EVAPORATIVE DRY EYE and MEIBOMIAN GLAND DYSFUNCTION

• EVAPORATIVE DRY EYE occurs when the tear film on the eye is unstable, and evaporates faster than normal (less than 10 seconds).
• Symptoms include: fluctuating and unstable vision, redness, irritation, “tired eyes”, pain, or discomfort.
• The underlying cause of EVAPORATIVE DRY EYE is the dysfunction of the MEIBOMIAN GLANDS of the eyelid. These gland are are found within the upper and lower eyelids. They secrete an oil (Meibum) into the tears of the eyes.

The oil makes up the top layer of the tear film, preventing the water layer of the tears from evaporating from the surface of the eye.

The following is a list of various treatments that we can implement to improve your dry eye symptoms:

Lifestyle Changes:

• Adequate water intake (8 to 10 glasses/day).
• Use a humidifier (especially during winter months).
• Avoid direct air flow on eyes (from ceiling fans, car vents, etc.).
• Increase your rate of blinking. Take frequent breaks from visual demanding tasks.
• BRUDER EYE MASK / warm compress for 10 minutes/day followed by lid massage to increase oil secretions on the eyes.

Artificial Tears / Liquid Gel / Ointment: use up to 4x/day. **If greater than 4x/day, PRESERVATIVE FREE tears are recommended**

TIP: For a cool and soothing effect when the drops are placed on the eyes, store your tears in the refrigerator.
For EVAPORATIVE Dry Eye (tears “break up” and evaporate of the eye in less than the normal time of 10+ seconds):

• SYSTANE BALANCE
• SYSTANE COMPLETE
• SOOTHE XP**
• RETAINE MGD**
• REFRESH OPTIVE ADVANCED**
• REFRESH OPTIVE MEGA-3**

Moist Heat followed by Meibomian Gland Expression:

• BRUDER EYE MASK: 10 minutes of heat over the eyelids,
• LIPIFLOW (https://tearscience.com/lipiflow/). Procedure peformed in office to

OMEGA 6 / OMEGA 3 FATTY ACID Supplementation:

• Previously only Omega 3 fatty acids(EPA/DHA) supplementation was recommended.
• A NIH study recently found Fish Oil alone (Omega 3 fatty acids) to be ineffective:
• https://www.nih.gov/news-events/news-releases/omega-3s-fish-oil-supplements-no-better-placebo-dry-eye
• A newer approach: Omega 6 (GLA), with a reduced role of Omega 3’s.
• HYDROEYE (https://www.sciencebasedhealth.com/) . 1570 mg GLA and
• https://www.ophthalmologytimes.com/nutrition/studying-role-omegas-dry-eye-disease-beyond-dream/page/0/1

PUNCTAL OCCLUSION:

• Devices inserted in the “drain” (puncta) of the lower / upper eyelid, which keep a greater volume of tears on the eye.
• Initially, dissolvable (within 7-60 days ) COLLAGEN plugs are inserted. Improvement may be immediate.
• If dry eye symptoms improve, SILICONE punctal plugs are then inserted. Note: These can be removed if necessary.

Prescription Medications:

• AZASITE (Azithromycin): off label use improves Meibomian Gland Dysfunction and evaporative dry eye.
• Use 1 drop 2x/day for first two days, then 1 drop/day for 28 more days.
• STEROID DROP / GEL “Pulse”: calms the cycle of inflammation associated with dry eye
• Preferably LOTEMAX (lowest side effects), used 4x/day for 2 weeks, followed by 2x/day for 2 more weeks.
• RESTASIS (Cyclosporine Emulsion): increases tear production that may be suppressed due to inflammation
• 1 drop, 2x/day. *Shake vial before using*. Improvement may take between 1 to 6 months.
• XIIDRA (Lifitegrast Solution): the newest approved medication “to treat the signs and symptoms of dry eye”.
• 1 drop, 2x/day. Improvement may occur within the first 2 to 6 weeks.
• LACRISERT (Hydroxypropyl Cellulose Insert): a slow release gel placed underneath the lower lid for all day lubrication

SCLERAL LENS THERAPY:

• Used for moderate to severe cases, these Medical devices bathe the surface of the eye with moisture during all waking hours of the day to rehabilitate the cornea.