Dry Eye
Ophthalmology located in San Francisco, CA
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Dry Eye Services Offered In San Francisco, CA
Do you have dry, irritated, red, or watery eyes? Dry eye specialist Dr. Bart has the training, experience, and equipment to treat dry eye optimally and to restore comfort and health to your eyes. In addition, Dr. Bart has dry eye herself and firsthand knowledge of a wide range of treatments. Call her office to schedule a comprehensive eye exam, or use the online booking feature today.
Tears are needed for our eyes to stay healthy and comfortable. The tear film moisturizes the eyes and enables clear vision. Debris is washed away with the tears when the eyelids blink. The tear film prevents infection. Dry eye syndrome is when the tears are not adequate in quantity or quality.
What are symptoms of dry eye?
• Stinging and burning
• Irritated, scratchy or gritty feeling, as if something is in your eye
• Redness
• Blurry vision, especially when reading
• Eye fatigue
• Light sensitivity
• Difficulty with night driving
• Mucus in or around your eyes
• Difficulty wearing contact lenses
• Watery eyes, frequent tearing
Many dry eye patients comment that it seems strange that they have a lot of tears in their eyes when their diagnosis is "dry eye". When the quality of the tears is poor, the tear glands often try to make up for it by increasing the quantity of tears produced.
How do tears work?
When you blink, a film of tears spreads over the eyes. The tear film is made of three layers:
• An oily layer
• A watery layer
• A mucus layer
Each layer of the tear film serves a function.
The oily layer makes the tear surface smooth and keeps tears from drying up too quickly. This layer is made by the eye’s meibomian glands.
The watery layer washes away foreign particles from the eye. This is the thickest layer and flows from the lacrimal glands in the eyelids.
The mucus layer stabilizes the tear film, enabling the tear film to stick to the eye. Mucus is made in the conjunctiva which is the clear tissue covering the white of your eye and the inside your eyelids.
What are the types and causes of dry eye?
Aqueous deficient dry eye: Dry eye may occur when not enough tears are produced and the watery layer is deficient. Some causes include:
• Age due to hormone changes; this occurs more often in women than men
• Certain diseases, such as rheumatoid arthritis, Sjögren's syndrome, thyroid dysfunction, lupus, diabetes, Parkinson’s disease, rosacea
• A lack of sensitivity of the corneal nerves, such as after refractive eye surgery, such as LASIK
• Some medications, such as diuretics (water pills) for high blood pressure, beta-blockers for heart problems or high blood pressure, allergy and cold medicines (antihistamines), heartburn medicines, sleeping pills, anxiety and antidepressant medicines
Evaporative dry eye: The most common type (86%) of dry eye occurs when the tears evaporate too quickly. Its most common cause is not enough oil in the tear film because the meibomian glands are blocked. This is called Meibomian Gland Dysfunction (MGD). Some other causes are:
• Environmental factors, such as allergens, smoke, wind (including a fan or a sleep apnea mask), or a very dry climate
• Blinking less frequently, such as when looking at a computer screen for a long time or reading
• Structural abnormalities of the eyelids, such as entropion (when eyelids turn in) and ectropion (eyelids turn outward)
How is dry eye diagnosed?
During an eye exam, Dr. Bart uses a slit lamp microscope to assess the surface of the eye, the appearance of the eyelids and how you blink. Other tests measure the quality and thickness of your tears and how quickly tears are produced. These include Schirmer's test, tear film osmolarity, meibomian grading, fluorescein tear film break-up time (TBUT) and staining of ocular surface epithelium using fluorescein and rose bengal. Imaging devices such as Lipiscan visualize the meibomian glands.
What are treatments for dry eye?
Artificial tears: Blinking spreads tears over the surface of the eye, keeping it moist. We blink less during visually intensive tasks such as staring at a computer, reading a book, or driving on a highway. We normally blink about 15 times per minute. When looking at a screen, book, or highway, we blink only 5 to 7 times per minute, causing dry eyes. Artificial tears are moisturizing eye drops that lubricate the eyes and can give temporary relief from dry eye symptoms. It can be helpful to use artificial tears just before getting started on a visually intensive activity such as computer work because once the eyes have become drier and more irritated, artificial tears may be less effective at improving symptoms. If dry eye symptoms are severe, artificial tears may need to be reapplied frequently because they evaporate after 30-60 minutes. Avoid eye drops with a redness reliever or allergy drug, which most Visine, Similasan and Naphcon-A drops have. Use preservative-free tears if you use artificial tears more than six times a day or are allergic to preservatives. Each tube of non-preserved artificial tears has multiple doses and is to be discarded 24 hours after opening. Artificial tear gels are thicker and provide longer relief, but temporarily cause blurry vision. Artificial tears and gels are purchased without a prescription.
Artificial tear ointment: If you often wake up with dry eyes that seem almost stuck shut, apply artificial tear ointment to your eyes just before you go to bed to improve comfort the next morning. However, note that the lubricating ointment blurs vision for several hours, so use caution if getting up in the middle of the night. Sleep apnea masks can cause dryness, even if they fit well. Just a small amount of air leaking from a mask can dry the eyes through the tiny space between your eyelids. Ointment at bedtime can be helpful in this circumstance as well. Artificial tear ointments are purchased without a prescription.
Warm compresses: A warm compress is placed over closed eyelids for about 15 minutes once or twice a day, loosening minor meibomian gland blockages and improving tears.
Dry environments: Wind can dry out the eyes, so wearing wrap-around glasses outside can be protective. When outdoor temperatures are extreme, we typically run heat or air conditioning, causing low humidity and dry eyes. It can be helpful to turn the air flow from a car’s vents away from the eyes or to move out of the flow a fan. A humidifier at home in the winter can improve symptoms. Other low-humidity environments include airplanes and office buildings. Artificial tears can ease symptoms in these circumstances.
Contact lenses: Contact lenses can cause chronic irritation. While counterintuitive, contact lens materials with a lower water content can decrease dryness, improving eye health and comfort. Contacts with higher water content tend to be less comfortable for dry eyes because they lose more moisture to the environment and absorb water from tears, wicking moisture from the eyes. Daily disposable contact lenses are also preferable to those that are replaced every 2 or 4 weeks.
Omega-3 fatty acids: It has been suggested that omega-3 fatty acids may help with tear production, but the research remains unclear.
Prescription eye drop medications: Restasis, Xiidra, Cequa, and others decrease inflammation and help increase tear production. Autologous serum is an option for severe cases.
Punctal plugs: Tears drain from the eyes through tear ducts. Blocking the ducts using tiny silicone or gel plugs can increase the amount of tears that stay in your eyes and help with dry eye symptoms. Putting in the plugs is painless, done in the office and takes about 12 seconds. These plugs can be easily removed later for any reason. Removal is also painless and is even quicker.
Devices that open meibomian gland blockages: Examples include LipiFlow, TearCare, iLux, Mibo Thermoflo, EyeXPress, NuLids, BlephEx, and Intense Pulsed Light Therapy (IPL).
Specialty contact lenses for severe dry eye: These are positioned on the sclera rather than the cornea, and include scleral lenses, PROSE and EyePrintPro.
Amniotic membrane products: These have protective and therapeutic properties. They reduce inflammation and pain, and heal the eye’s surface, helping return it to health and comfort.
Dry eye is typically a chronic condition that needs ongoing treatments to ensure eye health and comfort. We have many therapeutics for mild to severe dry eye, and more are on the horizon, including dozens of FDA clinical trials in progress.
If you have symptoms of dry eye, dry eye specialist Dr. Bart provides advanced and personalized treatments to restore comfort and health to your eyes. Arrange a dry eye assessment at the Bart Eye Center by phone or use the online scheduler today.
TESTIMONIALS
Dr. Bart has worked with me for several years to address chronic dry eye. I feel like we are partners in my treatment. I like to research medical treatments myself, and she very seriously considers each possible solution I bring to her from my research and tells me whether she thinks it's worth trying. (Many other docs dismiss patient input out of hand; one told me to stop researching on my own!)
Dr. Bart has squeezed me in for a last minute visit before a flight when my punctal plug came out, emailed me at home (after hours) with some information she thought I might want, and offered to special order some punctal plugs for me (at cost to her since they come in large quantities and she might not be able to use the special sizes for other patients). When the equipment for measuring corrective lenses came up with a bifocal prescription that just did not feel quite right to me, she got out pen and paper and did some complex math calculations to adjust the prescription. Then she had the company re-do the glasses for further adjustment.
No, she doesn't hold my hand and her front office staff does not give me lots of TLC, but I look for a doctor who is highly educated and whip smart, stays up on developments in her field, takes me seriously, sees me when needed, and works with me as a partner. Dr. Bart is the best!!!
Jeralyn S.
Fully Confident! First Rate Quality of Care
Dr. Bart is clearly well trained and, importantly, is an excellent communicator. She was patient with my questions, and her answers and other explanations were clear and thoughtful. She was able to anticipate my concerns and proactively address them.
Robert M.
I was so grateful that you saw me so fast, diagnosed me, and sent me on my way with medication. Your manner was calming and supportive as I was a little rattled being on vacation and then having to go to a physician! So thanks again for your quiet and gentle manner.
Bonnie L.
Dr. Bart is everything one could expect or ask of an eye doctor.
Paul S.