Chronic Dry Eye

Did you know that over 16 million Americans suffer from Dry Eyes?

Dry eyes is often talked about on the TV commercials, and your eye doctor may have already given you this diagnosis.  We understand it is an age related condition, or we may feel that it is allergy related.  Do we know for sure?

What we do know is that the eye is dry because either we are not producing enough tears, or our tears are drying up too quickly, leaving the eye without moisture.

In my research, I have found that the major cause of dry eye is dysfunction of the meibomian gland (MGD).  One study found that over 86% of dry eyes is caused by MGD.

I can almost see you scratching your head, and wondering what I just said.

The Meibomian gland is located behind the eyelashes on both the top and lower eyelids.  They produce a fatty substance that is added to the tears, and slows the evaporation of the tears.  When something happens to the production of the fatty substance, then we have eye problems.

Meibomian Glands (source: Dryeyedirectory.com)

MGD occurs when the meibomian glands, located in the eyelids, do not sufficiently produce and release the oils needed to protect and maintain a healthy tear film.  This exposes the watery layer underneath, leading to more evaporation.  Thus, the problem for many dry eye patients is not inadequate tear production, as thought for so many years, but a lack of oil production that ensures the protective integrity of the tear film is maintained on a daily basis.

While more prevalent in older adults, MGD can occur at any age. In addition, improved detection methods have shown that MGD can occur in young adults and children, possibly because of the common use of digital display devices today. Excessive use of display technologies can lead to infrequent blinking, called “evaporative stress”.   Infrequent blinking creates a demand for more lubrication on the eye, stimulating more oil production from the meibomian glands.  Over time, this leads to thickening of the oil, blockage of the gland opening and shutdown of oil production in the gland.

So, what can we do to alleviate dry eye?  One thing we can do is to oil ourselves within.  Increasing your dietary intake of Omega 3 can also improve dry eyes, according to an international panel of experts.

Recent studies also show that increasing Vitamin D levels can also reduce symptoms of dry eyes.

According to one study, people with low Vitamin D levels (<50nmol/l) were associated with dry eye symptoms in older individuals . Study participants took an oral vitamin D supplement of 1000IU (units) each day for nine weeks. After increasing supplementation, a significant number of people noticed a reduction in symptoms. Similarly, a recent study used 2000 units (IU) daily and found a significant improvement in dry eye symptoms.

Inflammation in the body can also cause dry eyes. Risk factors include Thyroid Dysfunction, Sjogrens Syndrome, Androgen Deficiency, Hormone Replacement Therapy and medications such as Anti-histamines or Anti-depressants.

Practical help is available too.  All too often, women who sleep without removing their eye makeup find that the makeup debris flakes off the eyelids and eyelashes, makes its way into the meibomian glands, and stops the flow of oils needed to keep the surface of the eye healthy.

Ingredients such as preservatives in skincare and makeup products can also exacerbate dry eyes. Browse this list of common toxic ingredients in mascaras.

Removing your makeup nightly and massaging the eyelids has been shown to help with the restoration of the function of that gland.

Eyelid cleansing is also important to reduce the buildup of debris, known as Anterior Blepharitis. This is a mixture of bacteria, mites, and their toxic byproducts exist on the eyelids and lashes. Like plaque on teeth, it’s important to cleanse your eyelids everyday.

Want to refresh your eyes? Use eyelid sprays such as hypochlorous acid to help cleanse bacteria and their biofilms. Spray on closed eyes and leaving them shut for thirty seconds can help. Try doing this regularly after removing your makeup at night.

Additionally, there are eye masks that can be purchased that can help.  These masks can be put in the microwave, and then applied to the eyelids.  The mask will heat up the meibomian glands, the heat will soften the oil in the glands, and normal flow may resume.  You can research these products yourself.

Warm washcloths can add heat to your eyelids. However, they lose their heat quickly. For people with moderate to severe MGD, it is recommended to get at least fifteen minutes of sustained (yet tolerable) heat to help loosen clogged oils.

Some products like glass-bead heat packs are washable. Others contain silver to help reduce bacterial buildup in the heat packs. New devices are available that add gentle vibration and help loosen material more.

There is also some research that shows CBD oil (10-15 mgs) daily can help restore the function of the meibomian glands.  When searching for this product, please make sure you are getting a good clean product.

Newer treatments for dry eyes include Intense Pulsed Light. This is a natural light treatment that helps to boost the metabolism of the Meibomian Glands. It also reduces fine blood vessels (known as telangiectasias) and inflammation on the surface of the eyes. Intense pulsed light requires several treatments. However, it is a drug-free, drop-free treatment for dry eyes.

Lipiflow offers a way of gently massaging and clearing Meibomian Glands. Newer in-office treatments by dry eye doctors also allow gentle warmth and clearing of clogged glands.

I hope that you are encouraged that Chronic Dry Eye is not something that you have to live with.  There are many things that you can do to help your Meibomian glands recover.

Until next time,

Dr. Polly