Top 5 things to know about Dry Eye.

• If you spend a dollar on treatment, you should be a dollar better.
• Dry Eye is not an allergy. The allergy is not dry eyes.
• There are dry eyes that bother the patient, and there are dry eyes that bother the doctor getting measurements for cataract surgery or LASIK.
• Unfrozen Serum Eye Drops work better, faster, and cheaper than most prescription treatments. It is usually only taken for two months every year or two.
• Chronic Meibomian Gland disease and Conjunctivo-chalasis are two conditions often misdiagnosed as dry eye.

Dry Eye is a very common and frustrating problem. It’s underdiagnosed, misdiagnosed, and sometimes even caused by doctors. 

The eye’s natural tears are very complex. Normally made up of water, mucus, and oil layer in a very special balance, they lubricate the eye so the lids glide over them.

They also keep small things from irritating the eye, and they help us see better. When something is wrong with tear film, we can have dry eyes. Dry Eye Syndrome is actually a number of conditions under one umbrella term.

Understanding the disease as a chronic one and being proactive rather than reactive in treatment are the keys to solving this frustrating problem.

Using the correct lubricant to keep your eyes from getting dry, as opposed to treating only when they feel dry, is crucial for success.

There two main categories of dry eye. For some, the tear production is low. For others, the tear composition is abnormal, and the tears evaporate too quickly. It is possible to have a little of both kinds.

Usually, the treatment for the low tear production type of dry eye is regularly dosed lubricant. I prefer Thera-tears Extra 3 times a day. It’s slicker, not thicker, and works 90% of the time. 

There was a time that preservative-free artificial tears were often recommended. But nowadays, the preservative in Thera-tears and the Refresh Family of drops disappears before it touches the eye (ie, when it “sees” light or air when out of the bottle). I don’t see the benefit for the preservative-free little vials, but also don’t recommend other brands with lots of preservatives that don’t disappear and can make the eye drier.

In times past, patients that failed conservative dry eye treatment measures were offered punctual plugs, which can keep the tears in the eye longer. I no longer recommend this as it makes things worse more often than better. Additionally, plugs are a terrible idea if you have blepharitis or meibomian gland disease. The plugs can keep abnormal tears in contact with the eye longer, creating more irritation. They don’t work as well as other things, so I don’t recommend them often.

Mild steroid drops (for a short time) can help but require follow-up because glaucoma and cataract can result from long-term unsupervised use. They also can be quite expensive and make contact lenses unclear. 

Cyclosporin (Restasis) drops and Xiidra is heavily promoted. I rarely see patients wowed by the results. Most complain of the expense and never-ending use. I notice that most patients who use them tell me they spend $1 on the drop and feel only a nickel better. We can do better.

IPL or intense pulsed light is another technology. It’s often touted for dry eye but works mainly for the meibomian gland disease version that responds to much cheaper treatment about 95% of the time. 

Many doctors will proceed stepwise through the above choices, but we tend to skip most of them because serum works better and is cheaper. Why not use the best treatment first? Serum drops have been the best thing for dry eye. It works quickly and doesn’t need to be continued forever. Most patients never go back to any other treatment after using a short course of serum.

Serum for Dry Eyes at The Eye Clinic of Florida

Serum drops are made from the patient’s own blood. Two tubes of blood are drawn. The blood cells are separated from the serum with a centrifuge. The human serum has many growth factors and hormones that can help dry eyes.  It’s been studied with published results in major respected journals for decades. It’s safe to use because it’s made from your own blood.

Typically, a patient will use the drop twice a day for two months. Unlike other treatments, the effect of serum drops last long after the two months you use them. The typical patient has 9-12 months of relief after using the serum.  In our experience, patients who try Serum rarely choose to retry Restasis.

We make the unfrozen version of serum drops. It works much better probably because the proteins we isolate are not damaged by freezing. Many places cannot do this because they are not doctor’s offices.

There are other causes of dry eye besides having low tear water layer production.

Meibomian gland disease or dysfunction is the most common mimicker of dry eye syndrome. It often can co-exist with regular dry eye. It sometimes goes by the name of ocular rosacea.

Many people with chronic dry eyes actually have blepharitis. Many doctors prescribe treatment for external blepharitis when internal blepharitis is the real problem. Shampoo scrubs of the lashes are a waste of time if the problem is the meibomian glands.

When internal blepharitis (meibomian gland dysfunction) is causing the tear film to evaporate too quickly, it is important to consider treatments that last. Think of oil on a puddle of water, like the image above. The oil prevents the water from evaporating. This is what the layers on our cornea mimic. When the oil layer isn’t there, the water evaporates quickly.

Many eye doctors are trained to use combination antibiotic-steroid eye drops every time the disease flares up. This will disappoint the patient and the doctor as the disease keeps coming back. The thick abnormal oil produced by the sick oil glands in the lid burns the eye and blurs the vision.