As an ophthalmologist specializing in treating dry eye, I often encounter patients who are frustrated with the care they have received by other eye doctors. I see patients whose symptoms persist despite having tried multiple treatments. Unfortunately, the treatment of dry eye is complex, and since it’s a chronic condition, it requires long term treatment. My goal is to help you understand effective management strategies for dry eye, empowering you to find the care you need.
I like to think of treating dry eye as putting pieces of a puzzle together, and if one piece is missing, it just doesn’t work. Breaking it down by treatment strategies is helpful.
Managing Dry Eye Syndrome Effectively
Effective management of dry eye syndrome involves a combination of lifestyle changes, home care routines, prescription medications and in-office treatments. Here are my strategies for helping my patients.
Controlling Inflammation is Key
Inflammation of the ocular surface is a cycle, as inflammation may be the cause of dry eye or may result from chronic hyperosmolar damage (when the tears have an increased concentration of salt). Steroid eye drops, Xiidra, Cequa, Vevye, Restasis, Omega-3 fatty acids, autologous serum tears and IPL all help to reduce inflammation.
Unplug the Meibomian Glands
When these glands become blocked, it is essential to unplug them so that they can start producing oil again. Lid hygiene, warm compresses, Omega-3 fatty acids, lid margin debridement and doxycycline are mainstays of therapy. While these treatments are helpful, often they are not enough. Intense pulsed light (IPL), followed by heated expression, is one of the most effective treatments for unplugging meibomian. If there is scar tissue inside the gland, probing of the meibomian glands with Maskin probes is highly effective. Treating Demodex is also very important. I have been very impressed and seen amazing results using XDEMVY.
Increase Lubrication
Increasing lubrication decreases hyperosmolar stress (makes the tears less salty), decreases inflammation and helps improve symptoms. There are several ways to increase lubrication including punctal plugs, artificial tears, Miebo, and Tyrvaya.
Make Simple Lifestyle Modifications
Using a humidifier to add moisture to the air, avoiding exposure to smoke, air vents and windy environments improve comfort. Moisture goggles can also be very effective. Blinking exercises help to increase tear production when on digital devices for long periods of time.
Addressing Nerve Damage
Lastly, pain can persist even after the surface of the eye is healed because of nerve damage, which is known as corneal neuralgia (or neuropathic eye pain). Treatments include autologous serum tears, amniotic membranes (stay tuned for more information about the new cryopreserved amniotic membrane that is comfortable, CAM 360), lyrica, Oxervate, gabapentin and low-dose naltrexone.
And Most Importantly, Don’t Lose Hope
While this all sounds like a lot, and it is, treating your dry eye will improve your quality of life. I always take a stepwise approach to avoid overwhelming patients, and to figure out what works best for them. Listening, caring and encouragement are just as important as new pharmaceuticals and cutting edge technology.
It is essential to have a good relationship with your ophthalmologist as I truly believe communication is the key to success.
If you experience mild dry eye symptoms, lifestyle changes may be enough to provide relief. If your symptoms are more severe, Dr. Lauren Zimski is a trusted Denver-area doctor you can depend on for customized treatment plans.
Schedule an appointment online or call 303-863-1231. First, take a few minutes to fill out our SPEED questionnaire and we’ll get in touch.
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