Prof. Mimouni performs a thorough evaluation of patients suffering from dry eye and related conditions. Not every person with dry eye requires the same treatment, and Prof. Mimouni tailors the therapy to the individual patient. In addition, each patient is examined for other conditions that can mimic dry eye but require different treatment.
What is “dry eye” or “dry eyes”?
Dry eye disease can be the result of insufficient tear production or accelerated evaporation of the tear film. Symptoms of dry eye include burning eyes, itchy eyes, a foreign body sensation, and intermittent blurred vision.
To your left you can see the official international definitions and classifications from the International Dry Eye Workshop.
Which clinical tools are used to assess dry eye?
Surprisingly, the symptoms of dry eye (what the patient feels) do not always correlate with the objective findings of the disease (what the ophthalmologist sees on examination). Basic tools for evaluating dry eye include measuring the tear break-up time, the Schirmer test, which provides a rough quantification of tear production, corneal esthesiometry, which assesses corneal sensation, and the use of vital dyes such as fluorescein, lissamine green, and rose bengal to evaluate the integrity of the epithelial cells (the outermost layer) of the cornea. These tests also help rule out other or additional diseases that can present similarly to dry eye syndrome.
What new technologies are available for diagnosing dry eye?
Several newer diagnostic tests are available for dry eye syndrome. These include tear film osmolarity testing (a marker of increased tear evaporation), inflammatory markers (such as MMP-9) to determine whether there is a treatable inflammatory component, and tear film lipid profiling (another indicator of excessive tear evaporation). Advanced imaging also allows us to measure tear meniscus height (reduced when tear production is low) and tear film break-up time non-invasively. In addition, infrared-based devices can image the glands along the eyelid margin in order to assess their condition and tailor treatment accordingly.
What treatments are available for dry eye?
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Dry eye has different levels of severity, depending on symptoms and clinical findings.
Mild dry eye: avoiding aggravating triggers, using artificial tears, warm compresses and eyelid hygiene, and anti-allergy medications constitute the first line of treatment.
Moderate dry eye: all of the treatments for mild dry eye, plus preservative-free artificial tears, lubricating ointments, a short course of a mild steroid, topical cyclosporine (such as Restasis) or lifitegrast (such as Xiidra), and nutritional supplements such as omega-3.
Moderate-to-severe dry eye: all of the treatments for moderate dry eye, plus antibiotics such as tetracyclines (doxycycline), autologous serum, and punctal plugs (the latter provided the inflammatory state of the eye is under control).
Severe dry eye: all of the previous treatments, plus a bandage or scleral contact lens and more advanced therapies such as punctal cautery, meibomian gland expression, treatment of the rosacea component with Intense Pulsed Light (IPL), and automated or semi-automated heating and expression of the glands using advanced devices such as LipiFlow, TearCare, iLux, Mibo, and BlephEx.