Dry eye syndrome, or DES, is characterized by chronically dry eyes. While symptoms can be triggered for a number of reasons, the cause is fundamentally a lack of proper moisture and lubrication of the surface of the eyes. The tear layer covers the highly sensitive corneal epithelial cells, with is essentially a three-layer fat sandwich. The outer layer of tears is an oily layer called meibum, produced by the meibomian glands. The middle layer is mostly water, produced by the aqueous glands. The aqueous gland is the same one that produces reflex tears. If you get an eyelash or some foreign body in your eye, these aqueous glands flush out your eyes to wash away the intruder. The tears don’t anchor properly, by design, and spill out on your cheek, with the foreign invader. The final layer of tears, the part that meets the corneal surface, is another oily layer, produced by the glands of Moll. This layer acts as an anchor to secure the entire tear layer to the front surface of the eye.
DES is generally the result of tears that do not contain the proper amounts of water, mucous, and oil components needed. Each of these layers serve a critical role in keeping our eyes moist. The normal time between blinks is between 10-12 seconds, in a normal functioning tear layer. If your tear layer breaks up sooner than that, the nerve endings in the highly innervated corneal cells are stimulated, resulting in the classic burning and stinging dryness symptoms that are so familiar to dry eye disease sufferers.

Our eyes rely on the proper production of tears to clear debris, protect the surface of the eye and keep them moist and functional. When our tear glands are not able to produce tears as needed, chronically dry eyes are often the result.

Symptoms include:
• Burning and irritation
• Constant watery eyes
• Feelings of grittiness
• Feeling like a piece of debris is in the eye
• Sensitivity to light
• Blurred vision
• Tired/heavy eyes
• White stringy discharge
• Recurrent styes or swollen bumps on the eyelid margin
• Inability to wear or tolerate contact lenses

Chronically impacted glands can lead to persistent desiccation of the cornea, severe dry eye symptoms, infection, and even corneal transplantation. It’s important to be evaluated in a timely manner if you suffer persistent symptoms, to be sure the progression of the disease is interrupted, before the onset of the advanced stages of the disease.

Whether you have been suffering from dry eyes for years or have just begun to notice the symptoms, relief is possible. We offer many different therapies and solutions to alleviate DES, depending on the severity and causes of the condition.
For individuals with less severe or seasonal dry eyes, we can offer a variety of prescription and over the counter eye drops. For people who have more severe dry eyes, we take a deeper look at what we can do to address the problem directly.
Tears are produced by a number of different glands, so the appropriate treatment depends on which of these is malfunctioning. Solutions can vary from prescribing hot compresses and eyelid massages, to therapies such as punctual inserts or plugs, specialty eyelid scrubs, oral supplements, prescription and/or non-prescription ointments or lubricants.

For more advanced cases, there is an exciting new technology known as Low Light Level Therapy (LLLT). This treatment is done in office, does not produce heat, and is safe for all levels of skin, with no risk for skin cancer. LLLT is used specifically in the case of Meibomian Gland Dysfunction (MGD). As mentioned earlier, the meibomian glands produce the outermost oily layer of the tears. This is the part that meets the air and is most susceptible to evaporation. MGD occurs when the product of the gland loses its viscosity and goes from the consistency of olive oil (normal) to the consistency of string cheese. Obviously, string cheese would not spread or protect well on the outer surface of the tear layer. Eventually, as gland production deteriorates, the glands can become impacted and completely obstructed.
Prior to the LLLT, there was no effective treatment for the later stages of MGD. LLLT uses light emitting diodes (LEDs) emitted in the infrared spectrum, to target the mitochondria (energy powerhouse) inside the individual cells. This cell specific interaction excites the movement of molecules inside the meibomian glands, with the result of softening the impacted meibum. This response is akin to placing a stick of butter directly from the refrigerator into the microwave oven for about 10 seconds. In this example, the butter is now much easier to spread on your morning toast. Medically, this means that the newly softened product of the glands is now much easier to digitally express, and therefore, much easier to reclaim the normal function of the previously impacted glands. In my experience so far, with this new cutting-edge technology, this has been a ray of light and a Godsend for chronic MGD sufferers. There is now light at the end of the tunnel if you suffer from these persistent quality of life changing symptoms.

For consultation contact our office to make an appointment with Dr. Battani to evaluate your dry eye symptoms and devise a treatment plan to address your individual needs.