Thanks to an increase in clinical research on Dry Eye Syndrome (DES) in the last few decades, there are many more diagnostic tests available to clinicians for determining the causes and forming a treatment plan specific to each patient’s Ocular Surface Disease (OSD). DES is a common and chronic problem, with almost fifty million American’s suffering from symptoms. We can now establish more specific root causes for each patient’s OSD and design treatment plans to better manage your symptoms and improve your long-term ocular health. Although Dr. Wilder has always had a special interest in helping her patients with Dry Eye, in years past the treatment options were limited. Fortunately, that is no longer the case and treatment options are available to help all patients improve their vision and comfort.
Dr. Wilder and her staff have spent innumerable hours on Dry Eye Education, attending Continuing Education conferences like “Dry Eye University” in Jacksonville, FL and other virtual workshops to learn all about new best protocols for diagnosing and treating the main causes of Dry Eye including Meibomian Gland Dysfunction (MGD), Aqueous Deficient Dry Eye, and Ocular Rosacea. Along with expanding clinical knowledge, Coastal Family Eyecare has invested in new technology and office renovations to create an entirely new exam lane dedicated to Dry Eye and other medical eye care management. This is our Dry Eye Center, and we are so pleased to welcome you in.
Please Note: All of the diagnostic testing and images can be billed to medical insurance along with the office visit.
At Coastal Family Eyecare, we like to give special attention to our Dry Eye patients, just like any of our other patients with ocular diseases that require special testing and monitoring. When you come in for your comprehensive annual eye exam, we will review any symptoms that you may be experiencing related to dry eyes and perform external imaging to look for signs of Ocular Surface disease. We will create an initial treatment plan and review home therapy steps to improve your symptoms and schedule you for a more in-depth evaluation. If you are current with your comprehensive exam, you may call and schedule a more focused dry eye evaluation at any time. Patient education is a core value for our team, so we have created informative educational materials to help reinforce our in-office recommendations. At your Dry Eye visit you can expect multiple tests and images to establish the causes of your Dry Eye as well as an extensive review of your treatment options.
OSDI (Ocular Surface Disease Index) Test: This questionnaire gives us qualitative data on how severely dry eye symptoms affect your day-to-day life. To find out your score, take the test here.
Inflammadry Testing: Inflammadry is a test for a specific anti-inflammatory marker, MMP-9. A technician will gently take samples of your tears from your lower eyelids, and the results take about 15 minutes to process. This painless test gives Dr. Wilder crucial information that will help her decide if medications like Restasis may help with your dry eye symptoms.
Tear Break-Up Time: Tear staining allows for valuable examination of the ocular surface. By placing a drop of yellow dye (don't worry, it washes out easily!) into the eyes, Dr. Wilder can measure how quickly your tear film breaks up, as well as measure the volume of your tears. The dye will also help evaluate damage to the ocular surface tissues.
Meibography: Using a special slit-lamp with Infra-Red imaging technology, Dr. Wilder takes images of the inside of the eyelids to look at the shape and measure any drop-out of your oil-producing Meibomian Glands. Although you may be able to see your own meibomian glands in the mirror with good lighting, the magnification and added contrast of the infra-red allows for high-resolution viewing and automatically grades gland loss and shows gland blockages. Meibography is used to diagnose and grade Meibomian Gland Dysfunction (MGD), an Ocular Surface Disease that is a leading cause of evaporative dry eye symptoms.
Anterior Surface Imaging: Using the same special slit-lamp needed for meibography, Dr. Wilder can get high-resolution, high-magnification (up to 40x!) images of the lid margins. With this imaging, she can diagnose Blepharitis, Demodex Mites, and Ocular Rosacea (another leading cause of dry eye symptoms).
Throughout your Dry Eye Visit, we will make sure you are comfortable and understand every part of the process. Based on the diagnostic testing and imaging results gathered, Dr. Wilder will develop a detailed treatment plan to improve your symptoms, vision, and reduce progression of the disease.
Most treatment plans for chronic conditions start with healthy habits! We educate all of our dry eye patients at the time of visit on home hygiene and healthy lifestyle choices to fight inflammation and promote the body’s natural processes. To read more about home therapies for dry eye relief, see our page The Importance of Home Lid Hygiene. Beyond lifestyle education and home therapies, Dr. Wilder will review prescription medications, punctal plugs, amniotic membranes, Zest, Tear Care, and IPL options to manage your DED.
Zest Treatment: This procedure exfoliates and debrides the lid margins and lash-lines with a special formula that fights inflammation and kills demodex mites. This deep clean is done after instilling an anesthetic drop for maximum patient comfort, and only takes about 15 minutes. Home lid hygiene is crucial for eyelid maintenance, but some patients require a more intense approach to get them back to a more manageable state.
Tear Care: When there are obstructions in the meibomian glands, the outer layer of your tear film is not functioning properly. This results in rapid break up and evaporation of the tear.
Home therapy with hot compresses and lid scrubs can help maintain the production of these oils and prevent future obstructions or infections. However, once the oils have thickened inside the gland, home therapy is ineffective in clearing the obstructions. In office Tear Care treatment effectively heats the glands and allows for removal of the obstructions. Chronic obstruction results in permanent loss of the glands. Therefore, Dr. Wilder advocates for effective treatments to maintain the lifetime function of these glands. After heating the glands with heating probes (Tear Care) or IPL, Dr. Wilder can remove obstructions in meibomian glands by expressing them with a special tool. This procedure is done with a local anesthetic drop to prevent discomfort and can take 30 minutes or more. Many of our patients report immediate relief in symptoms after having gland expression. To learn more, click to see our TearCare page.
Intense Pulsed Light Therapy: IPL therapy is used to eradicate demodex mites, treat ocular rosacea, and reduce inflammation in the eyelids resulting in improved meibomian gland function. This treatment is shown to be very effective following an FDA approved protocol. This treatment requires at least four sessions and includes Zest debridement and Meibomian Gland expression. It is the most advanced and comprehensive treatment we offer to combat chronic dry eye symptoms at the source. To learn more about IPL, see our Lumenis OptiLight page.
Prescription Medications: Medication may be prescribed at your visit to improve tear production and reduce inflammation based on diagnostic findings. There are many different topical or oral prescription medications that can improve your OSD.
Punctal Plugs: In some instances, based on a patient’s individual anatomy, or some underlying issue with creating tears, plugging the tear ducts with dissolvable collagen (short term), or silicone (long-term) plugs can be effective in relieving Dry Eye symptoms. The plugs prevent much-needed tears from draining away too quickly. Once Dr. Wilder has confirmed that the ocular surface inflammation is under control, small plugs can be placed in the tear canal to help keep the tears you are producing on the surface longer. This in-office procedure only takes a few minutes and is usually covered by insurance, making it a cost effective and convenient method for preserving your tears.
Amniotic Membrane: In severe dry eye patients the ocular surface can become very compromised. This can result in severe discomfort and vision fluctuation. Amniotic membranes are placed on the ocular surface for several days allowing for improved stem cell function and reduced inflammation. This results in a more stable ocular surface and improved visual function.