Dell Eye Institute for Dry Eye Research
at Dell Laser Consultants
Who we are: A team of doctors with the leading knowledge of dry eye syndrome
Our experienced ophthalmologist, Steven J. Dell, MD, is one of the leading eye surgeons in the United States. Dr. Dell’s prominent standing allows Dell Laser Consultants to secure technology and innovations often before they are available to the rest of the country. Dr. Dell has participated in dozens of dry eye research studies and is the Chief Medical Editor of Cataract and Refractive Surgery Today.
Divya M. Varu, MD is a fellowship trained corneal specialist and an expert in dry eye syndrome. Dr. Varu serves on a panel of nationally recognized leaders whom recently published the American Academy of Ophthalmology’s recommendations for the diagnosis and management of dry eye syndrome and blepharitis. These publications have been vital in educating ophthalmologists around the world. Dr. Varu is also a regular contributor to the journal Cataract and Refractive Surgery Today.
Derek Cunningham, OD is a nationally prominent educator and research scientist on dry eye syndrome. Dr. Cunningham chairs the Dry Eye Summit, a meeting of the top 35 optometric dry eye experts in North America. He serves as the Chief Medical Editor of optometry’s premier disease journal Advanced Ocular Care.
Sheila Barbarino, MD is a triple-fellowship trained oculoplastic specialist that specializes in correcting the delicate eyelid anatomy, which is crucial to the maintenance of a healthy tear film.
What you need to know
- It is estimated that as many as 50 million Americans suffer from dry eye syndrome.
- Dry eye syndrome is a chronic disease that impacts the quality of life of affected individuals.
- Although you can get dry eye at any age, there is increased risk with age.
- Wearing contact lenses increases the risk of dry eye syndrome.
Dry eye syndrome is the most common pathology that affects the eyes. It can be difficult to diagnose because it can present in dramatically different ways. Signs and symptoms associated with dry eye include: burning, grittiness, stinging, red eyes, light sensitivity, decreased night vision, and even an overall decrease in vision. Many dry eye patients experience some degree of decreased vision—like driving around with a dirty windshield.
Some of the less obvious signs of dry eye include: itchy eyelids, fluctuating vision, decreased contact lens wear time, and even tearing of eyes. Dry eye tends to get worse with age and can lead to sight threatening complications. Most patents are subtly bothered by dry eye, but if left untreated, it will likely get worse over time.
Treatment of dry eye can be as simple as using artificial tears or as complex as requiring surgical reconstruction of the eyelids. Dry eye must be addressed and treated prior to keratorefractive surgery, such as LASIK and cataract surgery. Treatment of dry eye is usually simple and well tolerated but can make a world of difference in one’s everyday life.
The Dell Eye Institute for Dry Eye Research at Dell Laser Consultants is proud to be the only comprehensive dry eye clinic in Central Texas and a national leader in the field.
The Complexity of Dry Eye Syndrome
Dry Eye sounds like a simple term, but it is a complex and sometimes poorly understood disease. Even amongst eye care specialists, there is significant confusion, because what a patient feels often does not always correlate with what the doctor sees upon examining the patient.
The tear film is a remarkably complex structure that combines essential fatty oils, water, proteins, electrolytes, and vitamins. Tear film cleans the eye, provides infection control, hydrates tissues, nourishes the cornea, lubricates against blink friction, and even serves as one of the most important optical surfaces for vision. The human cornea has one of the highest metabolic rates in the human body, but it has no blood supply; it relies on obtaining all of its nutrients from the tear film.
The tear film consists of three unique interactive layers:
- The lipid (oil) layer is produced by approximately 45 glands, which line the edge of each of your eyelids. This layer of the tear film is responsible for preventing dehydration and evaporation of the tears, increasing the quality of vision, and allowing the tear film to vertically cover the eye despite gravitational forces. Dry eye secondary to a deficient lipid layer is the most common form of dry eye and may represent as much as 65% of all dry eye patients. This type of dry eye may also be accompanied by red and swollen eyelid margins, eventually leading to the loss of eyelashes. Conditions closely associated with lipid deficiency include poor diet, contact lens wear, fair skin, and age. Treatments can range from oil containing artificial tears to nutritional therapies such as omega-3 fatty acids to heated automated expression of the eyelid glands.
- The aqueous (water) layer is primarily produced by the lacrimal gland, which is located on the outside corner of the upper eyelid. Dry eye secondary to a deficient aqueous layer is closely linked to oral medications, increased age, female gender, and poor diet. This type of dry eye can be treated with medicated eye drops and plugging of the tear ducts.
- The mucin layer is produced by conjunctival cells on the white part of your eyes and provides the base for the rest of the tear film can adhere to. Mucin deficiency can lead to a complex form of dry eye for which eye drops as well as oral therapies may be needed.
How is dry eye diagnosed?
The historical problem with dry eye is that what a patient feels rarely matches what the doctor sees upon examining the patient. This has lead to much confusion in the past and the missed diagnosis of dry eye syndrome. Like many other chronic diseases, the disease state can often be present for years before a patient starts to suffer significant effects. Furthermore, many patients suffer from dry eye syndrome in conjunction with other diseases, such as blepharitis, contact lens intolerance, ocular rosacea, seasonal and environmental allergies, and various systemic conditions. By utilizing the most advanced technology, our physicians are able to identify underlying causes or other disease factors that may be contributing to dry eye symptoms.
Testing at the Institute for Dry Eye Research at Dell Laser Consultants includes:
- SPEED™ dry eye questionnaire
- Tear film osmolarity testing
- Sodium fluorescein corneal staining
- Lissamine green conjunctival staining
- Tear meniscus evaluation
- High contrast digital corneal lipid layer analysis (LipiView®)
- Digital blink analysis (LipiView®)
- InflammaDry® ocular biomarker testing
- Corneal topography mapping
- Ocular allergy testing (customized for Central Texas allergens)
- Lactoferrin protein tear testing
- IgE immunoglobulin tear testing
- Sjö™ Sjogrens syndrome testing
- Schirmer tear production testing
No single test alone is adequate for establishing the diagnosis of dry eye. Results from multiple tests will add to our experienced physicians’ understanding of an individual’s specific condition in order to customize a treatment plan.
The Dell Eye Institute for Dry Eye Research at Dell Laser Consultants philosophy for treating dry eye
All patients with dry eye syndrome receive personalized treatment plans tailored to their needs. In general, the earlier dry eye syndrome is diagnosed, the more responsive it is to treatment.
The Dell Eye Institute for Dry Eye Research at Dell Laser Consultants can provide patients with all of the advanced dry eye therapies available in the United States. Our research and dry eye experts also have access to many products and therapies that are not yet commercially available in the United States through our participation in FDA sponsored clinical trials. We make all of these resources available to our patients to ensure world-class medical care.
Available Dry Eye Therapies Include:
- Artificial tears, gels, and ointments
Tear supplementation is a mainstay in the management of dry eye. Artificial tears, gels, and ointments improve the optical quality of the tear film, alleviate symptoms, facilitate adequate spreading of oil gland secretions, and increase the lubrication between the eyelid wiper and the ocular surface. Artificial tears can replenish both the aqueous layer and lipid (oil) layer of the tear film. Our physicians will provide specific recommendations based on the patient’s needs.
- RESTASIS® prescription eye drops
RESTASIS®, or cyclosporin 0.05%, is an eye drop that reduces inflammation and increases the eyes’ natural ability to produce tears.
- Punctal plugs (eyelid drainage plugs)
These minimally invasive plugs can be thought of as a drain stopper that goes in a sink. They recirculate and maintain more tears in the eyes, often decreasing or eliminating the need for artificial teardrops. They are painless and take less than one minute to place (usually in the drainage canal that is located in the lower eyelid by the nose). Both temporary and permanent plugs are available. Temporary plugs will dissolve like a sugar cube while permanent plugs are long lasting and made of plastic. Both types of plugs are so small that they are not visible with the naked eye.
- LipiFlow® Treatment
This computer automated 12-minute treatment heats up and massages the eyelid glands in order to express their contents and reduce retained inflammatory factors. This highly effective treatment is unique, as the heat is applied to the inner lid surface directly over the oil-producing gland. In affected patients, this treatment has been shown to reduce ocular dryness symptoms for up to 18 months. Many patients receiving this treatment are able to eliminate prescription medications for dry eye such as RESTASIS®.
- BlephEx™ Eyelid Treatment
This treatment removes debris and blockage from the eyelid gland openings on the margin of the eyelids. It leaves eyelids and lashes looking much more natural and healthy. It has been shown to relieve dry eye symptoms in affected patients for up to six months and can often extend the symptomatic relief of LipiFlow® eyelid treatments. In the same way a dental hygienist can clean your teeth much more effectively than you can ever brush them at home, our lid hygienists can use this technology to remove debris, oily secretions, and bacteria from the eyelid margin. This treatment can also be used prior to cataract surgery in order to decrease the risk of infection and/or inflammation.
- Consistent heat therapy eye masks
The application of heat to the eyelids is implemented by using warm compresses, a facemask, goggles, or similar device. Elevating the temperature of the eyelids can unclog oil-producing glands at the base of the eyelids in order to release necessary oils into the tear film.
- Cliradex™ Lid hygiene wipes
These medicated pads contain the active ingredient from tea tree oil. These wipes can control and deter a common organism that colonizes the eyelash follicle. If left untreated, patients may suffer from inflamed and uncomfortable eyelids.
- Eyelid hygiene wipes
These wipes help clear debris from the base of the eyelashes and help to open up the oil-producing glands at the base of the eyelashes.
- Nutritional therapies
Several foods and nutritional supplements have been shown to help dry eye and re-establish a healthy ocular surface. We will detail what commonly available supplements will help to alleviate a patient’s dry eye symptoms.
- Lifestyle alterations
Daily activities can affect one’s ocular comfort. Everything from medication usage to workplace ergonomics can have a significant effect on eyes. We will guide patients through simple changes in their day-to-day activities that will help alleviate dry eye symptoms.
- Intense pulsed light (IPL) therapy
The use of intense pulsed light (IPL) therapy has been suggested as an off-label treatment for certain patients with dry eye and/or ocular rosacea. Individuals who may benefit from this technology can be enrolled in an on-going study at The Institute for Dry Eye Research at Dell Laser Consultants.
For more information and to set up a consultation, please contact our office today to hear more or to schedule a consultation with one of our experienced ophthalmologists.