Dry Eye Clinic
Approximately 40% of the population in the United States suffers from Dry Eyes caused by demodex, meibomian gland dysfunction, blepharitis, and computer vision syndrome. We are one of a few offices in the Greater Sacramento Area that specializes in the treatment and prevention of dry eyes. Learn more about our treatment plans below.
The two treatments below can be done individually but often done together to really impact Dry Eye disease. BlephEx ® is a lid cleansing procedure to remove biofilm and debris. MGE with Collins® Forceps is a procedure to unplug and improve meibomian gland function.
BlephEx ® - Lid Exfoliation
This is a new in-office procedure that allows your doctor to remove excess bacteria, biofilm and bacterial toxins, the main causes of inflammatory dry eyes and lid disease
With regular treatments (usually every 4-6 months), you will enjoy of decreased chronic irritating symptoms associated with dry eye and blepharitis.
BlephEx ® – The Procedure
BlephEx ® spins a medical grade micro-sponge along the edge of your eyelid and lashes, removing scurf, debris and exfoliating your eyelid. The procedure lasts about 6-8 minutes – most patients report a tickling sensation.
Meibomian Gland Expression Using Collins® Forceps
Meibomian glands are modified sebaceous glands that line the eye lid margins. The interactive force of an eyelid blink allows meibum (oils) to secrete into the tear film. This oil is important to the tear film – enhancing it by spreading them evenly across the eye – it helps to create a smooth surface for seeing and maintaining consistent quality of vision.
In patients with MGD (meibomian gland dysfunction) the meibomian glands are not functioning properly. You may have oily lid margins, excessive oils in your tear film, inspissated glands. Left untreated you may have symptoms of Dry eye syndrome, thickened (tylotic) eyelid margins, telangiectatic vessels, loss of lashes, poliosis and notching of the eyelid margins.
Miebomian gland dysfunction is chronic and may require in office expression as well as daily lid hygiene regimen.
Meibomian Gland Expression Using Collins ® Forceps – The Procedure
Meibomian gland expression using the Collins ® Forceps is an in office procedure that is used in cases where your meibomian glands are obstructed (plugged up). The procedure utilizes forceps to express meibomian glands along your eyelid margins.
This procedure lasts between 5-10 minutes and is well tolerated by patients. It is performed with a numbing drop and generally patients feel pressure on their eyelids. Patients generally do not report pain.
You may need regular treatments (usually every 4-6 months) to help maintain healthy meibomian gland function.
Daily Lid Hygeine Regimen
Based on your Dry Eye/Blepharitis and Meibomian Gland Dysfunction, our doctors are recommending the following daily lid hygiene regimen. Our goal in this process is to develop a practical and effective therapeutic strategy for your individual situation. Between in office treatments, this is a way to maintain the effectiveness of your treatments between visits. With good compliance to the recommended daily regiment, your in office treatment may have longer lasting effects.
Step 1: Omega-3 Therapy (Oral Intake of Omega-3)
Omega-3 supplementation is key in management of dry eyes. Not all supplements are created equal – balancing two types of Omega-3’s EPA/DHA, maintain the high levels of effectiveness. Omega-3 that have complementing strong anti-inflammatory ingredients (Tumeric extract, evening primrose oil and green tea extract) are found in studies to be much more effective. Our doctors have researched supplements and have chosen these based on clinical experience as well as clinical studies on these products.
- EZ Tears™– take 1 capsule at the beginning of a meal with fat / twice daily.
- Nordic Naturals™ ProOmega D Xtra – take one teaspoon by mouth at the beginning of meal with fat/once daily (this is liquid contains 2000mg EPA/1000mg DHA)
Step 2: Remove Make Up and Warm Compresses
Step 2 and 3 are to be performed each night as a part of your routine eye lid hygiene. Remove all make up from your face and eye area using your regular regimen then follow up with warm compresses:
- Bruder Moist Heat Compress™ – After removing makeup, place Bruder mask in microwave for 20 seconds. Apply over closed eyelids for 2 to 10 minutes.
Step 3: Lid Cleansing
After the warm compress, do the following to remove meibum and bacteria that were expressed during the warm compress treatment.
- Blephadex™ EyeLid Wipes –use pre-medicated towelette to cleanse and remove debris on upper and lower lid margins by wiping along each lid 4-5 times. You do not need to rinse the excess.
- Avenova™ – Spray Avenova onto a cotton swab and rub twice along upper and lower lid margins. You may leave the excess liquid on your eye.
- Oasis Lids & Lashes™ - Use this gel cleanser to clean along your lid lines. Rinse with water.
Supplemental Therapy and Treatment
Tear Replacement Drops
These drops are designed to lubricate your eyes, especially as you are reading, working on
computers or concentrated on tablets or mobile devices. You may or may not need this once your Dry Eye/Blepharitis Syndrome is under control. If you feel like you need an artificial tear drop, here is our best recommendation for you based on your specific situation:
- Oasis Tears Preservative-Free™ - apply to eye as needed for dryness
- Oasis Tears Plus Preservative-Free™ – apply to eye as needed for long-lasting comfort
- Oasis Tears Multidose™ – apply to eye as needed for dryness
- Refresh PM™ - apply to eyes at night prior to sleeping
Water Intake & Antihistamine Usage
This section applies to everyone. Always remember to stay well hydrated: drink plenty of water and avoid caffeine products. Antihistamines such as Benedryl as well as allergy medications may contribute to dryness. Avoid those medications unless you absolutely need them.
Ceiling Fans in Bedrooms
Many of us have ceiling fans in our bedroom that moves air towards our eyes and can dry them out at night. Most fans have a reverse setting on them that will circulate air without directly moving air towards your eyes. Check for a switch directly on the unit itself.
Humidifiers in Bedrooms
Since most of our tear film is loss through evaporation, you may consider adding a humidifier to your bedroom or work space to add moisture to the air. This may assist in dryness!
Customized Prescription Eye Drops (Restasis®)
If needed, our doctor may also prescribe prescription eye drops for the treatment of your dry eyes. You will get specific instructions on this if it is necessary.
The inner corners of our eyes have puncta – which are drainages that allow tears to drain from our eyes. Twenty percent of our tears are leave our eyes by this pathway. In some cases, plugging the puncta with semi-permanent plugs may offer relief for dry eyes. Your doctor will work with you to see if this is a viable treatment for you.
Dry Eye/ Blepharitis - What is it?
Dry Eye/Blepharitis is a very common problem that affects millions every day. It occurs when the eye does not produce tears properly or the when the tears do not have the right consistency and evaporate too quickly. It is a chronic inflammatory disease of the eyelids caused by an overgrowth of normal bacteria living along the lid and the base of the lashes.
Since the eyelids are difficult to clean, this overgrowth of bacteria, biofilm, and toxins can worsen over the years, eventually causing significant damage to the eyelid, tear glands and dysfunctioning of the meibomian glands (MGD).
The best direct treatment for this lid disease is an in office BlephEx ® procedure to remove the excess bacteria, biofilm and toxins. Since bacteria grows constantly, maintaining a good lid hygiene between treatments is important. Regular in-office treatments are needed to remove bacteria and biofilm that are tough to remove during regular hygiene.
In many cases your meibomian glands may be clogged as well, if this is the case meibomian gland expression using forceps may be performed after the BlephEx ® procedure to allow the glands to improve oil secretions and improve the quality of your tear film.
We will describe to you each of the in office procedures below as well as the procedures for routine lid hygiene that should be done at home each day.
Symptoms of Dry Eye/Blepharitis & Meibomian Gland Dysfunction
- excessive mucus
- watery eyes
- heavy eyes
- inconsistent vision
- tired eyes
- increased light sensitivity
- difficulty driving at night
- contact lens discomfort
- achy/sore eyes
- sharp pain in eyes
- sandy or foreign body feeling in eye
Dry Eye Syndrome Has Multiple Contributors
- Medication such as antihistamine, nasal decongestants, tranquilizers, blood pressure medication, birth control, antidepressants.
- Computer use or mobile device use
- Disease of the glands of the eyelids, such as Meibomian Gland Dysfunction
- Pregancy or hormone replacement
- History of LASIK or cataract surgery
- Immune system disorders such as Sjogren’s Syndrome, Lupus and Rheumatoid Arthritis
- Thyroid disease, Grave’s disease and other systemic diseases