Dry Eye Specialty Clinic
At Triangle Eye Consultants, we provide a comprehensive approach to this disruptive and life-altering condition. From state-of-the-art technology to help determine why your eyes and vision are affected to creating customized treatment plans specifically for you, we strive to help you overcome the daily frustration and discomfort of your dry eye disease, even if you have suffered for years!
Significant advances have occurred in our understanding of dry eye and ocular surface disease. These advances have helped create enhanced ways to help dry eye sufferers and allow dramatic improvements in comfort and quality of life. This website contains a tremendous amount of up to date information and perspective regarding this condition. We encourage you to read through it and discuss any questions at your consultation.
What is Dry Eye Disease?
Dry Eye Disease is a condition caused by an unstable tear layer on the surface of the eye. Unstable tears lead to discomfort (including burning, excess reflex tearing, scratchiness/grittiness) and can cause increased blurring of your vision. The tear layer consists of 3 main components: oil, water and mucus. Each component is created by different parts of the eye and eyelids. The thin MUCUS layer is created by cells on the eye surface, the thick WATER layer is created by the lacrimal gland located under your upper eyelid near your outer eyebrow region and the OIL layer is created by many meibomian glands that line the upper and lower eyelids. Each component is essential and important. Any disruption in the creation or maintenance of each layer can cause the tears to become unstable and evaporate away from the front surface of the eye rapidly.
Meibomian gland dysfunction, inflammation of the tears and eyelids, blepharitis, ocular rosacea, various systemic inflammatory conditions, eyelid changes with age, nutritional deficiencies and increased use of technological devices are all possible contributing factors that cause increasing dry eye symptoms.
Basic daily care of the eyes and eyelids may be enough to control dry eye disease for some but others may require more extensive treatments including daily topical medications as well as various types of thermal pulsation procedures that can help empty the meibomian glands and give them a chance to become healthier over time. It is imperative that no matter what treatment plan is discussed that you follow through on a daily basis to increase the health of your eyes.
Treatments for Dry Eye Disease and Meibomian Gland Dysfunction (MGD)
Meibomian gland disease (MGD) occurs when the small oil glands in the eyelid become obstructed and no longer release the essential oil required to prevent tear film evaporation. If the oil layer of the tear film is lacking, this will lead to dry eye disease and excessive evaporation of the aqueous (ie-water) layer of the tear film. This leads to symptoms such as redness from inflammation, fluctuating vision from a rapid tear break up time, and discomfort. There are a variety of treatments for MGD. If you have tried the basic home remedies such as warm compresses, artificial tears, and lid cleansing then you should consider one of the advanced treatment options described below. Schedule your consultation to know which treatment(s) is optimal for you.
Intense Pulsed Light Therapy
Intense pulsed light therapy (IPL) has a history in dermatology, often used to treat skin conditions such as rosacea and hyperpigmentation. When used to treat dry eye disease (DED) and meibomian gland disease (MGD), the IPL utilizes pulses of light to liquefy and release hardened oils that have clogged meibomian glands in the eyelids. IPL also treats vascularization (abnormal blood vessel growth) and inflammation of the eyelids, reducing eyelid redness and stimulating healthy gland function.
How does it work?
Dr Gupta will begin your IPL treatment by placing protective eye shields over the eyes to protect them from the light pulses. Then, a thin layer of cooling gel is applied to the treatment area and a small device is used to administer the pulses of light to the area around the eyelids. The pulses of light help heat, liquefy, and loosen oils that have clogged the meibomian glands. After the IPL light treatment is complete, the meibomian glands are manually expressed to further release trapped oil from the glands and restore normal oil flow in the tear film. Oil is a very important component of the tears and prevents the tears from evaporation, which can lead to dryness.
Generally, patients receive 4 treatments for the initial series, followed by one maintenance treatment every 6 months. Your custom treatment plan will be designed for you. We use the first and only FDA approved device for dry eye treatment using the Lumenis IPL with patented Optimal Pulse Technology (OPT ® ). This device in its clinical trial was shown to significantly improve tear breakup time, meibum quality, and meibomian gland expressibility.
There are a variety of proposed mechanisms of why IPL works to treat MGD and DED:
- Light energy from IPL warms the meibomian glands to facilitate expression of meibum.
- The wavelength of light used in IPL is selectively absorbed by abnormal telangiectatic blood vessels and coagulates them. This both destroys blood vessels that perpetuate inflammation and decreaes the levels of pro-inflammatory mediators that contribute to dry eye.
- IPL may also reduce the load of demodex mites that lead to chronic blepharitis (inflammation of eyelid).
Microblepharoexfoliation by BlephEx®
Meibomian gland health can be negatively impacted by chronic excess bacteria, biofilm and bacterial toxins, leading to dry eye and MGD related symptoms such as redness, itching, dry eye, and ocular fatigue.
BlephEx® is a painless in-office procedure in which a soft medical grade micro-sponge is used to clean along the edge of your eyelids and lashes. This procedure effectively removes accumulated bacterial biofilm, much like a dental cleaning removes accumulated plaque and biofilm. Once the biofilm is removed, the orifice of the meibomian gland is less obstructed, which allows for better flow of oils and less inflammation related to bacterial overgrowth. At Triangle Eye Consultants we also uniquely offer meibomian gland expression as part of our procedure to help improve meibomian gland flow. We recommend continuing home lid hygiene to help maintain the effect of the treatment. Generally, it is optimal to have BlephEx® repeated about once every 4-6 months based on the severity of your disease.
Meibomian gland disease (MGD) is characterized by obstruction of the meibomian glands. When these glands are obstructed the tear film is disrupted and unstable. Tear Care is a uniquely designed procedure that utilizes both wearable and smart technology to deliver targeted thermal energy (heat) to the eyelids while allowing the eyelids to blink naturally during the treatment. After the 15 minute heating procedure, the glands are expressed with a unique and comfortable forceps. This allows for a customized expression of the meibomian glands, tailored to your needs. TearCare has been studied in the peer-reviewed literature and is safe.
Generally, patients have this treatment once every 6-15 months, depending upon the severity of their disease. Tear Care can also be used in combination with other MGD treatments to achieve optimal symptom management and gland health.
Meibomian Gland Expression
This is an in office treatment, often combined with other therapies, in which the eyelids are mechanically compressed to relieve the obstruction of the meibomian glands. Through this process a gentle forceps is used to completely evacuate the glands. This treatment can be performed in isolation or more often in combination with other treatments, such as IPL, Tear Care, and BlephEx.