The Oily Truth
Evaporative dry eye is the most common form of dry eye. Some reports indicate this group makes up 80% of dry eye sufferers. The underlying cause of evaporative dry eye is considered to be meibomian gland dysfunction (MGD), a condition in which the meibomian glands are not producing meibum (lipid produced by these glands) of appropriate consistency and volume. As you can read here, poorly functioning lipids within the tear film leads to rapid dehydration of the tears from the front of your eye. To be properly diagnosed a dry eye exam needs to be conducted by an experienced Eye Doctor.
What Cause Meibomian Gland Dysfunction?
Meibomian gland dysfunction is suspected to be caused by a number of underlying etiologies resulting in tear film dysfunction. There are two primary types of MGD, hyposecretory and hypersecretory, with hyposecretory being significantly more prevalent than the hyper faction. Blepharitis, or inflammation of the eye lid, is often a co-morbidity of MGD with many eye care practitioners considering it to be a primary cause.
The inflamation is thought to break down the natural action of the tear film in two ways. The first is an obstructive component, characterized by inflammatory mediators and debris on the surface of the eyelid serving as barriers to the normal flow of meibum. The second is a biochemical component, secondary to bacterial lipases breaking down the meibum, resulting in a more viscous substance that does not flow as easily and causes blockage.
Initial Treatments for Meibomian Gland Dysfunction
Lid hygiene and warm compresses
The initial treatments for MGD are designed to get at the root of the cause by decreasing the inflammation at the eyelid margins. Using eye sensitive cleaning wipes like Ocusoft lid scrub cleansers, helps to clean up the eyelids by removing bacteria and debris that are disrupting normal flow and possibly triggering inflammation. Second, warm compresses are recommended to be held over the eyelids before going to bed at night. The additional warmth serves to decrease the viscosity of the meibum, improving its consistency and flow. Studies have shown that the warm compresses must be held over the eyelids for at least 10-15 minutes to get any clinical benefit.
Artificial tears are a mainstay of dry eye treatment and most likely will be for years to come. There are a large number of artificial tears available, each formulated and designed for a specific function on the surface of the eye. When we discuss evaporative dry eye there are two brands of eye drops designed to specifically improve and buffer the lipid component of the tear film, Refresh Optive Advanced and Systane Balance. These two products need to be considered when discussing artificial tears for evaporative dry eye.
Omega 3 Fatty Acids
Omega 3 fatty acids have developed a name for being a homeopathic silver bullet. Health care professionals have recommended them as a supplement to help lower blood cholesterol and possibly prevent cancer. For dry eye there have been a few studies indicating that daily supplementation of omega 3’s (EPA and DHA, vs ALA) can decrease the inflammation associated with dry eye. The omega 3 fatty acids found in fish and fish oils are considered to provide better results compared to those found in flax seed and other plant based sources, and are therefore recommended to help decrease the inflammation associated with dry eye. Be sure to consult with your primary care physician and Eye Doctor before adding omega 3’s to your morning routine.
Check out The Oily Truth – Evaporative Dry Eye Treatments, for more advanced treatment options for evaporative dry eye.