Dry Eye Disease

Dry Eye Disease (DED), also known as keratitis sicca, is a condition in which there are insufficient tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing clear vision. People with dry eyes either do not produce enough tears or have a poor quality of tears.

Risk factors for dry eye are low humidity conditions, medications, eyelid problems, rosacea, and contact lens use. Dry eye is a common and often chronic problem, particularly in older adults. Common symptoms include irritated, gritty, scratchy, or burning eyes, a feeling of something in their eyes, excess watering, and blurred vision. Vision can be subsequently blurred when flare-ups occur. Advanced dry eyes may damage the front surface of the eye and impair vision.

The Doctors will examine the tear film on the eye. Special eyedrop dyes are employed to help the doctor to detect dry spots, measure tear quality and volume then make a diagnosis. Treatment of dry eye may include certain over-the-counter eyedrops, eyelid hygiene methods, prescription eyedrops including mild steroids, dissolving tear implants, and punctual plugs. If you believe you are suffering from Dry Eye Disease, make an appointment with Grand Rapids Eye Care today.

Dry Eye Disease is a condition in which there are insufficient tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing clear vision. People with dry eye do not produce enough tears or have a poor quality of tears. Dry eye syndrome is a common and often chronic problem, particularly in older adults. With each blink of the eyelids, tears are spread across the front surface of the eye known as the cornea.

Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye, and keep the surface of the eye smooth and clear. Excess tears in the eyes flow into small drainage ducts in the inner corners of the eyelids, which drain in the back of the nose. Dry eyes can result from an improper balance of tear production and drainage.

People with Dry Eye Disease may experience symptoms of irritated, scratchy, gritty or burning eyes, a feeling of something in their eyes, excess watering, or blurred vision. Advanced dry eyes may even damage the front surface of the eye and impair vision. The development of dry eyes may have many causes including age, gender, medications, medical conditions, environmental conditions, and more.

Dry Eye Consultation

Grand Rapids Eye Care has the Oculus Keratograph 5M. This is a topographer which is used to measure the curvature of the cornea, the front surface of the eye. It also contains software that can assess and help diagnose the many different types of DED. It measures tear film thickness, tear film dynamics, tear film evaporation, conjunctival redness and meibomian gland dysfunction. It provides a summary that is printed for each patient with instructions and recommendations. The Jenvis Dry Eye Report can be seen below. The Keratograph provides a map to dry eye relief and can track progress along the way. Please see our treatment forms for some of Dr. Kresnak’s favorite treatments for Dry Eye Disease. For a dry eye assessment please call our office for an appointment. In most cases this condition can be billed as a medical exam. We do not charge extra for the use of the Keratograph other than the portions that can be billed towards medical insurance.

Treatment Available

Dry eyes can be a chronic condition, but your eye doctor can prescribe treatment to keep your eyes healthy, more comfortable, and prevent your vision from being affected. Specific treatments aim to restore or maintain the normal amount of tears in the eye to minimize dryness or related discomfort and to maintain eye health. For more information, schedule a visit with your eye doctor.

For many years the only solution to DED was artificial tears. These tears add to the tear volume and for many this is all that is needed to control the symptoms of DED. Over the last ten to fifteen years much more has been learned about DED and new ways to manage the condition are now known. After a dry evaluation with Dr. Kresnak, your treatment plan will be developed specifically to your needs. Some DED treatments that Dr Kresnak performs are not billable towards medical insurance, but he will be sure to explain that before he performs the procedure. Some treatment options may include:

  • prescription eye drops
  • punctal plugs
  • meibomian gland experession
  • oral medications
  • corticosteriod drops

Meibomian Gland Expression

The Meibomian glands are oil producing glands that are located in the eyelids.  They are responsible for producing an important layer of our tears.  The oily layer of the tears prevents the tears from evaporating and plays a role in tear film stability.  There are two other layers of the tears, the aqueous layer and the mucin layer.  The aqueous layer is  the watery layer of the tears.  It comprises most of the tear volume and an increase in aqueous fluid is what happens when we cry.  The mucin layer is a very thin layer that helps tears adhere to the structures of the eye.  All three of these layers need to work together in a properly functioning tear system.  If either of these layers do not function properly, it can cause Dry Eye Syndrome (DES).  DES can cause burning, itching, redness, foreign body sensation, mild to moderate decreased vision and in severe cases, debilitating ocular pain.

Studies have shown that Meibomian Gland Dysfunction (MGD) is present in up to 70% of all cases of DES. 1  MGD results when the oily secretion changes consistency and becomes trapped in the gland.  Without the oily tear layer, the tears become unstable and evaporate.  This leaves the ocular surface exposed and can cause the symptoms of DES to begin.  MGD is more prevalent in women and shows an increase in occurrence after the age of 50. 1  It is estimated that 30-40 million people suffer from DES across the United States.

There are a number of different treatments for MGD.  These include oral and ocular medications, hot compresses, omega-3 fatty acids and artificial tears to name a few.  A dry eye evaluation with Dr. Kresnak will help determine which treatments are best for you.  For many patients, Dr. Kresnak recommends a meibomian gland expression.  This treatment involves an in-office hot compress followed by a manual expression of the glands with a pair of Tearse Meibum Expressing Forceps.  Dr. Kresnak will also take a video of the procedure to show you the meibum being expressed from your glands.  MGD expression is not a cure, but it will promote the healthy function of your meibomian glands while making at-home hot compresses more successful.  This treatment may need to be repeated in the future.

What is Blepharitis? Don’t I just have Dry Eye?

Blepharitis is a chronic inflammatory condition of the eyelids, often caused by bacteria or Demodex mites. Many people who have been diagnosed and treated for “dry eye” actually have blepharitis. Inflammation on the surface of the eye is common in MGD, dry eye, and blepharitis.

What are the symptoms of ocular surface disease?

  • Dryness and grittiness/scratchiness
  • Soreness/irritation
  • Burning or stinging sensation
  • Frequent styes and eyelid crusting
  • Redness and itching
  • Watery eyes
  • Scales and flakes on lids/lashes
  • Fluctuating vision and eye fatigue