The Four Corners region is beautiful, but our dry, arid climate makes Dry Eye Disease very common. Making matters worse is the amount of screen time that many of us can’t seem to avoid given our jobs and social demands. The main symptoms of Dry Eye Disease are irritation, redness, grittiness, foreign body sensation, dryness, and, paradoxically, excessive tearing and watery eyes.
What is the cause of Dry Eye Disease?
Dry Eye Disease is caused by a lack of adequate tear production, poor quality tears that evaporate too fast, or a combination of both of these factors.
Per the TFOS DEWS II report, there are 2 main types of Dry Eye Disease, Aqueous Deficient Dry Eye, and Evaporative Dry Eye. If you have Aqueous Deficient Dry Eye, it means that you are not producing enough tears from your lacrimal glands. These glands are located between your upper eyelid and your eyebrow. Certain diseases can lead to this, such as Sjogrens Syndrome, but arise without a specific cause. Evaporative Dry Eye means that you are likely producing plenty of tears, but the tears that you are producing are of poor quality and evaporating too fast. However, in practice, most patients have a combination of both of these types of Dry Eye Disease, and our goal in care is to determine which combination of treatment options are best for your unique combination of Dry Eye Disease.
How we detect Dry Eye Disease?
Specialized testing equipment and microscopic observation allows us to detect Dry Eye Disease.
At Peak Eyecare, we ask every patient if they have any irritation, dryness, redness, or watery eyes. If so, we perform an extra 5-min dry eye screening test with the Oculus K5M (at no additional fee). The first test on the machine takes a picture of your tear meniscus height, or the amount of tears that are resting on your lower eyelid between blinks, which we can measure through the software. (Figure 1: Tear Meniscus Photo)
Normal is at least 0.26mm, but if that height is less then 0.20mm, it is evidence that you are not producing enough tears, and likely have an aqueous deficient component to your dryness. The next test measures the amount of time it takes for your tears to evaporate. In a normal, healthy eye, we want your tears to remain stable for more than 15 seconds. For patients with Evaporative Dry Eye, the tears will break up way faster, sometimes less than 5 seconds. (Figure 2: NITBUT photo)
Next, an infrared image of the Meibomian Glands (the glands responsible for secreting the protective oil layer for your tear film, much more information in the next blog post) is captured, along with a high resolution photo of your eyelash line (Figure 3: Telangiectasia photo).
All of these images are reviewed in detail on the large, flat screen monitors in the exam room, where I will explain what I am seeing and what the best course of treatment will be given your unique ocular situation.
