Dry Eye Treatments: From Lipiflow to Punctal Plugs

What is Dry Eye?

Both Drs. Cavanaugh and Jaynes have an emphasis in dry eye treatment, offering a wide range of management options

Dry Eye Definition

“Dry Eye Syndrome” is a general term used to describe a group of conditions that cause inflammation of the surface of your eyes due to disruption of your eyes’ tear film. Your tear film has a very specific and unique recipe of mucous, water, and lipids that have vision, anti-inflammatory and comfort properties. Dry Eye Syndrome is chronic and tear film changes caused by dry eye can result in a variety of symptoms.

Meibomitis is a secondary cause of Dry Eye Syndrome. Meibomitis or Meibomian Gland Dysfunction (MGD) causes inflammation of the oil glands in your lids.

Classically, the term Dry Eye Syndrome is used when your eyes are not producing enough tears. This leads to an imbalance in your tear chemistry with resultant inflammation on the front surface of your eyes. Meibomitis is a secondary cause of Dry Eye Syndrome. Meibomitis causes inflammation of the oil glands in your lids. This inflammation causes clogging of the oil glands and results in an environment for bacteria to grow inside the oil gland. The combination of thickened oils and excessive bacteria results in an unstable tear film leading to Dry Eye Syndrome as well as other symptoms.

What Causes Dry Eye?

The following factors can cause or worsen Dry Eye Syndrome and/or Meibomitis:

  • Aging
  • Reading or spending time on the computer
  • Hormonal changes like menopause
  • Medications such as antihistamines, decongestants and antidepressants
  • Certain eye surgeries such as cataract or refractive surgery
  • Environmental conditions such as wind or dry climates
  • Various medical conditions such as diabetes, rheumatoid arthritis, or thyroid problems
  • Poor eyelid function
  • Nutritional deficiencies

Symptoms of Dry Eye & Meibomitis include:

  • Fluctuating vision
  • Burning
  • Redness
  • Excessive tearing
  • Tired eyes
  • Irritation
  • Blurred vision
  • Grittiness
  • Scratchiness

Types of Dry Eye: All Dry Eye is NOT the Same

Most patients have BOTH Dry Eye Syndrome and Meibomitis. Treatment is tailored to your clinical exam, symptoms, and unique health history / patient profile. Recall that Dry Eye Syndrome and Meibomitis are chronic and there is no cure for these conditions. The goal of treatment is to control your symptoms and improve your quality of life.

Dry Eye Treatment

There are several treatments available. These range from simple lifestyle modifications to more complex treatments and procedures. Modifying the environment is also important to alleviate dry eye symptoms. Some tips for modification are:

  • Avoiding outside windy and dry conditions
  • Using room humidifiers
  • Wearing wrap-around glasses when outside
  • Avoiding cigarette smoke

Punctal Occlusion has been used successfully for years in the treatment of DES. It is performed by placing small plugs in the tear drains in the eyelid. There are 4 drains total, one in each eyelid. This helps by preventing the tears from draining into the nose and thus keeping them on the eye.

In addition, prescribed medical treatment with anti-inflammatory medications, such as topical steroids or cyclosporine (Restasis), may lessen the chances that dry eye will progress to a more severe form. Restasis is an excellent new medication for the treatment of DES. It is speculated that chronic inflammation leads to decreased tear film production and eye irritation. Restasis acts to decrease the inflammation on the surface of the eye and help your body to produce better tears.

Other dietary supplements such as flax seed oil or Omega-3 fish oil will promote better quality tear film and may reduce the symptoms of Dry Eye Syndrome / Meibomitis.

Cavanaugh Eye Center offers a wide variety of Dry Eye and Meibomitis treatment options.

Treatment options include:

Supportive Therapy suggestions

Artificial Tears tailored to your specific type of Dry Eye

Medical therapy: Xiidra or Restasis

  • Prescribed medical treatment with anti-inflammatory medications, such as topical steroids, Xiidra, or Restasis, may lessen the chances that dry eye will progress to a more severe form. Xiidra is a promising new medication for the treatment of DES.
  • It is speculated that chronic inflammation leads to decreased tear film production and eye irritation. Medical therapy for dry eye acts to decrease the inflammation on the surface of the eye and help your body to produce better tears.

Lipiflow treatments

  • LipiFlow® is a treatment performed in your doctor’s office designed to remove blockages from the Meibomian glands, allowing them to properly function and produce the oils that make up the top protective lipid layer of the tear film. This treatment was specifically designed for Meibomitis or MGD, a certain type of Dry Eye. You can find detailed information on our Lipiflow page here.

Meibomian gland expression
Punctal Occlusion

  • Punctal Occlusion has been used successfully for years in the treatment of DES. It is performed by placing small plugs in the tear drains in the eyelid. There are 4 drains total, one in each eyelid. This helps by preventing the tears from draining into the nose and thus keeping them on the eye.
  • Keep current picture of punctal occlusion

Autologous Serum Tears

  • Autologous serum tears have been studied since 1984. They are a patient’s own serum that is compounded into eye drops for the treatment of severe dry eye syndrome. These drops are prescribed for patients to improve the ocular surface and comfort for patients that do not respond to traditional dry eye treatments. Serum tears contain all the components of human tears but at higher concentrations therefore it has to be compounded into an accepted strength and dosage form to improve the ocular surface and patient comfort.

Scleral Contact Lenses as moisture chambers

  • Scleral Contact lenses trap a reservoir of fluid between the lens and the eye. This fluid protects the cornea, and may even allow it to heal in some cases (ex: severe dry eye syndrome). In addition, this layer of fluid improves the patient’s vision.
  • Patients with conditions that affect the tear film (dry eye syndrome, graft vs. host disease, Sjogren’s syndrome, Stevens Johnson syndrome, and neurotrophic keratopathy), and patients with refractive error (nearsightedness, farsightedness, or astigmatism) who are unable to wear other forms of correction could benefit from scleral lenses.
  • How do they work for patients with tear film insufficiencies or dry eye? Some patients have disorders that affect the quality or quantity of tears that help to keep the eye’s surface smooth and healthy. The fluid reservoir trapped beneath a scleral lens may improve comfort for these patients, and may allow the corneal surface to heal.

Supplementation