Millions of people are afflicted with chronic dry eyes. The incidence of this condition increases with age and is more common in women, especially after menopause. Other factors that predispose to chronic dry eyes include certain medications (such as some used in treating high blood pressure), having laser surgery for vision correction, radiation therapy around the eye area, as well as dietary choices: a diet that is low in vitamin A (carrots and broccoli) and omega-3 fatty acids (fish, walnuts, flax seed) will exacerbate dry eye disease.
The standard treatment for chronic dry eye includes medications such as daily eye drops and ointments to hydrate and coat the surface of the eye. These topical products are generally needed daily for ocular comfort, as they do not treat the underlying cause of the symptoms. In some cases, patients have been prescribed omega-3 fatty acids and other supplements that support the lubrication of the eye, as well as topical steroids. Left untreated, chronic dry eye is painful and can lead to impaired vision, and eventually scarring of the eye.
Evaporative dry eye is a type of chronic dry eye. The condition results from ocular rosacea, which is an inflammation of the eyelid skin that causes the meibomian glands (present along the lid margins) to fail to produce enough natural oil to slow the evaporation of tears, or the oils produced by the glands are of a bad composition and instead of flowing smoothly over the eye, get trapped in these glands, causing styes and lid irritation. When that happens, patients experience a burning or gritty sensation, blurry vision and redness of the eyes and lids.
Not all patients with facial rosacea have the ocular component, and alternatively, not all patients with the ocular rosacea show signs of facial rosacea.
A new treatment utilizing Intense Pulsed Light (IPL) has been found to be effective for longer and better control of severe dry eye symptoms associated with evaporative causes. After IPL treatment, the lids look less red, there are fewer secretions and fewer symptoms. Often the need for frequent use of eye drops is alleviated.
IPL treatment provides relief for patients who have exhausted or failed to tolerate other treatment options, such as drops, compresses or antibiotics. IPL uses bursts of light to target the blood vessels around the upper cheek and lower eyelid. By closing down these blood vessels, the inflammation mediators can’t be delivered to the eye to cause irritation. (Abnormally dilated blood vessels carry inflammatory mediators, hence the risk in rosacea patients, as rosacea is a disease of such abnormally dilated vessels.) IPL also heats the meibomian glands that are blocked with stagnant secretions so that this material can be expressed more easily, returning the eye area to a healthier state.
Most patients require four monthly treatments to see full results, but many notice some improvement even after a single treatment. For patients severely affected with evaporative dry eye, maintenance treatments are recommended every two to six months, depending on their need.
There are 30 centers in the U.S. offering this treatment, and now it is one of several in the arsenal of treatments for chronic dry eye at Pittsburgh Eye Associates.