Treatment and Management
Click Here For More Information
Dry Eye Disease is a chronic medical condition, similar to having high blood pressure or diabetes. Chronic conditions require long term treatment and monitoring to determine the severity of the disease and effectiveness of treatment. Treatment plans will be created on a personalized basis to address the problems indicated by each patient’s clinical examination and diagnostic findings.
Common Causes of Dry Eye Disease include:
Low-risk strategies of DED treatment and management starts with identification and modification or elimination of offending environmental or lifestyle factors. Awareness of physical conditions that promote DED as well as certain offending systemic and topical medications is key to making potential modifications.
Environmental Factors
Environmental factors that may cause Dry Eye Disease include the weather (extreme cold or heat) and elements, altitude levels, smoke, allergens such as pollen and dust.
Lifestyle Factors
Lifestyle factors that can cause dry eye include computer or screen time spent without sufficient blinking, smoking or being around smoke often, contact lenses, previous eye surgery, and consumption of certain medications that may cause dry eye.
Physical Conditions
Physical factors that may contribute to Dry Eye Disease include malposition of eyelids or tear ducts, hormonal changes, Thyroid related disorders, and Sjogren’s Syndrome.
Symptom Management:
- Restasis or Cequa, is a prescription eye drop that reduces inflammation in the tear glands thereby increasing the body’s natural ability to produce tears.
- Adding omega-3 fatty acids to the diet as food or supplements. Omega-3s have been known to decrease inflammation of the eyelids and meibomian glands, which improves meibum (oil) production for healthier tears.
- The use of artificial tears or a moisturizing ointment/drops. Your doctor may recommend advanced lubricating eye drops that do not contain irritating preservatives. It is typically recommended to use these drops four times a day regularly.
- Be aware of your environment. Avoid air conditioning or windy conditions outdoors and increase humidity levels at home or work.
- Clean your eyelids and use warm compresses to control inflammation and keep the area free of excess oils and buildup.
- Blinking exercises during activities of prolonged screen time promotes full eyelid closure to hydrate the ocular surface and expression of meibum from our eyelids for a healthy tear film.
Advanced Dry Eye Therapy:
Following your consultation, your eye doctor will develop a Customized Treatment Plan to help relieve some of the dry eye symptoms you may be experiencing. Dry Eye is a chronic condition, but it can be controlled with some or all of the following treatment options:
LipiFlow® is an advanced thermal-mechanical device designed to treat Meibomian Gland Dysfunction (MGD) and Evaporative Dry Eye. It works by gently heating the eyelids and applying a light massage to the Meibomian glands, effectively clearing blockages and restoring gland function. The patented device uses Vectored Thermal Pulsation technology to apply heat and massage the inner eyelids, removing any obstructions within the glands.
LipiFlow® is a 12 minute in-office treatment that targets the root cause of your dry eyes rather than just treating symptoms. This Health Canada approved treatment has been shown to alleviate dry eye symptoms for a year.
IPL therapy is an in-office treatment that uses pulses of light to liquefy hardened oil that can plug the meibomian gland, clearing it and stabilizing the tear film. IPL also kills bacteria and mites, and decreases inflammation by closing abnormal blood vessels. By targeting these vessels, IPL generates heat that triggers the body’s natural healing process, helping to remove abnormal blood vessels and reduce inflammation. IPL therapy is considered the gold standard treatment to address the root cause of Meibomian Gland Dysfunction (MGD), Blepharitis, and Ocular Rosacea.
Signs and symptoms improve after just 1 to 2 treatments and continue to improve throughout the therapy course. Initial therapy typically involves 3-4 sessions spaced 2-4 weeks apart. IPL is followed by manual meibomian gland expression. Maintenance therapy depends on the duration, severity, and frequency of symptoms and is usually recommended every 6-12 months.
We combine IPL therapy with LipiFlow® treatment to target both inflammation and blockages in the Meibomian glands, offering a comprehensive solution for dry eye and MGD.
IPL is known to not only improve dry eye symptoms but also increases collagen production, enhancing the overall appearance of the skin.
Meibomian Gland Expression involves applying pressure to the eyelids to release oils from the glands. Eye specialists use small forceps or paddle-like instruments, such as the Mastrota paddle, to apply pressure to the lower and upper eyelids. Successful expression of meibum from the glands helps to improve the quality of oil production and reduces dry eye symptoms. Your eye doctor can determine if additional procedures are needed and can teach you how to perform meibomian gland massage at home for long-term management.
ZEST is a gentle and effective cleansing treatment for the eyelids and base of eyelashes. This in-office based treatment is ideal for removing bacteria, biofilm, Demodex mites, dandruff, debris, and oil using a uniquely formulated gel with refined extract of okra. The Zocular formulation additionally has restorative and anti-inflammatory properties that calm and soothes eyelid inflammation which alleviates signs of redness and irritation.
We recommend ZEST for patients with Blepharitis and/or Meibomian Gland Dysfunction (MGD) as well as pre-surgically for those preparing for cataract surgery.
Patients often notice significant improvements just after one treatment and is recommended maintenance treatments every 4-6 months.
Serum tears are made from blood and are rich in platelets and growth factors that help cells grow and heal. They also contain important vitamins and proteins that protect and repair the eyes. These tears are especially useful for treating eye conditions like dry eye disease and Sjogren’s syndrome, which can damage the cornea. Studies have shown that serum tears can help regenerate corneal nerves and improve eye health. Additionally, serum tears have antioxidant properties that protect the eyes from damage caused by free radicals.
Punctal plugs are tiny devices inserted into the tear ducts to slow tear drainage, keeping the eye surface moist and comfortable. They relieve symptoms of dry, itchy, and burning eyes. There are two types: temporary plugs, made of materials like collagen that dissolve within days to a week, often used post-refractive surgery or semi-permanent plugs, made of durable medical plastic like silicone, lasting 3-6 months.
This treatment is ideal for chronic dry eye, aqueous deficient dry eye, and post-refractive surgery patients, especially once inflammation is managed.
Eyelid Malposition Surgery
Lid malposition surgery addresses conditions like entropion and ectropion. Entropion involves the inward rotation of the eyelid margin, causing lashes to misdirect. Ectropion, on the other hand, is the outward rotation of the lid margin. Both conditions can affect the upper and lower eyelids, leading to poor lid closure, incomplete blinks, and exposure of the cornea. This results in inadequate tear film distribution and chronic ocular surface irritation, significantly impacting quality of life with symptoms like blurred vision, excessive tearing, pain, and foreign body sensation. Surgery is often necessary to correct these malpositions, improving symptoms of dry eye and ocular irritation.
Chalazion Excision
A chalazion is a small, non-infectious lump that forms in the upper or lower eyelid due to the blockage of the meibomian gland, which produces fluid to lubricate the eye. Chalazions typically resolve on their own over a few months. Treatment options include warm compresses, gentle eyelid massages, and over-the-counter remedies. However, surgical removal may be necessary for several reasons including if the chalazion does not resolve, if the chalazion becomes infected, size of chalazion impacts ocular comfort or vision.
Punctoplasty
Punctoplasty is a surgical procedure to treat punctal stenosis, a condition where the external opening of the tear duct (punctum) narrows or becomes occluded, often causing excessive tearing and eye irritation. Symptoms include overflow of tears, increased moisture in the eyes, and redness or irritation from constant tissue use. Initial management may involve punctal dilation for diagnostic purposes, but most patients require surgery to create an adequate opening, maintain punctal position, improve tear drainage, and preserve lacrimal pump function.
Punctal Cautery
Punctal cauterization is a surgical procedure that permanently closes the external opening of the tear ducts (punctum). The goal of this technique is to effectively increase tear film volume and retention, treating ocular surface disease. While retaining tears through punctal cautery can worsen symptoms in cases of poor quality meibum or other inflammatory conditions, if aqueous deficiency persists, prioritizing cauterization and avoiding excessive reopening of the tear ducts may be more crucial than ensuring drainage.
Amniotic membranes are used as biologic bandages to protect and support the healing of the corneal surface. They treat various conditions, including keratitis, chemical burns, corneal erosions, and chronic epithelial defects related to dry eye. Treatment is often times combined with autologous serum eye drop.s While not a cure for chronic dry eye, amniotic membranes help create a healthier corneal surface for ongoing treatment.
Scleral lenses are an option for treating dry eye, especially in patients who haven’t responded to conservative treatments. These large-diameter rigid gas permeable (RGP) lenses vault over the cornea and extend to the sclera, creating a fluid reservoir that hydrates the ocular surface and improves optical quality
Managing Dry Eye
Custom Treatment Plans include home therapies to manage dry eye symptoms and to prevent the symptoms of dry eye from occurring. Home therapies are applicable to anyone interested in reducing the risk of getting DED or those with intermittent or asymptomatic DED.
Dry Eye Compress masks are an at-home treatment that can be used to promote dry eye relief. These masks are heated in the microwave and applied to the eye, helping to unclog blocked oil glands. They help to treat dry eye and irritation, relieve swelling and inflammation, and improve the production of oils by the Meibomian glands. By promoting proper eye lubrication, the eye can better expel bacteria and debris.
Thealoz is a drops solution for the management of dry eye symptoms. This formula is preservative-free and helps protect the eyes. The key ingredient Trehalose protects the surface cells of the eye from drying out and helps to restore the tear film.
The benefits of this product:
- No preservatives
- Lubrication and protection of the eyes
- Can be used as often as necessary
- Useful for environmental-related dry eye symptoms (such as air conditioning or computer use)
Thealoz Duo drops provide long-lasting relief from eye discomfort and dryness. There is no blurriness after applying the drops, and is completely free from preservatives and phosphates. The key ingredients Trehalose and Sodium Hyaluronate protects the ocular surface cells and helps to restore the normal osmotic homeostasis of tears.
The benefits of this product:
The i-lid’n lash® Plus cleansing wipes is a paraben-free eye hygiene product that are used on individuals suffering from symptoms of dry eye and eye discomfort. It is formulated with tea tree oil, which provides effective, gentle cleansing and hydrating without irritating residue or stinging.
The benefits of this formula:
- Hydrates and soothes area around the eyes
- Does not irritate lids or lashes
- Enhances dry eye treatments
- Effective at removing ocular debris and makeup
Omega 3 fatty acids reduce inflammation and improves dry eye symptoms. It is thought improve the meibum quality in the tear film.
Omega 3 supplements provide higher concentrations of triglycerides than what can be consumed through diet alone. The American Heart Association and the American Cardiology Association recommend 2-3 grams of omega-3s daily (EPA+DHA). De 3 PRN Omega provides 2240mg of EPA and DHA in an ultra-purified triglyceride (rTG) form, which is similar to the natural form found in fish but without impurities.
