Date: 20/10/2018
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What Do You know about

"DEWS" and Dry Eyes

What do you know about ‘DEWS’?  Now, we are in the South, so I am not talkin’ about ‘doos you know this’ or ‘doos you know that’.  I’m talking about DEWS.  DEWS stands for the Dry Eye Workshop Study Group, an international collection of expert Optometrists and Ophthalmologists that specialize in dry eyes.  They have recently published their second collective report to advise practitioners and patients on one of the more common eye problems in the world – dry eyes or more commonly and accurately known as ocular surface disease/disorder.  Dry Eyes as a title can sound confusing simply because a lot of the time a patient will say ‘my eyes don’t feel dry; however, they do burn, or they itch, or they feel scratchy, or they hurt, or they water a lot (isn’t that a confusing symptom for a person with dry eyes?!).

To bring us all to the same page, ocular surface disorders or what we’ll call dry eyes are typically caused by two types of underlying problems.  Either you don’t produce enough (water) or the tears you have evaporate away quickly.  This latter cause is due to the small oil glands at the base of the eye lids and eye lashes.  You and I don’t notice them unless they get blocked up (a stye) but they function every day each time we blink to secrete a small amount of oil to the front layer of the tears.  This oil is a clear optical surface for good vision but also keeps the tears in place so they don’t evaporate away. 

Therefore, we call this oil gland problem when it causes dry eyes an “evaporative dry eye”. It is actually the most common cause of dry eye or ocular surface disorders.  In fact, when I started teaching interns and residents, I would always tell them that nine out of ten eye infections or eye problems have an underlying evaporative oil gland dysfunction component.  Why?  Because if the oil glands are not secreting well and the tears are therefore evaporating too soon, the eye’s natural defense mechanism is greatly reduced.  We have fewer tears so there is less to wash out offending antigens (pollens, infectious bacteria, virus’, etc.).  If we have a healthy tear film made up of good oil glands, then we typically ought to be able to hold our eyes open for a good ten seconds, or much longer, without having to blink.  If our lacrimal gland is not providing enough of the water element into the tears that is called an aqueous or (reduced water level dry eye).  That is the second type of dry eye.

Now that we know the basics, how do we treat this?  According to DEWS the most important treatment for very mild dry eyes are simple lubricant drops.  This is only for the patients that have occasional or mild symptoms.  When we get into the mild or moderate category where it becomes symptomatic enough for you to mention to us, then we must be more assertive.  We need to address the number one cause of dry eyes and those are the meibomian glands or oil glands.  These oil glands eventually become inflamed, clogged and can even atrophy away.  Once they are gone, we never get them back.  So, it is essential for us over our lifetime to keep our meibomian glands open, functioning and releasing a good quality of oily fluid.  A poor quality of oily fluid is often one that precipitates a big problem.  People who have Rosacea or have a Northern European (Irish, Scottish, English, Germanic) heritage, are very prone to having clogged meibomian glands.  While we can use heat as an early intervention, more often we need to use a technique called Lipiflow.  This is a professional, in-office procedure where we heat up the eyelid glands and gradually express all the existing fluid out and allow the body to replenish (with our help) new and better oil gland fluid.  Prior to Lipiflow we only had mechanical lid wipes or pressing with the fingers method which really has been shown often to be more damaging than helpful. 

Lipiflow is an extremely valuable treatment, not just to improve a patient’s symptoms but to decrease the chance of infections, other front of the eye problems as well as to make sure that we keep the glands healthy and not dying over time.  When you come in to see us make sure you talk to your eye doctor about any dry eye symptoms or any symptoms at all (itching, burning, irritations, scratchiness, redness or pain that you may have - on occasion, sporadically or regularly).  Cool Springs and Donelson EyeCare doctors will take a close look at your meibomian glands and your tear production to see if Lipiflow or other treatments could be helpful in providing you current and lifetime comfort and the avoidance of dry eyes.  DEWS reinforces how important this is.

Call us at 615-889-0147 if you have any questions, or if you would like to make an appointment! 

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