TREATMENT OF DRY EYES

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Treating dry eyes can be frustrating, and, at times, unrewarding.  Newer technologies have emerged that can help to alleviate some of the symptoms of dry eyes and to halt or slow its progression.

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The treatment of dry eyes is best directed toward the cause:

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• MUCUS:  There is limited treatment for mucus deficiency. Treatment essentially is directed and replenishment of tears and moisture with artificial lubricants and humidification of the environment.

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• AQUEOUS: The conventional approach to aqueous insufficiency is tear replenishment with artificial tears. 

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Artificial tears are manufactured in many different consistencies. Different preparations focus on oil replenishment, others try to enhance deficiencies in the aqueous component and still others include adjuvants like fatty acids.  Artificial tears also come in a preservative-free variation. These have fewer chemicals and may be less irritating with frequent application.

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Medications:  There are several topical medications intended to increase aqueous production. These are prescription medications that are variations of an anti-inflammatory drug called "cyclosporins".  They are applied twice daily, usually take several weeks to reach therapeutic levels and are used indefinitely.  Brand names include:  Restasis, Xiidra and Cequa.

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• OIL:  Oil is only 5% of the tear film but it is critical to its preservation and durability.  

 

If a person does not have a proper oil layer, the tear film will evaporate prematurely, resulting in a foreign body sensation.  Paradoxically, tears will run out of the eye because of poor retention.  When working at the computer or staring, people typically reduce their blink frequency.  This allows the tear film to evaporate and for the eyes to become dry.

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• HUMIDIFICATION OF THE ENVIRONMENT:   While this modality seems intuitive, it is often neglected.  Humidifiers replenish some of the lost moisture and can temporarily reduce dryness.

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• LIPIFLOW:​   There is a newer technology intended to revitalize the oil glands that have begun to function less efficiently.  Lipiflow applies heat and pulsations to the eyelids in order to melt the oil that has become dormant and to extrude this sludgy oil from the Meibomian glands.   Meibomian Gland Dysfunction (MGD) is a frequent cause of crusting of the eyelids seeing flakes on the base of the eyelashes, and even fluctuations in vision.  Treating these glands may maintain the vitality and halt or delay the gradual decay of the oil-producing Meibomian glands.

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• PUNCTAL PLUGS:​   The tears drain from the eye through an elaborate canal system that brings them into the nose. Some people who do not produce an adequate quantity of tears benefit from having the opening of this drainage system occluded to allow the tears that are made to stay in the eye longer.  Punctal plugs can be 'temporary' lasting only weeks to months before they dissolve, or 'permanent'.

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• AMNIOTIC TISSUE OVERLAYS:​   Amniotic tissue essentially consists of stem cells. Placing very thin layers of these stem cells has helped some people with damaged corneal due to dry eyes. The application is simple and the lens 'dissolves' after a few minutes, but the improvement in the corneal surface is gradual and can continue for months. 

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