In the past 2 blog posts, we have dug into the causes of Aqueous Deficient Dry Eye Disease, as well as treatments for mild to moderate Aqueous Deficient Dry Eye Disease. However, in some cases the cornea is so damaged that those treatments are not enough. If your cornea is severely damaged, you are at risk for infection or scarring, which can lead to permanent vision loss if not improved quickly.
What can be done about extremely dry eyes?
One of the most effective treatments for severe corneal damage from dryness is an amniotic membrane. At Peak Eyecare, we typically use Prokera membranes made by Bio Tissue (Figure 1). These membranes are harvested for this specific purpose, and will aid in healing your cornea when placed on your eye for 1 week. In most cases your medical insurance will cover this treatment. These membrane are typically very well tolerated. The negatives for treatment with amniotic membranes is that we can only treat one eye at a time, as it will substantially reduce your vision during the week that it is in place, and it is slightly uncomfortable at first.
If the damage seems to be lingering and is not improving with the above treatments, another option we will consider is autologous serum eye drops. These drops are made from the plasma of your own blood, and thus has a much more targeted affect on decreasing the inflammation on your ocular surface and promotes healing of your cornea. To make these drops, your blood is drawn, then centrifuged to separate the serum from the rest of the blood. This serum is harvested and put into eye drop bottles to be used daily. While very effective, this process is not cheap, so I only recommend it when necessary.
Historically, eye doctors would treat Aqueous Deficient Dry Eye with punctal plugs. You have 2 puncta on each eye that drain your tears, one in the upper eye lid and one on the lower eyelid. They are located on the nasal side of each lid, and they drain tears to the back of your Nose and throat. This is why when you cry, you nose starts to run. The thought behind blocking the puncta with a plug was that if a patient is not producing enough tears, we can block the drain, thus keeping the eyes more lubricated. However, as we just discussed, the major cause of Aqueous Deficient Dry Eye is inflammation, so if we block the drain of the eye, we are keeping the inflammatory factors on the ocular surface, thus making the inflammation worse. An analogy would be dirty water in a sink. We would not want to plug the drain of the sink if our goal is to remove the dirty water.
That being said, there are rare cases when I will recommend and install temporary punctal plugs, always in combination with some of the above treatments. Examples would be severe Sjogrens Syndrome, or a condition called Neurotrophic Corneal Ulcer, found most commonly in uncontrolled diabetic patients. For these patients, we must use everything at our disposal to keep the eye lubricated and protect the eye from permanent scarring that could lead to blindness.
However, as I mentioned in What is Dry Eye Disease, most cases of dry eye disease are not strictly Aqueous Deficient Dry Eye Disease, but rather a combination both Evaporative Dry Eye Disease and Aqueous Deficient Dry Eye Disease. Consequently, we almost always combine different treatment to effectively treat your dryness. If you eyes are bothering you, we would love to help, and promise to do all we can for as long as we need to in order to improve your eye comfort.