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Posted on 11-12-2015

Ugh. Got Those Dry Eye Blues?

Doctor holds blackboard reading Dry Eyes

Check Out This New Take on an Old Condition

Great news for Dry Eye sufferers!

We're so excited to bring you the latest developments in how doctors understand and treat the most common cause of Dry Eye.

A new perspective that can greatly improve your comfort and put money back in your pocket for a change.

Dry Eye describes an extremely uncomfortable condition that affects people of all ages and can have many causes. As much as 87% of cases, however, are caused by a chronic and progressive condition called Meibomian Gland Dysfunction (MGD).

The meibomian gland produces an oily substance that prevents tears from evaporating too quickly. In MGD, the oils harden and don't make it onto the tear film in sufficient (or any) quantities. Too little oil = rapid evaporation = dry eyes.

So, if you're one of the 87%, artificial tears may not be the best approach, since they don't address the underlying problem. If your MGD is mild enough, you may even be able to manage it through better hygiene, which we'll talk about in part 3 of this series. Ka-ching!

And, because our patients are intelligent and inquisitive, we're going to give you the whole lowdown on this condition in three blog posts.

  • Part 1 will describe MGD symptoms and associated complications.
  • Part 2 will discuss the latest medical treatments. There are some very effective new solutions. No pun intended.
  • Part 3 will go over other causes and cover home care: specific things you can do yourself to treat or even prevent the gritty, scratchy, watering misery of Dry Eye.

Basically, this series is a user-friendly Master Class that will teach you everything you need to know to understand and conquer Dry Eye caused by MGD. Artificial tears be gone!

Right. Now, what’s this big news??

Until very recently, doctors thought Dry Eye was the result of lacrimal insufficiency. The lacrimal glands (Fig. 1) produce the watery (aqueous) part of the tears.

The standard treatment was artificial tears, which are very expensive, and frankly, don’t often work well in these cases.

Eye cross-section showing lacrimal & meibomian glands.
Fig. 1. Tear production glands.

Doctors also tried using steroid drops and other methods with only limited success.

Everything we did seemed like a band-aid. At best people were getting some temporary relief. But the problem never went away, and often got worse.

Now we know lacrimal insufficiency accounts for only a small percentage of Dry Eye.

It's another gland that's the big offender here: the meibomian gland (Fig. 1) is at the core of most sufferers' dry eyes, and the problem is epidemic.

The latest research has prompted a real shift in the way we understand and treat Dry Eye, opening up many new treatment possibilities. So, this is for you early adopters out there, read 'em and weep...less.

Understanding Tears and the Dry Eye Cycle

Our tears consist of three layers, each of which has an important job to do. You can see in Figure 2 that water comprises most of the tear film. You may also notice that the lipid (oily) layer we are concerned with floats on the aqueous layer.

Tear Film Composition
Figure 2. Tear film composition

The lipid layer is produced by the meibomian glands, located behind your eyelashes. There are 20-30 of them, lined up like soldiers, with their openings on the ridge between your eyes and eyelashes (not where the eyelashes come out). (Fig. 3)

Meibomian gland openings
Figure 3. Meibomian gland openings

Your eyes become dry when this lipid layer is inadequate, allowing the aqueous layer to evaporate too quickly. And, when your eyes are dry, your lacrimal gland produces more of the aqueous layer, which is why one symptom of dry eyes can be watering eyes!

So, here’s the drama:

The Dry Eye Cycle

  • When the meibomian gland is inflamed, the lipid layer - which should be like clear baby oil - is thick, more like gel or toothpaste.
  • Now the tear film mix doesn’t include enough oil.
  • The tears evaporate too quickly.
  • The corneal nerves become exposed, making your eyes feel as bad as it sounds: burning and gritty.
  • This, in turn, stimulates the lacrimal gland, which responds to irritation by making even more aqueous tears.

There you have it. This is why artificial tears often don’t work. They don’t address the underlying problem.

You’ve probably noticed by now, here at Jackman Optometry we are all about the underlying problem.

Misery is in the eye of the beholder

You may have experienced some of following symptoms, for instance, during allergy or cold and flu season. But, if they continue, you’ll want your eyes to be evaluated to make sure nothing serious is going on.

Early Symptoms of Dry Eye

  • Dry, burning, gritty or scratchy feeling
  • Sensation of something in the eye
  • Not enough tears
  • Too many tears
  • Redness
  • Blurry Vision
  • Eye strain or fatigue

Remember that untreated, MGD will continue to worsen with time. The meibomian fluid will become so thick that the gland won’t be able to empty regularly. Now you also have a perfect medium for bacterial growth. This leads to those not-so-awesome crusty eyes, like what you get with conjunctivitis (pinkeye). Only there’s no quick fix antibiotic to make it better.

Symptoms of advanced MGD:

  • Bacterial overgrowth
  • Crusty eyes
  • Eyelashes falling out
  • Eyelashes growing the wrong way, possibly scratching the cornea
  • Red eyelids
  • Thick, heavy, drooping lids
  • Lids curling toward or away from the eye

Finally, if these conditions continue, the meibomian oil will become very hard, completely blocking the meibomian ducts.

At that point, not only do you have no oily layer to keep your tears from evaporating non-stop, but the glands themselves can actually atrophy and disappear. Forever.

Great, now what do I do?

The bad news is that MGD can affect the quality of your life - and your looks! - severely, if left untreated. The good news is that we have several new options to treat it.

If your dry eyes aren’t bothering you too much, stop back here in two weeks for our next post in the series, thoroughly covering the latest medical treatments. At that point, if you’re still concerned, you can head to your eye doctor as a very informed patient, making it easier for you to decide together which option(s) to try.

On the other hand, if you notice some of the more advanced symptoms, it’s the right time to go see your optometrist. S/he can actually examine your meibomian glands to evaluate the extent of your problem, also checking for any other causes.

MGD won’t clear up overnight, so after seeing your optometrist you can come back here to learn more about additional treatments to consider.

Why do teeth get all the attention?

One big takeaway from this post, is that eye care is now being seen as similar to dental care. Just as our teeth and gums need regular daily care at home, it turns out our eyelids also need regular care to keep them healthy and looking good.

It’s a similar cosmetic situation, too. You don’t want your eyelids all red and droopy the same way you don’t want your teeth all brown and stained.

Once you understand what causes Dry Eye and have seen some medical treatment options, you’ll want to come back for the third part in this series where we present the latest and greatest home care techniques. Scientists have been busy developing simple methods for keeping those eyelid oils clear and runny.

Our goal is to make this information available and accessible so that you will be an informed consumer with happy eyes.

Meantime, if you catch MGD early, home care may be all you’ll ever need. So, please feel free to make an appointment for evaluation at our Orange office by phone, 714-543-2022, or on the web.

Watch for the next post in this series, where we present the slick new technological solutions to MGD!

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