Dr. Michael Behforouz
As featured in
"Best of 2011"
The eyes make two different types of tears. Basal tears are produced slowly and steadily throughout the day. They contain a precise balance of mucous, water, oil, proteins and antibodies that nourish and protect the front of the eye. These tears are important in maintaining the lubrication of the eye.
The second type of tear, called a reflex tear, does not have much lubricating value. Reflex tears serve as an emergency response to flood the eye when it is suddenly irritated or injured. Reflex tears are produced in such large quantities that the tear drainage system is flooded and tears spill out onto the cheek. Another cause of reflex tearing is irritation of the eye from lack of basal tears. If your eye is not producing enough lubricating tears, you have dry eye. That is why one of the most common symptoms of dry eyes is tearing!
For over 60 years, the term “Dry Eye” has been generally applied to a variety of uncomfortable eye surface problems, much in the same way the term back pain is generally used. The eye feels uncomfortable, but the cause is unknown. Dry eye symptoms have primarily been thought to be a direct result of the eye’s inability to produce the proper amount of natural tears, but we now know that is not the case for many dry eye sufferers.
Today, the leading cause of dry eye is known to be Meibomian Gland Disease (MGD) for over 86% of patients who present with symptoms, such as discomfort, redness, tearing, gritty or burning sensations and blurry vision. While MGD is chronic and progressive, if caught early, it can be effectively treated to stop the progression and maintain optimal eye health.
MGD occurs when the meibomian glands, located in the eyelids, do not sufficiently produce and release the oils needed to protect and maintain a healthy tear film. This causes the watery layer in the tear film to evaporate. Thus, the problem for many dry eye patients is not inadequate tear production, as thought for so many years, but a lack of oil production that ensures the protective integrity of the tear film is maintained on a daily basis.
The only electronic FDA-cleared treatment for MGD is LipiFlow, which uses a precise application of heat to the inside of the eyelids, close to the location of the meibomian glands, and massage to outside of the eyelids.
LipiFlow uses vectored thermal pulsating eyepieces known as Activators. LipiFlow Activators are precisely designed to provide necessary inner and outer lid contact to properly apply heat and massage and evacuate the meibomian glands. The entire treatment takes approximately 12 minutes.
The clinical science behind MGD as the primary cause of dry eye and its treatment is supported by over 25 years of scientific research. Removal of the gland blockages is essential to improve gland function and reduce the progression of MGD. Over time after treatment, the meibomian glands may become blocked again because of continued evaporative stress, which is caused by infrequent blinking from modern lifestyles and leads to thickening of the gland secretions and blockage of oil production.
When the Vectored Thermal Pulse (VTPTM) LipiFlow treatment is properly applied, the heat and gentle massaging action evacuate the blockages from the glands, allowing the glands to resume oil production. You and your eye care professional can determine how often LipiFlow should be repeated based on evaluation of your gland function and structure over time.
The most common way to treat dry eyes is to replace the tears that are missing. This is accomplished through the use of artificial tear preparations. Artificial tears are made in liquid, gel and ointment forms. Some are preserved and others non-preserved. Your doctor will recommend different types based on the type and severity of your dry eyes.
When infection, inflammation of the eyelids or clogged oil glands contribute to dry eye, special lid cleaning techniques or antibiotics may be recommended. It may also help to avoid hot, dry or windy environments or to humidify the air in your home or office.
Punctal occlusion is a medical treatment for dry eye that may enable your eyes to make better and longer use of the few lubricating tears they do produce. During this procedure, a small silicone plug is placed in the opening of the tear ducts (the tear drain). This effectively blocks the draining of the tears from the eyes and keeps them on the surface of the eyes longer and in greater quantity.
Restasis is a new therapy for dry eye. Its formulation, topical cyclosporine, can increase the quality and quantity of tears and the surface of the eye. These eye drops are taken twice a day.
At Center for Sight, we use a multi-faceted approach to each patient’s dry eye problem. Each patient will have an individualized plan utilizing different treatments, specific to their dry eye condition.
3985 W. 106th St., Ste. 120, Carmel, IN 46032