Dry Eye

Dry Eye (Ocular Surface Disease)

Dry, scratchy, irritated eyes and blurry vision are among the most common complaints encountered by eye doctors. These symptoms, often referred to as “dry eye ,” can be a constant source of discomfort and can greatly impact your quality of life. Dry eye is the most common form of a lesser known, broader condition called ocular surface disease, or OSD. A chronic disease, dry eye generally occurs when the eye does not produce the adequate quality or quantity of tears necessary to keep the eye properly lubricated.

Once very limited, diagnostic technology for dry eye has progressed significantly in recent years, inspiring a wave of revolutionary new treatment options. Instead of simply aiming to mask dry eye symptoms, The Dry Eye Center within our Elkhart office is one of the only area facilities to specialize in identifying the unique source of your condition to create a customized treatment plan based on YOUR specific needs.

How do tears work?

Tears are made up of three layers:

  • Mucin layer: As the base layer, mucin works like a glue to keep tears on the eye.
  • Water layer: The middle water layer is designed to lubricate the eye, wash away particles, and prevent infection.
  • Oil layer: This outer oil layer of the tear film helps prevent tears from evaporating.

If any of these tear layers are not working properly, it can cause dry eye.


What are common dry eye symptoms?

  • Excess tearing
  • Burning
  • Itching
  • Redness
  • Irritation
  • Pain
  • Blurry Vision/Fluctuation in vision throughout the day
  • Vision that improves with squeezing the eyes or blinking

What causes dry eye?

  • Aging
  • Menopause
  • Lack of sleep
  • Not drinking enough water
  • Not blinking enough
  • Dry or windy environments
  • Smoking
  • Heavy makeup use
  • Contact lens use
  • Use of a CPAP
  • Prior eye surgery (LASIK, cataract, eyelid, etc.)
  • Systemic conditions (rheumatoid arthritis, thyroid disease, Sjogren’s syndrome, diabetes)
  • Certain medications
  • Eye drops that “get the red out”
  • Glaucoma medications
  • Overuse of preserved artificial tears or allergy drops

What is blepharitis?

Blepharitis is a very common, chronic inflammatory condition of the eyelids, often caused by bacteria. This typically worsens with age and is not adequately treated with just facial soap and water. Many patients with Blepharitis have itchy eyelids, loss of eyelashes, and crusty debris at the base of their eyelashes.  Children and adults can suffer from blepharitis and it is commonly associated with increased risk of styes.

What is MGD?

Meibomian Gland Dysfunction or MGD is the leading cause of Dry Eyes. It is a progressive disease that develops when the meibomian glands (oil glands in the eyelids) become blocked. The meibomian glands are found in the upper and lower eyelids and are extremely important to eye health and stability of the tear film because they produce oils that keep your tears from evaporating too quickly and protect your cornea.

How does The Dry Eye Center diagnose and treat this disease?

Dr. Ann Madden has been specializing in identifying and treating dry eye for years. Diagnosis generally involves measuring the quantity and quality of your tears. She and our dry eye team use a wide range of state-of-the-art tests to look for damaged cells and dry spots on the surface of your cornea. The position and function of your eyelids will also be examined to make sure there are no problems with tear distribution. Based on your results, your doctor will talk you through all of your treatment options before making the best recommendation for you. Your treatment may include one or a combination of the following:

  • iLux® meibomian gland treatment
  • In-office BlephEx® eyelid deep cleaning
  • PROKERA® biotissue (biologic corneal bandage device)
  • Warm Compresses/Heat Masks
  • Artificial Tears/Gels/Ointments
  • Punctal plugs
  • At home Lid scrubs
  • Omega 3 vitamins (HydroEye®)
  • Blinking exercises
  • Sleep goggles or masks
  • Moisture chamber goggles
  • Changing skincare regimen and/or makeup
  • Prescription eye drops
  • Oral antibiotics
  • Biologic bandage contact lens device/amniotic membrane

What is the iLux treatment?

The iLux procedure is designed to provide dry eye relief for patients with meibomian gland dysfunction (MGD). MGD occurs when meibomian glands in the eyelid do not secrete meibum (the oily layer of the tear film) properly. As they progressively become inflamed the meibum becomes thick like butter. Prolonged inflammation can lead to meibomian gland dropout or atrophy. We have a limited number of these glands, and once they are gone, they cannot be restored. Dr. Madden encourages routine eye exams to catch issues like this early so that they may be treated. In this case, with iLux.

During the iLux procedure, Dr. Madden uses an small device to warm the eyelid and melt the blocked meibum. Gentle eyelid compression then expresses the melted meibum through the orifices. Treatments are comfortable, efficient, and quick, with most taking less than 8 minutes. The iLux procedure is FDA approved.


What is the PROKERA biotissue treatment?

PROKERA biologic corneal bandage devices inserted and removed, much like a contact, in the doctor's office to treat dry eye and other ocular surface diseases. PROKERA products provide faster and more effective healing of the cornea with less pain, scarring, and inflammation, leading to clear corneas and improved clinical outcomes.

What is BlephEx?

BlephEx is a safe, in-office procedure that deep cleans the eyelid margins and removes the biofilm on the surface of the eyelid margins that can block the meibomian gland openings and also contribute to increased irritation and crusty debris. It does not hurt and usually only takes a few minutes for a trained technician or Dr. Madden to perform. Typically, patients who need BlephEx will continue to have it done every 4-12 months.

Ready to schedule a dry eye exam?

Are your dry eye symptoms due to a lack of tears, poor tear quality, allergies, or something else altogether? Then call to schedule an appointment at The Dry Eye Center in Elkhart.

What can I expect at my dry eye exam?

  1. Thorough review of your medical history
  2. Testing for tear quantity and quality
  3. Testing for the presence of inflammatory markers in tears
  4. Meibography: non-invasive imaging of the structure of the meibomian glands in the eyelids
  5. A thorough exam of your eyelids, eyelashes, eyelid glands, conjunctiva, and cornea
  6. A treatment plan tailored to you
  7. A follow-up appointment to monitor your progress

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