Here’s an eye opener! “Dry eye” is the number one complaint written on our history forms. Some have it so badly it causes sleeplessness, blurred vision, severe pain, and adherence of lids to eyeballs. Some spend hundreds of dollars a month for expensive hi-tech medication which work marginally at best. Eventually all prescription medications fail.
If you have dry eyes and get LASIK, you have just started a nightmare for both yourself and guys like me. Even cataract surgery on dry eyes is a can of worms. And, since many of the glaucoma medications exacerbate “dryness,” I personally squirm at treating those who cannot keep ocular surface disease under control.
“Dry eyes” is actually a misnomer for a myriad of ocular surface diseases. So, what’s at the heart of “dry eye” problems? It’s a matter of having the proper portions of stuff in your tears. The base of the tear film is gooey stuff (mucin). A thick layer of watery stuff (aqueous) lies on the gooey stuff, and oily stuff (lipid) preventing evaporation lies on top of it all. A deficiency in any of these can cause dry eyes.
There are two major categories of dry eyes.
- Too little water
- Too little goo
Too little water is vastly more common. This category can be broken into two types:
a. Too much evaporation, i.e. evaporative dry eye (EDE).
b. Too little water production, i.e. aqueous deficient dry eye (ADDE)
Of these two, the vast majority is evaporative dry-eye. Nine out of ten of all dry eyes are EDE.
Evaporative dry eye means too little oil. There are 25 meibomian glands in the upper lid and 20 in the lower (+). When they are sick there is not enough oil, and we call it meibomian gland disease (MGD) or meibomitis. It’s an epidemic! Why?
We typically blink about every 3 seconds (22 blinks per minute). Electronic gods – computers, televisions, e-tablets, and cell phones transfix their captives. The blink rate falls to 7 bpm. Further, complete blinks break fixation and cause mistakes and fiery deaths if you are playing Save the Galaxy. Strong healthy blinks express the meibomian glands. When the meibomian glands are not fully expressed, the oil congeals, orifices clog, glands become sick and dry eye complaints begin. Without management the meibomian glands eventually die.
Computers are not the whole story. Now throw in: antihistamines, decongestants, tranquilizers, blood pressure meds, antidepressants, birth control pills and hormone therapy. Include: contact lenses, skin diseases, pregnancy, eyelid disease, LASIK, cataract surgery, and cosmetics. Also: forced air in home and auto, zero humidity flights, urban air, smog, rural agronomy fall-out, and allergies. And still, the list is incomplete.
What’s the cure?
The first step is to find exactly your problem. The same image science (MRIs) available for macular degeneration and brain tumors is now accessible for meibomian gland dis-function, and the lab techniques for analyzing Ebola, herpes, and AIDs is offered for these same ocular surface diseases. A very precise diagnosis is now available for dry eyes.
Some clinics specialize in cataracts, glaucoma, or refractive surgery. Others, like us here at Family Eye Clinic of Pullman extend their expertise into ocular surface disease diagnosis and management.
The most exciting resolve of ocular gland diseases is TearScience’s diagnostic and therapeutic management systems, i.e. LipiView and LipiFlow. They have developed a way of physically unblocking meibomian glands through a simple, short and comfortable process done at Family Eye Clinic. It’s a non-surgical out-patient procedure unencumbered by regulation. Currently, much like LASIK, TearScience’s procedures come at a bargain. Yet some fear that eventually the “regulators” will insist and the price will go through the roof.
Of course TearScience is not the only management for glandular eye disease. The array of pharmaceuticals that can adjust your tears to the proper stuff is astronomical. They come in topical, oral, prescription, non-prescription, preserved and unpreserved.
So there is no reason to suffer with uncomfortable eyes anymore.