Step Ladder Approach to Treating: Tearing, Burning, Itching, Foreign Body Sensation [Blepharitis, Meibomian Gland Dysfunction (MGD), Dry Eye Syndrome, Conjunctivitis]
You should not feel eye discomfort when you blink & move your eyes. Constant itching, foreign body sensation, burning, irritation, tearing is NOT normal. If you have such symptoms, we know how to help. There is hope! Patience and a step ladder approach is the best way to help your eyes feel better.
1. Let us know IF: you wear contact lenses; have itching worse than the burning or vice versa; have pets; travelled abroad recently; using new detergents, chemicals (ie, fingernail polish, makeup); have ROSACEA. Tell us if you have arthritis & dry mouth symptoms.
2. We’ll check under the microscope (Slit Lamp) for: Viral Conjunctivitis (usually very itchy; history of a cold or around someone with “Pink Eye”? We check for a pre-auricular lymph node; Antibiotics do not help viruses) or Bacterial Conjunctivitis (profuse yellow or green discharge; treated with antibiotics). If we see Papillae we think, Allergy or Giant Papillary Conjunctivitis (GPC) if a CL wearer; if see Follicles, we think virus. Crusting on lids, notes Blepharitis. Clogged meibomian glands means Meibomian Gland Dysfunction. A dry tear film &/or conjunctival &/or corneal changes, suggests Dry Eye Syndrome.
STEPS for TREATMENT: We start with as natural remedies as possible.
1. Lid Hygiene: Warm Compresses, diluted Baby Shampoo Scrubs (with or without prescribed Erythromycin ointment): 2x/day at least (see instruction sheet). This step is key. Continue periodically even if your eyes feel better. The heat opens the meibomian glands to help its Lipid come out to help your tears stick on your eye longer. If you get tired of step 1, look at step 8: IPL, LF, IDP
2. Diet & Environmental Modifications: Eat more Omega 3’s in Fish Oils, Cod Liver Oil (be aware of mercury level & be sure not rancid). Dr. Sears & TheraTears Nutrition: medical grade oils are best. Increase intake of Walnuts, Salmon, Tuna, Mackerel, Sardines, Eggs from omega 3 fed chickens, ground flaxseed; flaxseed, soybean or palm oil. Avoid sun exposure. Stop smoking. Eat green leafy veggies. Check with your Primary MD to eliminate offending systemic medications if possible.
3. We may measure your tear osmolarity (or/& Schirmer’s test) if symptoms severe or not improving with STEP 1, 2. We’ll recommend Artificial Tears: Non-preserved (NPAT) are best but more expensive. If symptoms include itchiness, we recommend putting in refrigerator to keep cool and help with itchiness. If significant allergic component present, we’ll prescribe an anti-allergy drop.
4. Doxycycline 20mg (up to 50 mg by mouth) helps MGD; also helps in rosacea, ocular rosacea
5, 6. If symptoms severe, and #1 is being done, we may add a low dose steroid drop for a couple of weeks. We then add Cyclosporine Restasis drops (can take weeks-months to work), and then decrease the steroid (long term use can increase risk of high eye pressure, glaucoma, cataract).
7. When ocular inflammation is controlled with above steps, we might use Punctal Plugs (temporary or permanent) to keep tears in eye longer.
8. Intense Pulsed Light (IPL), LipiFlow (LF), Intraductal Probing (IDP) & intraductal steroid injections: help relieve discomfort, especially if warm compresses too time consuming. Not covered by insurance. Initial studies show good results in opening Meibomian Glands and relieving dry eyes.
9. Moisture Chamber Glasses: helps in moderate to severe dry eye.
10. Autologous Serum helps patients if other treatments have failed.
11, 12. Prokera Contact Lens; Anti-inflammatory pills: needed in patients with severe dry eye
13, 14. Amniotic Membrane Transplant, Lid Tarsorrhaphy; needed in patients with severe dry eye
15. Lacrimal Gland Stimulator (in testing phase)
We are an Integrated Dry Eye Treatment Center.
We offer patients all existing options available anywhere in the USA to help with Dry Eyes, Meibomian Gland Dysfunction, Blepharitis, and/or Rosacea. Call us at Visionary Ophthalmology for an appointment if needed: 301-896-0890
You do not have to continue to suffer with constant tearing, foreign body sensation, and other dry eye symptoms.
If you do not improve with the early steps, you may have scar tissue in the glands (fibrotic & neovascular changes can cause obstructive Meibomian Gland Dysfunction [MGD] despite constant warm compresses and lid massage) and may need to have one of the options in step 8 to feel relief.
Step Ladder Approach to DRY EYE TREATMENTS:
START at STEP 1 & 2 which should be continued each day especially ifsymptoms return.
Sometimes steps are skipped to try to help improve your symptoms faster.
15. Lacrimal Gland Stimulation (in testing phase)
14. Lid Tarsorrhaphy &/or Conjunctivalchalasis surgery,
13. Amniotic Membrane Transplant: available at VO
12. Anti-inflammatory pills: prescribed
11. Prokera Contact Lens: available at VO
10. Autologous serum: available in our office (VO)
9. Moisture Chamber Glasses: can be purchased online
8. Intense Pulsed Light (IPL) or LipiFlow or Intraductal
Probing with or without Intraductal steroid injections:
Works well in many patients. If you are tired of warm
compresses, the cost of artificial tears? Ask about these
options (all are available in our office.)
7. Punctal Plugs (temporary or permanent); Probe & Irrigation of Ducts may be needed
6. Cyclosporine Restasis drops: works well; may take weeks to feel benefit
5. Low dose steroid drop: long term use has risks (ie: high eye pressure, cataract)
4. Doxycycline by mouth: low risk of diarrhea; avoid sun; don’t use if pregnant
3. Artificial tears: Non-preserved are best but cost more (put in refrigerator if
itchy symptoms); Anti-allergy drops may be needed if significant itchiness
2. Eat: Omega 3’s in Fish Oils, Cod Liver Oil: medical grade works best
1. Lid Hygiene: Warm Compresses, Baby Shampoo Scrubs, +/- Erythromycin ointment