What Does A Dry Eye Look Like?

Definition of Dry Eye

The technical definition of a dry eye is: “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles”*

Root Cause

Meibomian Gland Dysfunction (MGD) is the source of dry eye conditions for 86% of the time. The other 14% of the time dry eye is due to a lack of the aqueous water layer.

How It’s Normally Supposed to Work

When you blink fully the glands squeeze out a small amount of oil onto the eyelid margins. The act of blinking spreads the oil to cover the watery layer and protect it from evaporation.

What Goes Wrong

When these glands become blocked, production of the necessary oil to protect the water layer of the tear film becomes compromised. This causes the water layer to evaporate and leave the corneal surface exposed and inflamed. This process is known as meibomian gland dysfunction, or MGD.

The Proven Scientific Remedy

The clinical science behind MGD as the primary cause of dry eye, as well as its treatment, is supported by over 25 years of scientific research. Gland blockages can be alleviated gently and quickly with specialized technology at Brill Eye Center. Restoring proper oil gland secretions reduces the progression of chronic MGD. It is vitally important to analyze the health of these oil glands and fix them before they atrophy and disappear forever.

*Source: The Ocular Surface 15 (2017) Page 273 TFOS DEWS II Report

Learn more about Dry Eye and MGD

Common Questions About Dry Eye:

Q: Visine is no longer working to relieve my dry eye. What else can I do?
View Answer

A: If your eyes are frequently uncomfortable, it’s time to make a diagnosis of what is wrong. You need to see an eye care professional who can make a diagnosis of what the main problem is. The diagnosis will drive the recommendations for treatment.

Q: What lifestyle changes can I make to improve my dry eye symptoms?
View Answer

A: Treating symptoms is only a temporary solution.  Dry eye is a chronic and progressive disease so it’s important to not just put a bandage on the problem. Here’s a few ideas: Stop smoking, wear sunglasses outside, avoid air directly blowing on you from fans, start a good omega-3 like Easy Tears brand, and make sure you are not a lazy blinker when using your digital displays. Let your eye doctor determine the root cause of your dry eye so you can find more permanent relief.

Q: Why do my dry eyes feel worse in the morning?
View Answer

A: Many patients don’t know it, but they sleep with their eyelids partially open. If you wake up with pain, scratchiness, the sensation that there is something in your eye, or mucous discharge, it could be caused by Nocturnal Lagophthalmos or a poor sealing of the eyelids.  Because the eyelid does not close completely, it allows the tears in your eyes to dry out, making them feel uncomfortable. It’s tricky to diagnose because you can’t watch yourself as you are sleeping to see if your lids are partially open. We can perform tests to see if this is the cause of your irritation.

Q: Can I just use over-the-counter eye drops to cure my dry eye?
View Answer

A: Over-the-counter eye drops may help alleviate symptoms by temporarily lubricating eyes, but for ongoing conditions, proper diagnosis and treatment provides relief of dry eyes by treating the root cause rather than just the symptoms.   These drops usually are designed to supplement the watery layer of the tears, but this is the issue only 14% of the time. If you use these lubricating drops but the problem recurs in a few minutes, you will need a better answer.

Q: Could my itchy eyes simply be from allergies?
View Answer

A: It is certainly possible that your eyes are irritated and itchy due to allergens, however, it is important to take note of how long these symptoms last, since they are also a key indicator of dry eye. If the discomfort persists after allergy season comes and goes, it could be a sign of a more serious problem, such as dry eye. Good antihistamine and mast cell stabilizer drops are on the market. Look for Bepreve, Lastacaft, and Pazeo Rx drops as the best ones. Dry eye and allergies can also coexist. Antihistamine medications will also dry the eye out, so beware, the fix may be more complex than you think.

Q: My current eye doctor says he treats dry eyes, but I’m not finding any relief.  Is it just my bad eyes or the doctor not helping?
View Answer

A: As always with any medical problem, the ways to treat it vary. For most eye care professionals, dry eye patients may represent a nuisance. Their vision fluctuates with glasses and creates contact lens intolerance. Brill Eye Center has the latest proven diagnostic and treatment tools to address the diagnosed condition. We have a passion for dry eye resolution and love to share the information to address your problems.  We prefer to use your time wisely and scientifically treat the root cause of your dry eye instead of trying to just mask the problem with merely palliative treatments.  If you go to the emergency room with a broken leg, it is better to cast your leg than just mask the pain with drugs and not solve the root cause.

Steps In The Brill Dry Eye Experience

  • Step 1: Screening
  • Step 2: Diagnosis
  • Step 3: Treatment
  • Step 4: Healing
  • Step 5: Maintenance

Step 1: Screening

  • You will fill out the Standard Patient Evaluation of Eye Dryness Survey (SPEED).
  • If your score is greater than 6, you have dry eyes, also called Meibomian Gland Dysfunction or MGD for short.
  • We will collect a detailed medical history, including medications that make your eyes dry.

Step 2: Diagnosis

Schedule a dry eye evaluation. Tests will be done to look at your...

  • Blink pattern
  • Lipid layer thickness
  • Number of oil glands yielding clear oil
  • Lipid Layer thickness and amount of glands yielding clear oil
  • Meibography infrared photography of the oil glands to detect atrophy
  • Evaluation of eyelid inflammation, styes, and chalazia
  • Dye testing for irritation of cornea and conjunctiva
  • Eyelid closure and eyelid seal evaluation
  • Tear Osmolarity. The saltier your tears, the more evaporation you have
  • Staining of the eye with fluorescein and lissamine green for inflammation
  • Tear production with zone quick phenol red thread testing for adequate moisture
  • Screening for ocular allergies, viruses, bacteria, and mite infestation of the eyelids

Step 3: Treatment

Discuss treatment modalities depending on the diagnosis

  • BlephEx exfoliative eyelid deep cleansing procedure
  • LipiFlow thermal pulsation procedure
  • Anti-inflammatory steroid eye drops
  • Restasis or Xiidra
  • Lubrication eye drops
  • Bandage contact lenses
  • Amniotic membrane use for enhanced healing
  • Eyelid closure and eyelid seal evaluation
  • Scleral contact lenses for corneal surface protection and better vision

Step 4: Healing

Discuss what to do to make sure the MGD heals and does not progress further

  • Specific Omega-3 supplements for dry eyes
  • Blink instructions
  • Eyelid cleansing procedures
  • Lubrication eye drops
  • Bandage contact lenses
  • Ongoing professional care and monitoring
  • Refit into contact lenses that are better for dry eyes

Step 5: Maintenance

Follow-up visits to recheck comfort level and ocular healing

  • Health of meibomian glands
  • Oil flow from oil glands
  • Stability of tears
  • Status of blepharitis
  • Corneal health
  • Vision stability
  • Environmental factors
  • Medications
  • Contact lens wearability
  • Tear Osmolarity
  • Eye redness decrease
  • Symptoms relief
  • Overall eye appearance

Step 1: Screening

View More

  • You will fill out the Standard Patient Evaluation of Eye Dryness Survey (SPEED).
  • If your score is greater than 6, you have dry eyes, also called Meibomian Gland Dysfunction or MGD for short.
  • We will collect a detailed medical history, including medications that make your eyes dry.

Step 2: Diagnosis

View More

Schedule a dry eye evaluation. Tests will be done to look at your…

  • Blink pattern
  • Lipid layer thickness
  • Tear breakup time and stability
  • Lipid Layer thickness and amount of glands yielding clear oil
  • Meibography infrared photography of the oil glands to detect atrophy
  • Evaluation of eyelid inflammation, styes, and chalazia
  • Dye testing for irritation of cornea and conjunctiva
  • Eyelid closure and eyelid seal evaluation
  • Tear Osmolarity. The saltier your tears, the more evaporation you have
  • Staining of the eye with fluorescein and lissamine green for inflammation
  • Tear production with zone quick phenol red thread testing for adequate moisture
  • Screening for ocular allergies, viruses, bacteria, and mite infestation of the eyelids

Step 3: Treatment

View More

Discuss treatment modalities depending on the diagnosis

  • BlephEx exfoliative eyelid deep cleansing procedure
  • LipiFlow thermal pulsation procedure
  • Anti-inflammatory steroid eye drops
  • Restasis or Xiidra
  • Lubrication eye drops
  • Bandage contact lenses
  • Amniotic membrane use for enhanced healing
  • Eyelid closure and eyelid seal evaluation
  • Scleral contact lenses for corneal surface protection and better vision

Step 4: Healing

View More

Discuss what to do to make sure the MGD heals and does not progress further

  • Specific Omega-3 supplements for dry eyes
  • Blink instructions
  • Eyelid cleansing procedures
  • Lubrication eye drops
  • Bandage contact lenses
  • Ongoing professional care and monitoring
  • Refit into contact lenses that are better for dry eyes

Step 5: Maintenance

View More

Follow-up visits to recheck comfort level and ocular healing

  • Health of meibomian glands
  • Oil flow from oil glands
  • Stability of tears
  • Status of blepharitis
  • Corneal health
  • Vision stability
  • Environmental factors
  • Medications
  • Contact lens wearability

Dr. Brill Brings Science to Dry Eye Treatment

Dr. Brill graduated with honors from Illinois College of Optometry in 1978. He had the privilege to serve as Division Optometrist at Ft. Riley, KS for four years, leaving the service with the rank of Captain. Dr. Brill began his own practice in 1983—Brill Eye Center—in Mission, KS, after devoting a year to exclusively seeing infants and children in a pediatric eye practice. He is an early adopter of technology, and his practice is diverse with an emphasis on specialty contact lenses, dry eye disease, and luxury eyewear. In 2010, Dr. Brill earned an Executive MBA degree with top honors from the Bloch School of Management in Kansas City with emphasis on innovation and entrepreneurship. He currently serves on several professional and community boards and regularly lectures to his colleagues locally and nationally.

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