more regularly, and less redness in the eyes.
This is a new treatment for dry eye and blepharitis. IPL is not a laser, but a light-based therapy. It has long been used in dermatology to treat vascular facial lesions, rosacea spots, and pigmented areas.
Filters are used to apply specific wavelengths of light to target abnormal blood vessels in the eyelids and skin that are often responsible for causing eyelid inflammation and resultant meibomian gland dysfunction.
Many patients with evaporative dry eye have associated rosacea and blepharitis. Recent studies have found that IPL can be used to treat evaporative dry eye disease because it targets the abnormal blood vessels and increases the flow of impacted meibomian secretions.
We do not currently offer this treatment at Duke but plan to in the future.
The light therapy is not applied directly to the eye and eye protection is used during the procedure. Your physician will first determine the light settings based on your skin type.
Next, a protective eye shield is gently placed to cover your eyes. A cool gel is placed onto the skin surface and then the IPL treatment is performed. Most patients experience a tingling and heating sensation as the light is applied. Lastly, the meibomian glands are expressed to relieve the gland obstructions.
The procedure is relatively comfortable and quick -- taking only about 10 to 15 minutes in total. Most patients require four treatments initially (one per month) and then maintenance treatments are required on an annual basis. This may vary depending upon each individual patient’s disease severity.
Often an underlying systemic can cause of dry eye disease. These can be related to chemical imbalances or toxicities in the body potentially causing inflammation that can manifest or exhibit symptoms of dry eyes listed above.
Special testing can be performed to evaluate and look for these imbalances and then treatment can be tailored to correct these deficiencies.
Some known systemic conditions that can be related to dry eyes include: rheumatoid arthritis, Sjogren’s syndrome, infections, thyroid disease, adrenal conditions, hormone imbalance, (including pre-, peri-, and post-menopause as well as andropause), food allergies and other gastrointestinal (GI) issues, and heavy metal toxicities.
For more information about dry eye treatments, contact the Duke Eye Center to make an appointment near you in Raleigh, Durham, Cary, Winston-Salem, and many areas of North Carolina.