Ocular Surface Disease is a group of conditions affecting the eyelids, cornea, and tear film including dry eye syndrome, meibomian gland dysfunction, and blepharitis.

DRY EYE SYNDROME

Dry Eye Syndrome is caused by a decrease in production of tears by the lacrimal gland or increased evaporation of tears from the ocular surface. Inflammation plays a role in affecting the glands and tissues of the eye in their ability to produce a normal tear quality. Allergies and screentime can also have an impact.

Over-the-Counter Treatments

  • Artificial Tears
    Supplement natural tear volume with one drop 4x per day in both eyes. Recommendations: Systane, Refresh, iVIZIA, Oasis, Thera Tears, Soothe and Blink. Use preservative-free tears in individual vials if more than 4x/day.

  • Lid Hygiene
    Use diluted Johnson & Johnson Baby Shampoo once daily on the eyelid margin. Alternatives include Ocusoft lid scrubs or Systane lid wipes. Add Hypochlor or Avenova spray.

  • Artificial Tear Gel/Ointments
    Thicker formulations for overnight use. Recommendations: Systane Gel, Refresh Gel, Genteal Severe, Celluvisc, Refresh PM, Systane Nighttime.

  • Allergy Treatment
    Pataday for relief from allergic conjunctivitis symptoms such as dryness, redness, watery eyes, and itching.

  • Modify Your Environment
    Redirect air vents, take breaks from the computer, avoid overhead fans, use a room humidifier, drink more water, and consider moisture goggles when sleeping. Remember to take a 20 second break for every 20 minutes of screen time.

Prescription Treatments

  • Xiidra, Restasis, Cequa, or Vevye
    Prescription eye drop used to treat dry eye disease. It works by reducing inflammation on the surface of the eye, specifically targeting certain proteins involved in the inflammatory response that leads to dry eyes Xiidra and Vevye may take 1 month; Restasis and Cequa may take up to 3 months. 

  • Tyrvaya
    Nasal spray to temporarily increase tear production.

  • Serum Tears
    Eyedrops made from the patient’s own blood, compounded by a specialty pharmacy or eye bank.

Procedural Treatments

  • Punctal Plugs
    Small, biocompatible devices inserted into the tear ducts (puncta) to block tear drainage. By reducing tear outflow, they help retain natural tears on the eye’s surface, alleviating symptoms of dry eye. Punctal plugs can be made of silicone or collagen and may be temporary or semi-permanent, depending on the material used

  • Amniotic Membrane
    Small membranes can be applied as an in-office procedure using a biologically preserved graft or as a bandage contact lens. They contains growth factors, anti-inflammatory proteins, and natural wound-healing properties that aid in repairing the cornea and restoring a healthy tear film.

MEIBMOIAN GLAND DYSFUNCTION (MGD)

MGD is a deficiency in the oil producing glands of the eyelid. It is a common condition where the meibomian glands in the eyelids become blocked or dysfunctional, leading to a lack of oil in the tear film. This causes tears to evaporate too quickly, resulting in dry eyes, irritation, and inflammation. MGD is a leading cause of evaporative dry eye disease.

Over-the-Counter Treatments

  • Warm Compresses
    Use a clean washcloth soaked in warm water or a commercially available mask (Bruder Mask) or make your own mask from dry rice-in-a-sock for. Microwave for around 20 seconds. Place over the eyes for 5 minutes. USB style plug-in masks are also commercially available and often include timers.

  • Omega-3 Supplements
    Beneficial for eyelid oil glands. Options include purified fish oil like Nordic Naturals or Physician Recommended Nutriceuticals (PRN). Newer studies show the benefit of a supplement, Hydroeye (a blend of GLA, omega 3 fatty acids, antioxidants, and other key nutrients) which we carry and sell for our patients. 

Prescription Treatments

  • Xiidra, Restasis, Cequa, or Vevye
    Prescription eye drop used to treat dry eye disease. It works by reducing inflammation on the surface of the eye, specifically targeting certain proteins involved in the inflammatory response that leads to dry eyes Xiidra and Vevye may take 1 month; Restasis and Cequa may take up to 3 months. 

Procedural Treatments

  • TearCare
    In-office procedure to improve the function of the meibomian glands in the eyelids. The TearCare system consists of flexible, adhesive devices that are placed on the patient’s eyelids to gently warm the glands, followed by manual gland expression. The heat helps to liquefy the thickened oils in the glands, and the expression process helps clear the blockages, allowing the glands to function more normally. A recent study found that TearCare was superior to Restasis in improving tear break-up time (TBUT) and meibomian gland secretion.

BLEPHARITIS

Blepharitis is a chronic inflammation of the eyelids, often caused by bacteria, oil gland dysfunction, or Demodex mites. It leads to symptoms like redness, swelling, crusting at the base of the eyelashes, irritation, and sometimes dry eyes. Blepharitis is a common condition that requires regular eyelid hygiene to manage.

Over-the-Counter Treatments

  • Lid Scrubs
    Daily lid scrubs help to remove debris, oil, and dead skin cells from the base of the eyelashes, preventing bacterial buildup and reducing inflammation. Use a pre-moistened eyelid wipe (e.g., Ocusoft, Systane lid wipes) or a gentle cleanser. Alternatively, use diluted baby shampoo (one part baby shampoo to 10 parts warm water) on a clean cotton pad or cotton swab. Gently scrub the base of the eyelashes and along the eyelid margins, focusing on areas with crusting or debris. Rinse thoroughly with warm water afterward.

  • Lid Sprays
    Antimicrobial solutions like hypochlorous acid sprays (e.g., Avenova, Hypochlor) help to reduce bacteria on the lids. Use once or twice daily

Prescription

  • Xdemvy
    Prescribed eye drops twice daily for 6 weeks to kill Demodex mites, which can cause inflammation in the lid margin.

  • Antibiotics
    Topical drops, eyelid ointments, and oral antibiotics are sometimes necessary to treat bacterial overgrowth in the lid margin. These can be pulsed for several days, or used chronically like in the case for low-dose oral Doxycycline.

This article was originally written on 5/29/2023 by Angelique Pillar, MD and updated 9/15/24