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The Treatment of Dry Eye

After speaking with you, examining your eyes, and performing some diagnostic tests, Dr. Muller will create a customized treatment plan specifically for you based upon the condition of your eyes.

The first line of therapy is education, environmental and dietary modification, and other holistic recommendations.

Artificial Tears, Gels, Ointments and Lacriserts:

  • Preservative Free Artificial Tears: These products vary in their consistency, some are the consistency of water, while others are thicker, or more viscous. You should begin by using these drops 4 to 6 times each day. These drops can be instilled in your eyes with your contact lenses in.
  • Preservative Free Gels: These products are more viscous, or thicker than drops, and therefore stay on the ocular surface longer. The drawback is that they can blur vision, but only slightly and only temporarily (i.e. for one to two minutes). If you are able to tolerate these during daytime hours they are very healthy for your eyes. You should use them a minimum of four times a day. If you cannot tolerate minimally blurry vision during daytime hours, you can use them at bedtime. Gels are also great to use while flying, as the air in airplanes is extremely dry.
  • Lacriserts: (Hydroxypropyl cellulose ophthalmic inserts): is a prescription “pellet” that you comfortably place in the space between your lower eyelid and your eye. This “pellet” slowly dissolves over many hours offering you continuous preservative free lubrication and moisturization. How to use Lacrisert

Anti-inflammatory Treatments:

The underlying problem with dry eye is ongoing inflammation on the ocular surface. This ongoing inflammation causes long term damage to the surface of your eyes and to your tear producing glands (therefore further reducing tear production over time if not properly treated).

  • Corticosteroids: Steroids can be used in the form of eye drops which are available in varying strengths. Steroids are also available in ointment form, usually used at bedtime. Throughout any treatment with steroids, Dr. Muller will monitor your eyes closely to make certain you don’t have any side effects or complications.
  • Topical Cyclosporine-A (Restasis): treats dry eye by suppressing inflammation, increasing tear production and by protecting your lacrimal glands (tear glands) from being continuously damaged over time. Restasis.com
  • Xiidra (lifitegrast ophthalmic solution 5%): An FDA approved eye drop, taken twice daily, which improves both the signs and symptoms of dry eye. Xiidra.com
  • Tacrolimus drops or ointment: have been shown to improve tear stability and the health of the ocular surface. Tacrolimus is also beneficial in the treatment of allergies which effect the eyes.
  • Tetracycline/Doxycycline: When prescribed in their full strength/dosages these medications function as antibiotics. When prescribed at lower dosages, this group of medications act as anti-inflammatory agents. Dr. Muller frequently uses these medications, in varying dosages, to treat dry eye, blepharitis, rosacea, meibomitis, styes (hordeola), chalazia, cellulitis, etc.. They can be prescribed for days to weeks, or safely used (in lower dosages) for months.
  • Azasite (azithromycin ophthalmic solution) is an antibiotic eye drop that also has anti-inflammatory properties.
  • Omega-3 fatty acids: Omega-3 fatty acids, ideally from both fish and flaxseed sources, are very healthy. Omega-3 fatty acids have a beneficial effect on dry eye due to their anti-inflammatory properties. They are also essential fatty acids that your eyes, lids and tear film need to function their best, be their healthiest and their most comfortable. Unfortunately, our body cannot produce them and most of us don’t get enough Omega-3s from our diet. Omega-3 fatty acids are an important part of any complete dry eye relief program; they also benefit the health of your joints and your heart. Omega 3 Fatty Acids

Eyelid Hygiene:

  • Eyelid Hygiene: Twice each day when you are washing your face, either at the sink or in the shower, you should “shampoo” your eyelashes and clean your eyelids. You can use a dilute mixture of water and baby shampoo, or simply use your face or bar soap. Applying a warm compress to your closed eyelids for 20-30 seconds prior to cleaning your eyelids/eyelashes will liquefy your skin oils and loosen crust, thus enhancing your cleansing. Dr. Muller and her staff will teach you how to do this optimally, including massaging the oil secreting glands in your eyelids. Eyelid Hygiene

Punctal Plugs, or Tear Augmenters:

  • Punctal Plugs are tiny (much smaller than a grain of rice), comfortable, biocompatible inserts that are easily placed in your tear ducts to block tear drainage from the surface of your eyes (i.e. a percentage of your tears are dammed up on your eyes instead of allowing them to run immediately off of your ocular surface). This passively increases the quantity of tears on your eyes, thereby increasing moisture and relieving dry eye. Dr. Muller places an anesthetic eye drop in your eye and then painlessly places a plug into the small openings in the nasal aspect of your eyelids. By performing this simple procedure your eyes immediately benefit from having more tears on the ocular surface, rendering your eyes more moist, more comfortable and healthier. Punctal plugs are readily reversible; they come in many shapes, sizes and materials. Dr. Muller will educate you regarding which plugs she feels would most benefit you. There are certain circumstances in which Dr. Muller may offer a more permanent solution, namely partial cautery of your punctum (drainage ducts).

Autologous Serum:

  • Autologous Serum: These are special eye drops which are custom made for you taking advantage of all of the natural growth factors, immunoglobulins, vitamins and other essential components that are present in your own blood. Dr. Muller will give you a prescription for autologous serum eye drops and you go to the New York Blood center where a unit of blood is drawn from you (as if you were donating blood). Your blood is then spun down using a centrifuge and the plasma rich liquid on the top is made into eye drops for you. The contents of the plasma from blood has been shown to decrease inflammation, promote healing and increase the comfort of the surface of the eye (and other parts of the body).

Secretagogues:

  • Secretagogues: Cevimeline and Pilocarpine are medications taken orally to increase secretions throughout the body. They are used in the treatment of dry mouth, for which they are FDA approved. They also improve dryness of the eyes, skin, nose and vagina (treatment of these conditions is considered an off label use of these medications).

Amniotic Membranes:

  • Amniotic membranes are therapeutic biologic corneal bandages (similar to contact lenses) used to enhance and facilitate healing for the treatment of dry eye and other ocular conditions. The corneal bandage lenses are composed of amniotic membrane (placental tissue). The natural therapeutic properties of these amniotic membranes helps to reduce inflammation, enhance comfort, decrease pain and scarring, and promote and expedite healing. Dr. Muller gently and painlessly places the amniotic membrane on your eye in her office and you wear the amniotic corneal bandage for a couple of days. Amniotic membranes have received FDA clearance for wound healing. In-Office Use of Amniotic Membrane

Treatment of Meibomian Gland Dysfunction: (MGD)

  • Holistic treatment
  • Prescription Medications
  • Mechanical Treatments:
    • Blepharoexfoliation using Golf Club Spud Debridement-Scaling procedure
    • Microblepharoexfoliation (MBE) using BlephEx
    • LipiFlow

True Tears: (www.truetear.com)

  • New technology that uses tiny pulses of energy to stimulate tear production.

Prose:

  • Boston Sight Prose is a customized prosthetic device fabricated for people with severe dry eye (and several other eye conditions). It is intended to replace, or support, impaired ocular surfaces with the goal of improving vision and comfort. It was FDA approved in 1994.

Humidifiers:

  • Using a humidifier when you’re traveling, on your desk at home or at work and at your bedside is of great benefit. This is especially true if you travel to dry environments, in the fall and the winter, and when the heat and air conditioning are on.

Hydration:

  • Staying well hydrated is extremely important. Drinking 7 to 8 eight ounce glasses of water each day, or drinking enough water until your urine is straw colored, is ideal.

Sleep:

  • Being well rested is imperative to your overall health and the health of your eyes. Getting 7 to 8 hours of sleep each night is recommended. Nighttime eye shields can protect your eyes while you sleep. These are especially helpful if you sleep with your eyes partially or intermittently open, or if you sleep with a ceiling fan, a regular fan, near a vent, or with a C-pap machine. (Nighttime Dry Eye Relief)

Treating other Eye Conditions:

  • It is extremely important to diagnose and properly treat other eye conditions that can exacerbate dry eye and make it much more difficult to treat (i.e. allergies, blepharitis, meibomian gland dysfunction, rosacea, etc.).

Limiting Medications Which Exacerbate Dry Eye:

  • Minimizing, or completely eliminating, medications that exacerbate dry eye is extremely helpful.

Decreasing Contact Lens Wear:

  • The healthiest way to wear contact lenses is to simply wear them for going out socially, playing sports and exercising. Wearing eyeglasses to work is much healthier for your eyes since most people are sitting at a desk reading their computer screen(s) and/or documents the greater part of the day.