Windows to the World
Dr. Chih explains the causes of dry eye disease to one of her patients.

Dr. Chih explains the causes of dry eye disease to one of her patients.

Thermal treatment unclogs eyelid glands, eases symptoms of dry eye disease

The eyes are called “the windows to the soul.” Conversely, they are also the “windows to the world.” Researchers estimate that about 80 percent of what people perceive of the world comes through what they see. Regrettably, there are myriad disorders that can affect the eyes and distort that perception. 

Dry eye disease, a condition marked by inadequate moisture from the tear glands, is one of those maladies. Chronic dry eye disease is common in the United States.

“An estimated 30 to 40 million Americans suffer from dry eye disease,” reports Andreea Chih, OD, an optometrist at Central Florida Eye Specialists, which has offices in DeLand, Lake Mary, Orange City and New Smyrna Beach. 

“And nowadays, even more people are at risk for developing dry eye because the way many use their eyes is more visually demanding,” the doctor adds. “Today’s world is highly digital. People spend a great deal of their time staring at their computers, smartphones and other electronic devices. These visual tasks require a lot of concentration, and when people are concentrating, they tend to blink less, which dries out the eyes.

“In the past, dry eye was considered an age-related condition. That’s not the case anymore. Children are developing dry eye as well. That was especially true this past year. During the first year of the COVID pandemic, most children were home-schooled, which meant they were staring at computer screens for much longer than they would under normal circumstances.”

People with dry eye can present with a variety of signs and symptoms, Dr. Chih informs. They may experience tearing; and burning, redness or irritation of the eyes. Some experience eye fatigue with light sensitivity.

“Vision may fluctuate in people who have dry eye,” the optometrist expounds. “Sometimes, the eyes feel scratchy or gritty, particularly toward the end of the day.”

To diagnose dry eye, a physician examines the eyes through a microscope, looking for dry spots on the cornea (the eye’s surface) or conjunctiva (the tissue that covers the white part of the eyeball).

“But we rely most heavily on symptoms reported by the patient because even without dry spots on the cornea, certain symptoms signal dry eye,” Dr. Chih explains.

Tear Film Instability 

With dry eye, the cornea is not being lubricated properly because the eyes are not producing enough tears or producing poor quality tears. This tear film instability leads to inflammation and damage to the cornea.

“As a result of an unstable tear film, dry spots form on the cornea, which is highly innervated and therefore sensitive,” Dr. Chih describes. “The dry spots cause irritation and pain, which can result in blurred vision. The spots can also lead to additional problems, including heightened sensitivity to allergens and ocular surface inflammation.

“Adequate tears are not just necessary to keep the eyes moist, but they also act as an antimicrobial to keep the eyes protected from infection. When there are insufficient or poor quality tears in the tear film, the eyes are at greater risk for infection.”

According to Dr. Chih, there are many potential causes for dry eye disease. Certain medications can cause the eyes to become dry. These include diuretics (water pills) for high blood pressure, antihistamines for allergies and colds, medications for anxiety and depression, and medications to treat heartburn.

“Environmental factors can also contribute to the development of dry eye,” Dr. Chih discloses. “Being in a smoky environment, overhead fans and vents, and airborne allergens can exacerbate dry eye. 

“Hormonal changes, such as those experienced by women going through menopause, can also have an impact on the eyes. Certain medical conditions such as thyroid disease and Sjögren’s syndrome can exacerbate dry eye as well.”   

Targeted Thermal Energy 

The tear film is composed of three layers: the water-based aqueous layer, the oil-based lipid layer and the mucin layer. All three layers in the proper ratio are required to maintain an adequate tear film. 

The layers are maintained by structures at and around the eye surface. These include the meibomian glands in the eyelids, which secrete the oil for the lipid layer, and the lacrimal glands above the eyeball, which secrete the water for the aqueous layer. Mucin is made by specialized cells called goblet cells, found on the conjunctiva.

“Dry eye is often the result of blockage in the meibomian glands,” Dr. Chih observes. “These glands produce the oily layer of the tear film, but can become clogged, which leads to an unstable tear film and, ultimately, dry eye. If these glands are not treated, they can atrophy and lose function. So, it’s important to treat dry eye as early as possible.

“Initial treatment is generally conservative, consisting of over-the-counter lubricating eyedrops. Eventually, it may become necessary to move on to prescription drops and treatments such as heat masks and eyelid massages with warm compresses. If those treatments fail to resolve the symptoms, we may recommend serum tears, which are eyedrops made from the patient’s own blood products.”

Warm compresses are often recommended to heat the meibomian glands to unclog the glands and permit the healthy flow of oil into the tear film. Sometimes, warm compresses are not sufficient. Dr. Chih and her colleagues at Central Florida Eye Specialists offer a new, innovative procedure that goes a step further. It is called the TearCare® system.  

“TearCare is an in-office procedure that delivers targeted thermal energy to the eyelid margins while allowing the patient to blink normally,” Dr. Chih describes. “The thermal energy heats up the meibomian glands and liquifies the oils produced by these glands.  

“The TearCare procedure is essentially a professional deep cleaning of the eyelids, similar to a deep cleaning of your teeth that you would receive from your dentist. You can brush and floss at home, but you don’t get your teeth as clean as your dentist does. Warm compresses done at home cannot clean the meibomian glands and unclog them as well as a TearCare treatment.

“The Tear Care treatment is more effective than warm compresses. It heats the lids at a much higher temperature in order to liquify the oils in the meibomian glands, therefore producing a better quality and more stable tear film, easing the symptoms of dry eye.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. mkb
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    • Central Florida Eye Specialists

      Central Florida Eye Specialists offers an extensive list of medical and surgical treatments so that they can better serve their patients. They evaluate your individual needs and setup the most appropriate treatment method. Some of their s... Read More

    • Andreea Chih, OD

      Andreea Chih, OD, earned her Bachelor of Science degree cum laude from the University of Michigan in Ann Arbor and her Doctor of Optometry degree with highest honors from the Michigan College of Optometry in Big Rapids. Dr. Chih completed a resi... Read More