Dry Eye Clinic

BlephEx

BlephEx® is a new, in-office procedure that allows the doctor to take an active role in treating dry eye and blepharitis.
BlephEx® removes excess bacteria, biofilm and bacterial toxins, the main causes of inflammatory dry eye and lid disease.
With regular treatments, patients finally enjoy a life free from the chronic and irritating symptoms associated with dry eye and blepharitis.
The BlephEx® treatment is well tolerated and only takes a few minutes to perform.

Why BlephEx?

The in office treatment thoroughly and precisely eliminates the scurf and bacterial debris that builds up along the eyelid margin. This build up causes inflammatory eyelid disease. Removal of the debris improves overall eye health and eliminates many dry eye symptoms. The eye produces more tears and looks much better.

The eyelid cleaning takes a few minutes per eye, and the results are felt immediately.

Blinking Exercises

Dry Eye Syndrome

Red, gritty and scratchy eyes can have a number of causes and possible treatments. In addition to discomfort and fluctuating vision, dry eyes can lead to styes and infection. At Westside Optometry we consider dry eyes a symptom of ocular surface disease (OSD). Regular eye examinations can prevent complications and provide the opportunity for you to get help with treatment.

If you have ocular surface disease, you may notice discomfort any time of the day. For some people with lack of tear production the eyes are gritty and sore first thing in the morning. For others the symptoms worsen as the day progresses. Air conditioning, smoke, drafts, and cold temperatures become difficult to tolerate. Vision may fluctuate with poor tear quality and prolonged screen time. It may feel like there’s a foreign body in your eye, or your eyes may have a sandy feeling. You may find that your eyes are watering constantly or that strands of mucous are accumulating in spite of the fact that you are suffering from “dry” eyes.

What’s Going On? Normal tear film consists of three layers: mucin, aqueous, and lipid. Abnormalities in production, content, or distribution of these three layers or in eyelid function will cause the various conditions commonly known as dry eye.

Lipid Problems: These are the most common cause of dry eye. Glands in the eyelid produce lipids. Greasy lotions, incomplete removal of makeup, or skin conditions like dandruff can plug the glands and prevent lipids from secreting.
Aqueous Deficiency: This can be a side effect of certain medications you’re taking. The culprits include antihistamines, diuretics, hormones, and psychotropics.
Mucin Deficiency: Chronic infection or trauma to the eye can cause a lack of mucin. Autoimmune diseases (Sjorgren’s syndrome, Rheumatoid Arthritis and Lupus) negatively effect the mucin layer too.
Eyelid Problems: The eyelid may turn in or out as a result of the aging process or of scarring. Tears then spill over the eyelid, allowing the eye to become dry. Depending on the severity of the situation, this problem may need plastic surgery to repair the eyelids.
Acne Rosacea can negatively effect the eyelids and tear quality in more than 20% of Rosacea sufferers.

Also, ocular surface disease can be aggravated by inflammation of the eyelid margin due to poor blinking, excessive make-up and blepharitis. In this case, the whites of the eyes and rims of the eyelids will be red and irregular.

It usually takes multiple approaches to control OSD. A combination of the following may improve comfort: good eyelid hygiene, the use of artificial tears and lubricating ointments, newer agents designed to heal tissue such as Cyclosporine, omega-3 supplements and punctal occlusion (the insertion of a silicone plug into the tiny opening that drains the tears). Examining controllable factors such as medications, topical creams and lotions, and minimizing environmental influences like wind, smoke and screen time can enhance treatment success.

At Westside Optometry, we use Thermal Expression and BlephEx procedures in the office for longer term relief and treatment of dry eye symptoms. Ocular surface disease can be a chronic problem but continued care and maintenance of the eyelids will minimizes symptoms and future complications.

Demodex

Blepharitis or eyelid inflammation is a very common, chronic condition. According to studies, the most likely cause of blepharitis is demodex, commonly referred to as eyelash mites. Demodex mites can cause ocular inflammation and exacerbate many pre-existing ocular surface conditions such as dry eyes.

Common signs of Demodex caused blepharitis is redness of the conjunctiva (white of the eye) and redness of the eyelids. Symptoms include itchy lids, burning eyes and a foreign body sensation. Styes are a very common sign of Demodex. The Demodex mites live in the hair follicles and meibomian glands where they create inflammation and obstruction.

Bleph Ex is a treatment done in the office to remove debris from around the lash follicles and the eyelid margins. This reduces the Demodex population immediately.

As most blepharitis tends to be due to demodex infestation, the best treatment is to attack the mites. While total elimination is not realistic, it is reasonable to reduce the number of them. At Westside Optometry we recommend the use of Oust Pads at home. The Oust formulation uses a derivative of tea tree oil that is less toxic to the eye, but just as potent. If the infestation is severe, we will recommend an in-office cleaning to remove the debris on the lashes.

Demodex is thought to be associated with acne rosacea. We recommend using the Oust towelette on the entire face.

Tear Osmolarity

Tear Osmolarity is an important biomaker of ocular surface health. Increased tear osmolarity means the tears are too salty. The hyperosmolar tears are destructive to the surface of the eye and linked to dry eye disease.

Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.

At Westside Optometry we will analysis your tears to quantify the osmolarity. We will take a sample of tears from each eye and use the TearLab device to measure osmolarity (the saltiness of your tears). As osmolarity in your tears increases, the ocular surface cells become damaged. The test is quick and requires no drops, it only requires an amount of tear fluid no larger than the period at the end of this sentence.

Tear Osmolarity For a video description about tear osmolarity and TearLab, click on the image.

Thermal Expression

One of Westside Optometry’s mainstay treatments for ocular surface disease is a microwaveable eye mask to use at home. This heat mask works much better than a hot washcloth because it maintains heat for 6 to 10 minutes. Until recently we used the same technique in the office to warm the meibomian glands before expressing them.

Our new device is used in the office. It produces constant heat, but more targeted and sustained. Heat and gentle pressure are applied to the eyelids with a special device that melts the waxy substance trapped inside the meibomian glands.

Once sufficient heat has been applied (about 10 minutes) the doctor will apply compression to the lids to express the clogged meibomian glands. The application of controlled and localized heat is beneficial for dry eyes, blepharitis and styes.

In most cases, the doctor will follow the thermal treatment and expression with a BlephEx session to clean the lids and lashes thoroughly of all debris and demodex.