In an age of excessive screen time-with people spending endless hours working on a computer or scrolling on social media-dry eye has become a more prevalent complaint from patients. As a result, Dr. Tari Thomas has taken a special interest in researching and taking educational courses on the topic so PVC can provide the highest quality care in the diagnosis and treatment of dry eye.
According to Dr. Tari, symptoms of dry eye can include:
- burning and stinging sensations
- scratchy or gritty feeling
- tired eyes
- fluctuating vision between blinks
- itchy or irritated eyelids
Normally, tiny oil glands along the upper and lower eyelids called meibomian glands contain oil which is pushed onto the eyelid with each blink to create the outer, protective layer of the tear film. However, if the oily tear layer is not healthy, the next layer of the tear film, which is water, will evaporate causing stinging and burning or excessive tearing. Both are a form of dry eyes.
"What happens when you're working on a computer, phone, or looking up close for a long period of time, you don't blink nearly as much as when looking at a distance," Dr. Tari said. "Then, you're not blinking so you're not getting that oil moving. The stagnant oil in those glands will thicken up and become more like butter than oil. This causes less productive blinks resulting in dry eyes."
When a patient visits PVC complaining of dry eye, steps for diagnosis include infrared imaging of the oil glands as well as testing for inflammation and the osmolarity of the tears. PVC has many options for treating dry eye, and its optometrists work with patients to decipher the best regimen for relief.
Dry eye is chronic and progressive, which means if you do not treat it, it will get worse," Dr. Tari said. "For clogged meibomian glands, we need to actually force that old oil out of the glands because if you do not, the clogged glands will just drop out and disappear never to return. This creates a much more difficult dry eye situation that is harder to treat."
Unclogging those glands can be treated by following. Please note that none of the dry eye treatments listed below are covered by any vision or medical insurance except an HSA or FSA.
- Warm compresses and lid cleansers at home. This is usually the first line of treatment which will need to continue indefinitely as long as you work on your computer/phone or look up close for extended periods of time.
- Low Level Light Therapy (LLLT), which involves intense LED red light. During the in-office treatment, patients wear a lightweight mask for 15 minutes to melt the oil in the meibomian glands. The light heats deeply into the oil glands but does not feel hot to the skin. It is an intense hot compress for your eyes because it penetrates more deeply than an at-home warm compress. This procedure cost $89 per treatment and can be done in conjunction with other treatments.
- iLux Thermal Expression. The doctor uses a specialized handheld device that warms the inner and outer sides of the eyelid which melts the meibum oil. Then the oil is expressed, or released, by gently squeezing the lid. The eyelids are numbed during the process so there is very little sensation and no pain. The cost for this procedure is $589. It may need to be repeated every 6 months or yearly depending on the degree of ongoing home therapy and related visual behaviors.
- Intense Pulsed Light (IPL). This doctor uses a specialized laser to administer several warm, painless zaps across the cheek and next to the eye. The heat penetrates deeply to reduce cellular inflammation that can be a root cause of meibomian gland disfunction. Generally, three to four treatments four to six weeks apart are recommended. The cost is $149 per treatment.
Other treatments for dry eyes that may or may not be related to meibomian gland disfunction are as follows. These may be covered by medical insurance.
- Prescription eye drops, such as Restasis, Cequa or Xiidra, that would be used twice daily on an indefinite basis to control the ongoing cycle of inflammation in the eye.
- Regenereyes drops which are available only through the doctor's office that are not only a lubricant and an anti-inflammatory agent, but also contain biologic components that aid in healing the cornea.
- Punctal Plugs which are tiny silicone cylinders that are inserted into the punctum (tear duct) of the eye to decrease outflow of the tears in the eye. The plug slowly dissolves over time and will need to be replaced every six months. We usually try a two-week test plug to see if the treatment will be beneficial.
The doctors at Pflugerville Vision Care will work with each individual patient to determine both the cause and best treatment for their dry eyes. With dry eye being a chronic disease, this will be an ongoing process and may change in treatment over time. We look forward to building a relationship with each patient on the road to better comfort and vision.