Dry Eye & Blepharitis

Patients often experience both Dry Eye and Blepharitis together.

What is Dry Eye?
Dry eye syndrome is a common disease in which the eye under-produces tears or tears leave the eye too quickly. A normal functioning eye constantly produces tears to form a tear film, which acts as moisturizer and lubricant. For someone with dry eye, the resulting lack of moisture and lubrication can cause a variety of problems. When tears evaporate too quickly, we refer to this as Meibomian Gland Dysfunction (MGD).

Dry eye symptoms may include:

  • A burning, stinging, or scratchy sensation in the eyes
  • Blurred vision, heavy eyelids or eye fatigue
  • Eyes may redden and become easily irritated by wind or smoke
  • The eyes may produce stringy mucus
  • Contact lenses may be difficult or impossible to wear
  • Sometimes the eye will actually produce excessive tears, and overflow*

*Though it sounds contradictory, sometimes the eye will actually produce excessive tears, and overflow. The eye becomes irritated by the lack of lubrication and attempts to cleanse itself with a flood of tears. This is a similar phenomenon to the tearing that occurs when foreign matter is stuck in one’s eye.

Dry eye syndrome is typically more common in older people and women (especially post-menopausal women), however there is increased prevalence of dry eye in younger patients due to personal devices such as phones and computers. There are many other factors that can cause dry eyes, including:

  • Over the counter and prescription medications such as antihistamines, beta-blockers, sleeping pills, pain relievers and many others. Overuse of diuretics can also play a role in developing dry eye. For this reason, it is very important to inform your ophthalmologist or optometrist about any medications you are currently taking, which can help the doctor in the proper diagnosis of the disease.
  • Inflammation of the eye lacrimal gland or conjunctiva
  • Disease processes that alter components of tears
  • An increase in the surface of the eye as a result of thyroid disease, for example
  • Cosmetic surgery if eyelids are opened too widely

Testing for dry eye:

One method of testing can be done through the evaluation of meibomian glands under a microscope with gentle pressure at the lid margin. Another method is using a piece of equipment, called LipiScan™, which can visually see the structural damage to the meibomian glands.

Another fast, easy, and accurate test to help diagnose dry eye disease is called the TearLab®Osmolarity Test, and it is performed in our office, requiring only 50-nanoliters of a tear sample for analysis – a sample smaller than the period at the end of this sentence. It is more patient friendly than older generation tests, as it is not intrusive, and requires no anesthesia. The TearLab® Osmolarity Test gives the doctor information about the salt content of your tears, which is an indicator of dry eye disease.

For more information about dry eye disease, click here.

tear lab

Simple Treatments for dry eye:

  • Artificial tears: Mild to moderate cases of dry eye syndrome may be treated by applying artificial tear eye drops as little or as often as necessary. There are a wide range of products available without a prescription that the doctor can recommend.
  • Prescription medications: Can sometimes increase tear production for those with chronic dry eye. By targeting inflammation, these drugs can sometimes increase tear production for those with chronic dry eye.
  • Conserving tears: An effective way to make better use of the tears in the eye is to close the tear ducts, thus preventing existing tears from leaving the eye as quickly. This may be done temporarily, with punctal plugs made of collagen, or permanently with silicone plugs or by cauterizing the tear ducts closed.
  • Controlling one’s environment: Patients should address situations in which tears evaporate quickly; for example, by using a humidifier in a dry house, wearing wrap-around glasses in the wind, and not smoking.

More Sophisticated treatments:

  • Blephex®
  • LipiFlow®

What is Blepharitis?

Blepharitis is common and persistent inflammation of the eyelids, which in turn causes Dry Eye symptoms.

Symptoms include:

  • eye and eyelid irritation
  • itchiness of the eye
  • redness of the eye
  • stinging or burning of the eye

What causes Blepharitis?

Everyone has bacteria on the surface of their skin, but in some people, bacteria thrive in the skin at the base of the eyelashes. For these people, large amounts of bacteria around the eyelashes can cause dandruff-like scales and particles to form along the lashes and eyelid margins.

How are Dry Eye and Blepharitis treated?

Dry eye and blepharitis are often chronic conditions, but can be controlled with the following treatment options:

  • Warm compresses – Wet a clean washcloth with warm water, wring it out, and place it over your closed eyelids for at least one minute. Repeat two or three times, rewetting the washcloth as it cools. This will help to loosen the scales and debris around your eyelashes. It also helps dilute oil secretions from nearby oil glands, preventing the development of a chalazion (pronounced kuh-LAY-zee-un) — an enlarged lump caused by clogged oil secretions in the eyelid.
  • Eyelid scrubs – Using a clean washcloth, cotton swab or commercial lint-free pad soaked in warm water, gently scrub the base of your eyelashes for about 15 seconds per eyelid. We recommend scrubs sold through our office such as HypoChlor Solution or SteriLid®.
  • Antibiotic ointment – Your doctor may prescribe an antibiotic ointment. Using a clean fingertip or cotton swab, gently apply a small amount at the base of the eyelashes before bedtime.
  • BlephEx – BlephEx is an in office procedure that provides a microblepharoexfoliation along your eyelids to completely exfoliate and remove the built-up bacteria and debris that is causing, or will cause, inflammation of your lids. Comparable to getting your teeth cleaned at the dentist, this is a deep cleaning treatment that will require maintenance at home using eyelid scrubs or warm compresses as described above in between treatments. It is performed in the office by our optometrist, Dr. Elaine Bourdeau, and takes about 30 minutes. It is not covered by health insurance. For additional information regarding BlephEx, visit their Website.
  • To see if you are a candidate for BlephEx, call 703.858.9800 and schedule your consult with Dr. Elaine Bourdeau, today!

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