Symptoms vary from person to person and may include: • A feeling of discomfort or pain in the eye • Dryness • A sensation of something in the eye • Itchy or red eyes • Stinging and burning eyes • Watery eyes (this may seem counterintuitive, but it is a response of the eye to try and compensate for the lack of tears) • Sensitivity to light • Difficulty wearing contact lenses • Trouble with vision, such as blurred vision or decreased night vision • Eye fatigue

Tears are made of water, oil and mucus. They function to lubricate the eyeball. There are many different causes of Dry Eye, including: • Age: As we age, our eyes produce fewer tears. This is why Dry Eye is more common in older adults. • Gender: Women are more likely to suffer from Dry Eye than men, due to hormonal changes during menopause. • Medications: Certain medications can decrease the production of tears, or make the tears evaporate more quickly. These include antihistamines, decongestants, blood pressure drugs like beta blockers, oral contraceptives, and antidepressants. • Medical conditions: Inflamed eyelid glands that become clogged with oil cause blepharitis (inflammation of the eyelids), and eye mites accumulate in the oil glands and are common with Acne Rosacea and other skin conditions. Dry Eye can also be a symptom of other medical conditions, such as Parkinson’s, Sjögren’s syndrome, rheumatoid arthritis, lupus, diabetes, thyroid disease, and vitamin A deficiency. • Meibomian gland dysfunction (MGD): When the meibomian oil glands in the eyelids become blocked and unable to produce tear film that covers the eyeball, it is called MGD. MGD is believed to be the leading cause of Dry Eye Disease; and is especially important for patients who need cataract surgery or refractive surgery (Lasik and other forms of refractive surgery). Treatment of MGD is vital to the outcome of any surgical procedure. Optimizing eye health is key to a good surgical outcome. • Environmental factors: Dry Eye can be caused by wind, smoke, and dry air. This is why it is more common in places with low humidity, heat, and cold weather, such as deserts or high altitudes. • Eye surgery and corneal damage: caused by contact lens use, corneal nerve damage and laser eye surgery can temporarily induce or exacerbate Dry Eye Disease and worsen vision, increase symptoms, and impact the outcome of eye surgery. • Lifestyle conditions: smoking, less blinking while reading, driving, doing computer work, preservatives in eye drops, and diets low in omega 3 fatty acids and vitamin D can lead to Dry Eye.

Our providers will perform a comprehensive exam that includes asking about your symptoms and medical history and employing approved Dry Eye testing. The exam usually includes a slit lamp examination, during which they will look at your eyes with a special microscope to check for any damage to the surface of the eye. Your doctor will also perform tests to measure the amount of tears you produce, and the quality of your tears. This can be done with a test called the Schirmer test, in which strips of paper are placed under the lower eyelids to measure tear production. Our clinic also relies on Inflammadry testing and TearCare testing.

The goal of Dry Eye treatment is to improve eye comfort and normalize the ocular surface. There are many options that can be combined to find the best treatment, and offer the most relief, for you. • Lifestyle changes, including quitting smoking, avoiding sun, windy and dry environments, increasing humidity in your environment, staying hydrated, increasing the intake of essential fatty acids, and wearing sunglasses. • Becoming mindful of the need to blink while using a computer. • Warm eye compresses to release clogged eyelid glands. • Eyelid hygiene. • Artificial tears • Antibiotic eye ointment and drops for eye mites and to release clogged eyelid oil glands. This improves the quality of your tears and moistens the eye. • Prescription eye drops like Restasis and Xiidra • Steroid eye drops (for short term treatment) • Punctal plugs, placed in your tear ducts to prevent your tears from draining from the eye. Temporary dissolving plugs can be tried to see whether this helps, and if so, longer lasting plugs can be placed. • Cautery, a procedure to scar the tear ducts, can acts as permanent punctal plugs • Lipiflow, a medical device that creates heat to unclog blocked eyelid oil glands, allowing released oil to improve the quality of your tears and moistens the eye