CONDITIONS

DISEASE & MANAGEMENT

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Dry Eye

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DRY EYE

DESCRIPTION

According to the American Academy of Optometry, in normal conditions, our eyes regularly make tears to stay moist. If our eyes become irritated, or if we cry, our eyes make more tears than usual. In other situations, our eyes don't make enough tears or something can  affect the layers of the tear film. In those cases, we end up with dry eye.

For a detailed report about dry eye, click here.

TYPES OF DRY EYE

Evaporative Dry Eye - Evaporative dry eye (EDE) is the most common form of dry eye syndrome. Caused by a lack of quality tears, its' usually caused by a blockage of the oil glands that line the margins of your eyelids.

Common symptoms include grittiness, like there is sand in your eyes, a stinging sensation, blurred vision, sensitivity to light and eye fatigue.

Aqueous Deficiency Dry Eye - This type of dry eye occurs when you don't produce enough tears. It causes eye pain, redness, and vision problems. While causes could range from age to your immune system attacking your body rather than helping it. 

TYPES OF TESTS

Tear Osmolarity (Tear Lab)


Hyperosmolarity has been described in the literature as a primary marker of tear film integrity. When the quantity or quality of secreted tears is compromised increased rates of evaporation lead to a more concentrated tear film (increased osmolarity) that places stress on the corneal epithelium and conjunctiva. Levels of osmolarity correlate with the severity of the disease.




Inflammadry


The Inflammadry is an in-office test that detects elevated levels of inflammation or elevated levels of MMP-9. It has been demonstrated that ocular surface disease demonstrates elevated levels of MMP-9 in the tears. Inflammation is present before the clinical signs of dry eye. Increased MMP-9 may contribute to increased corneal disruption and corneal surface irregularity.




Tear Quantity & Volume


Tear Meniscus Height (TMH): Measuring the TMH is helpful in diagnosing aqueous deficiencies as it is used to estimate tear volume. A TMH of less than 0.2mm is suggestive of dry eye. Schirmer I Testing: Schirmer I testing measures aqueous secretion. A 5x35mm filter paper is used and the end of the paper is inserted into the outer 1/3 of the inferior conjunctival sac. The amount of strip wetting is measured after 5 minutes. Schirmer I is performed without anesthesia and measures both basal and reflex tear secretion.




Anterior Segment Evaluation


Tear Break-Up Time: Tear Break-Up Time measure tear film stability and is helpful in the detection of lipid and mucin deficiencies. A moistened fluorescein strip is applied to the bulbar conjunctiva and the patient is asked to blink. The tear film is scanned using a biomicroscope with a cobalt filter and is evaluated for the first nonstaining area from the last blink. Normal TBUT readings are 15-45 seconds. Ocular Surface Staining: Fluorescein dye is the most commonly used stain to evaluate the ocular surface. It is present any time the integrity of the epithelial surface is disrupted. Lissamine green dye stains devitalized cells and is helpful for evaluating the conjunctiva. The amount of ocular surface staining is graded using various methods.




Meibomian Gland Assessment and Expression


The Meibomian glands can be evaluated by lid eversion and transillumination with light or with topographical instruments. At the Illinois Eye Institute, we have several instruments to help visualize the Meibomian glands (meibography). This allows us to analyze and quantify the amount of gland loss or atrophy and note areas of occlusion and dilation to manage the condition appropriately.




Adjunctive Tests


Sjo Testing: Sjögren’s Syndrome (SS) is a chronic, systemic progressive autoimmune inflammatory disease. It is characterized by immune-mediated destruction of lacrimal and salivary glands and early hallmark symptoms include dry eyes and dry mouth. The classical serological markers for SS are anti-Ro/SSA and anti-La/SS-B antibodies. Other antinuclear antibodies (ANA) and rheumatoid factors (RF) are also included as the more common serological markers detected for SS. The Sjö test is an advanced diagnostic panel for the early detection of SS for patients with dry eye. It includes the 4 traditional and 3 new proprietary biomarkers- salivary protein 1, carbonic anhydrase 6, parotid secretory protein. Oculus Keratograph 5: The Keratogrph 5M is an instrument that is very beneficial in the management of dry eye patients. It has the ability to measure non-invasive tear film break up time (NIKBUT), tear meniscus height, evaluate the lipid layer, measure tear film dynamics, and take high resolution images of the Meibomian glands and of the bulbar conjunctiva.





TREATMENT

Identifying the underlying cause of dry eye and any associated co-morbidities is the key to successful management of dry eye. Your optometrist at the Illinois Eye Institute will make the appropriate treatment recommendation based on the examination findings and severity of your dry eye. Types of dry eye treatment range from tear supplements, tear film stabilizers, medical therapy, punctal inserts, nutritional supplements, lid therapy, and in-office therapies such as Meibomian Gland Expression and BlephEx.

BEFORE YOUR VISIT

Fill out both of these forms before you arrive:

OSDI Questionnaire

DEQ-5 Questionnaire

SERVICE AREAS PROVIDING TREATMENT

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Cornea Center for Clinical Excellence

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3241 S. Michigan Ave.

Chicago, IL 60616

312.225.6200

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