Dry Eye Treatment in San Diego
Contact our office at (619) 425-7755 to schedule a consultation for dry eye treatment.
Dry eye is a condition that can, at times, be debilitating for some. Most of us associate tears with emotions and such, but tears play an important role in the health of your eyes. Tears are critical to the eyes for lubrication, cleansing, and protection. Healthy eyes are continually bathed by tears produced by a combination of three glands located above both eyes. Sometimes a person has a decrease in tear production, or the tears produced are of poor quality. The result is a condition called dry eye.
At California Retina Associates we employ a variety of treatments for dry eye, but we’re especially excited about two newer treatment options: amniotic membrane application and LipiFlow. Both of these treatments are meant for moderate to severe cases of dry eye.
What are the symptoms of dry eye?
When a person has dry eye, these are the typical symptoms:
- Stinging or burning eyes
- Stringy mucus in or around the eyes
- Excessive tearing
- Excessive eye irritation in windy or smoky conditions
- Scratchiness on the eyes
- Discomfort wearing contact lenses
Why does tear quality matter?
Every time your eye blinks, a film of tears washes down the front of the eyeball, keeping it smooth and clear. When healthy, these tears consist of three layers: an oily layer, a watery layer, and a mucus layer. The oily layer, produced by the Meibomian glands, is the outside layer. Its purpose it to reduce tear evaporation and smooth the tear surface. In the middle is the watery layer we usually associate with tears. The lacrimal gland produces this layer that cleanses and washes out any foreign particles or irritants. The inner layer consists of mucus produced by the conjunctiva. Mucus allows the tears to adhere to the eyeball.
Tears need to have all three layers to perform their function on the eyes.
What causes dry eye?
Dry eye can result from various problems. As we age, everyone’s tear production drops. This is especially true of women after menopause. Often, tear quality is diminished when the Meibomian gland is blocked because tears evaporate too quickly from the eye without the protection of the outer oil layer. A variety of medications can also reduce tear production: antihistamines, diuretics, beta-blockers, sleeping pills, nerve medications, and pain relievers.
Dry eye really comes down to one of these (or a combination of) three problems:
- Lack of saline water
- Dysfunctional Meibomian oil glands
- Inflammation of the glands that make the saline water and oil
Dry Eye Treatment Options at California Retina Associates
- Lipiflow: LipiFlow is a thermal pulsation system for treating evaporative dry eye caused by poor tear quality. LipiFlow applies controlled heat to the inner eyelids to open blocked Meibomian glands, improving the quality of the patient’s tears and alleviating dry eye.
- Restasis/Xidra: are eye drop medications which can help reduce the symptoms of dry eye.
- Amniotic Membrane: An amniotic membrane, the inner layer of the fetal membrane, has anti-inflammatory, anti-fibrotic, anti-angiogenic, and anti-microbial properties. It is used for severe cases of dry eye that don’t respond to other treatment options. Amniotic membrane placement is not used for patients with mild dry eye who do not have corneal changes.
- Punctal Plugs: helps to block the drainage system so your tears don’t drain fast.
- Artificial Tears and Ointments: is a good temporary treatment to lubricate the eyes.
What is amniotic membrane?
An amniotic membrane, the inner layer of the fetal membrane, has anti-inflammatory, anti-fibrotic, anti-angiogenic, and anti-microbial properties. This material comes from Caesarian section donors. When placed on the damaged cornea, the amniotic membrane creates a fetal environment that promotes corneal healing and helps return the cornea surface to a normal state. These procedures are used for severe cases of dry eye that don’t respond to other treatment options. Amniotic membrane placement is not used for patients with mild dry eye who do not have corneal changes.
At California Retina Associates, we use ProKera, a sutureless form of amniotic membrane that was approved for use by the FDA in 2003.
Who is a good candidate for amniotic membrane treatment for dry eye?
Good candidates for amniotic membrane treatment for dry eye should have ocular irritation, burning, itching, pain, sensation of a foreign body in the eye, and decreased vision quality and blurring. There should be inflammation in the corneal epithelium and an irregular corneal surface. This is not a treatment option for patients with mild dry eye.
How is amniotic membrane treatment done?
ProKera features a 16-mm thermoplastic ring that, when placed beneath the upper and lower eyelids, holds the amniotic membrane in place on the affected area of the cornea. To do so, we first apply topical anesthesia to the eye. We then hold the upper eyelid and ask the patient to look down. The ProKera is inserted into the upper white of the eye under the upper eyelid, similar to insertion of a contact lens. We then pull down the lower eyelid and slide the bottom edge of the ProKera under the lower eyelid. We check placement with a slit lamp and the procedure is finished. In most patients, the amniotic membrane and the thermoplastic ring are removed after five days.
What are the benefits of amniotic membrane treatment for dry eye?
ProKera offers three options, Regular, Slim, and Plus. Slim is thinner and is more comfortable. This can be a better option for younger patients whose eyelids are tighter than older patients. Adults benefit from ProKera and ProKera Plus because they have laxity in their eyelids.
The benefit of amniotic membrane treatment is that the cornea heals. This happens very quickly in most patients, often within just a couple days. This clears discomfort, heals the cornea surface, and returns 20/20 vision.
What are the risks with amniotic membrane treatment for dry eye?
The FDA has cleared the use of ProKera and the tissue bank providing the amniotic membrane is also under FDA control. The tissue has passed rigorous quality control tests. This is a safe and effective treatment using natural tissue to heal the cornea.
What is LipiFlow?
LipiFlow is a thermal pulsation system for treating evaporative dry eye caused by poor tear quality. LipiFlow applies controlled heat to the inner eyelids to open blocked Meibomian glands, improving the quality of the patient’s tears and alleviating dry eye.
How does LipiFlow work?
LipiFlow uses a disposable eyepiece to apply controlled heat to the inner eyelids and intermittent gentle pressure to the outer eyelid. This combination of heat and applied pressure opens the Meibomian glands, allowing them to secrete the lipids that have been blocked. This allows the natural flow of lipids and resumes natural production of tear film oil. The procedure is painless, and we treat both eyes at once. The procedure takes around 20 minutes.
What are the benefits of LipiFlow treatment for dry eye?
LipiFlow is a painless treatment that provides immediate relief to most patients. By clearing the blocked or impeded Meibomian glands, normal tear production is returned. This condition can be chronic, so most patients will need to repeat LipiFlow treatments on a yearly basis.
Who is a good candidate for LipiFlow?
You’re a good candidate for LipiFlow if the basis of your dry eye is the quality of your tears. When the Meibomian glands are blocked, necessary lipids are not released, so your tears don’t have the necessary oils to effectively regulate evaporation. To assess your candidacy for LipiFlow, we evaluate your tears’ lipid layer and identify gland blockage.
What are the risks with LipiFlow treatment?
This is a very safe, very low-risk procedure. LipiFlow simply delivers controlled heat and pulsating gentle massage movement to the eyelids. This is completely non-invasive and safe.