Warm compress/mask treatment
This treatment improves symptoms by increasing the amount of oil coating the eye surface. Tiny oil glands can become blocked with debris from dried skin, bacteria, excess mucus from eyes and hardened oil. By using warm compresses it softens the oil inside the glands, making it easier to come out when gentle pressure is applied, much like butter or margarine turn to a liquid form when heated on the stove or microwave. For the most thorough treatment, our office can supply you with a special mask designed to hold the heat for an extended period of time. Place the mask in the microwave for 25-30 seconds and then place the hot mask over the eyes for 5 minutes, then repeat. This soothing treatment is like a mini trip to the spa for your eyes. If you do not have the mask a washcloth can be used. Place a clean washcloth under very hot water from the faucet. Squeeze the cloth to remove excess water. Gently place the hot, moist cloth over your closed eyelids. Gentle pressure or rubbing over the lids can also be done. When the cloth cools, place it back under the hot water and repeat. Do this for 5-10 minutes every evening. With more severe symptoms you can do the treatment twice daily.
Dermatologists treat many skin conditions with oral antibiotics. Blepharitis is a type of skin condition that affects the eyelids. In cases of severe blepharitis, an antibiotic pill (Doxycycline, Tetracycline, Minocycline) can be used to help your eyes feel better. No one knows exactly how this pill works to improve blepharitis. It is NOT by killing bacteria, but through some other beneficial action, which helps your oil glands to function better. There can be minor side effects from Doxycycline such as stomach upset and sun sensitivity. Always wear sunscreen if you will be out in the sun for long periods of time. Let your doctor know if you are using blood thinners or other medications known to interact with antibiotics.
All normal skin has bacteria living on the surface. With blepharitis, there can be an excess growth of bacteria around the eyelashes, which leads to worsening eye irritation. This overgrowth of bacteria occurs when there is a buildup of dead skin cells and oils around the skin and eyelashes of the eyelid. When the debris of dead skin, excess mucus and bacteria is removed, a potential source of inflammation and infection is also removed. There are three methods to cleanse the skin and improve the environment around the eyelids.
- Individual towelettes – contain a mild detergent and antiseptic that cleans the eyelid. Use it to wipe around the eyelids and lashes nightly. Rinse with warm water. Available in our office and the grocery store or pharmacy.
- Lid cleansing foam – this product contains foam, like shaving cream, that is rubbed on the eyelids and lashes each night. Rinse with warm water. Available in our office and the grocery store or pharmacy.
- Baby Shampoo – can be used to cleanse the eyelids and lashes without irritating the eyes. Rub a small dot on your palm with water to create a bubbly solution and rub this on the eyelids and lashes. Rinse with warm water.
Dry air leads to increased evaporation and worsening dry eye symptoms. During certain times of the year, the air has less humidity. This is especially the case during the summer months when it is hot and dry outside, or the winter months when the heat is on the inside. In Las Vegas, it is difficult to humidify your entire house, but as you sleep a humidifier in the bedroom can lead to improved symptoms.
Staying hydrated is important to maintain an adequate supply of tears. Drinking enough water (half your body weight in ounces per day) provides the body with the necessary building blocks to create healthy tears.
A prescription medication called Restasis is available to treat dry eyes. Restasis actually helps the eye to produce more tears by controlling inflammation on the eye and in the lacrimal gland. Restasis is a very dilute solution of Cyclosporine, an immunosuppressant medication used to control inflammation and decrease rejection in people with organ transplants. Restasis should be used twice a day in addition to any of the other dry eye treatments you are already using. As a prescription medication, it requires consistent use to be effective. The initial effect from Restasis may take 6-8 weeks to develop. Studies show an increasing beneficial effect of improved tear secretion up to one year after starting the medication. You may notice mild redness and stinging for a week or two after starting the medication.
Steroid drops (Prednisolone or Fluoromethalone FML) can be used to treat some of the redness and swelling that can come with dry eye and blepharitis. These drops are usually used for a few weeks on an intermittent basis. Overuse of steroids can lead to premature cataracts and glaucoma. These medications are commonly used to get the symptoms of dry eye under control while more long-term treatments such as Restasis are getting started.
Lacrisert is a tiny pellet that you place in the pocket behind the lower eyelids once a day. It slowly dissolves to release a thick gel onto the eye throughout the day. It is good for more severe dry eye and for patients who may have a hard time getting artificial tears in the eye regularly.
New research into the metabolic pathways of tear production has lead to the development of oral dietary supplements that improve dry eye symptoms. We have had good success with these products, with most patients feeling better, and some patients having a dramatic improvement in their symptoms. Our doctors may suggest that these supplements be added to your treatment program. Omega-3 oils have been found by research to alleviate some types of dry eye. Taking flaxseed oil or fish oil capsules can provide these Omega 3 oils. Some patients get ground flax seed meal and put it on salads and in smoothies. There are also specially made pills that combine not only Omega 3 oils, but also additional healthy oils mixed with vitamins found to support eye health. We have a premium Omega 3 fish oil capsule available in our office. Other options can be found in the grocery store or pharmacy.
The oil layer is one of the most important layers of the tear film. These important oils lubricate the eye and prevent evaporation of the tears. Blepharitis causes the oil glands to become inflamed and produced a thick, poor quality oil (see picture). By softening the oil in the glands and expressing any unhealthy oil and debris, either by manual expression or with the specially designed Lipiflow method, healthy oil can be produced to keep moisture in the eye. Research has also shown this method to be more helpful than warm compresses alone. Although the Lipiflow treatment is expensive, a single treatment may be effective for up to one year. The manual expression is a less costly procedure but may have a little more discomfort than the Lipiflow device.
This is a skin treatment using light therapy, which was originally used to treat the fine blood vessels of Rosacea. When pulses of light are applied near the eyelids, patients experience improvement of dry eye through improved oil production from the meibomian glands.
These are goggles that keep the air around the eye more humid, limit evaporation of tears and keep out wind and irritants. They are particularly helpful for patients with severe dry eye. There are several different size and shape options available.
This thick antibiotic eye drop can also be beneficial for the treatment of blepharitis. The eye drop is used once a day to help decrease the growth of bacteria around the eyelid as well as to help the oil glands to make better oil to soothe and lubricate the eye. The drop is very thick like honey. Try to keep the bottle stored with the tip pointed down to make it easier to squeeze a drop out of the bottle.
You may not want to read this section if you are a little bit squeamish about bugs. There is a small mite (Demodex) that lives in your hair follicles around the eyelashes and eyebrows. Every adult is likely to have a few of these mites on the skin and develop no symptoms or issues from the mite. However, in some patients, there is either an increased amount of mites or an allergic reaction to them. This leads to classic blepharitis symptoms with red crusty eyelids, itching, burning, and even blurred vision. This type of blepharitis does not respond to typical treatments and may require repeated application of Tea Tree Oil to kill the mites.
Certain disease can make it more common to have symptoms of dry eyes. In these cases treating the underlying condition can help with dry eye. Some of these systemic diseases are:
- Rheumatoid Arthritis
- Sjogren’s disease
- Graft vs Host disease
Why am I starting to develop dry eye symptoms now?
Changes in systemic medications, environment, eating habits, stress, age, eye surgery and sickness, can all have an impact on the production of healthy tears. As a result, a person can develop dry eye symptoms at any time.
How does LASIK/PRK cause dry eye?
Healthy corneal nerves are necessary to signal the body to create more tears when dryness develops. With refractive surgery, such as LASIK, the corneal nerves are cut. This disruption of the corneal nerves blocks the normal feedback mechanisms between the cornea and the tear gland and can cause worsening dry eye symptoms. You should not have LASIK if you already have dry eye symptoms that are not well controlled. The ICL or PRK are better options for patients with significant dry eye symptoms. NV Eye Surgery is one of the leading clinics in Las Vegas offering ICL lens implants to treat nearsightedness (myopia).
How can dry eye effect my life?
The effects of dry eye on the quality of life range from mild irritation to severely debilitating, and everything in between. Having dry eye syndrome can impact how long a person is able to read a book, look at the computer, go outside during windy or hot weather, make it difficult or painful to open the eyes and make vision blurry and difficult to see to work or drive. Working with our doctors and being part of a team focused on treating your condition and supporting you through the challenges associated with dry eye can help get you through even the most difficult days.