Dry Eye Treatment in Fresno

Dry eye happens when your tears can't keep the surface of the eye healthy, either because you don't make enough of them or because they evaporate too quickly. It's one of the most common reasons people see an eye doctor, and with the Central Valley's heat, dry air, dust and wildfire smoke, it's a major issue here.

Over-the-counter drops help for a while, but lasting relief means finding the cause. We start with a thorough dry eye evaluation, including meibography, tear film analysis and osmolarity testing, and then build a treatment plan around what we find.

Symptoms

• burning, stinging, or a gritty, sandy feeling
• red, tired eyes
• blurry vision that clears when you blink
• sensitivity to light
• trouble wearing contact lenses
• watery eyes, surprisingly often (see below)
• eyes that feel worse at a screen, while reading or driving, or in wind or air conditioning

Causes

• Blocked oil glands. Glands along the edges of your eyelids make the oil that keeps tears from evaporating. When they're clogged or inflamed, a condition called meibomian gland dysfunction, tears evaporate too fast. It's the most common cause of dry eye.
• Age and hormones. Tear production drops with age, and dry eye is more common in women, especially after menopause.
• Screens. We blink much less when we concentrate on a screen.
• Surroundings. Heat, low humidity, wind, dust, smoke and air conditioning.
• Medicines, including antihistamines, decongestants, and some blood pressure medicines and antidepressants.
• Health conditions such as Sjögren's syndrome, rheumatoid arthritis, lupus, diabetes and thyroid disease.
• Contact lenses and eye surgery, including LASIK, which can cause dryness for a while.
• Eyelid problems, such as blepharitis, or lids that don't close fully.

Our dry eye evaluation

• Meibography photographs the oil glands inside your eyelids, to see whether they're blocked or have shrunk.
• Tear film analysis looks at how much tear you make and how quickly it breaks up.
• Osmolarity testing measures how salty your tears are. A high reading is a sign of dry eye, and the number helps track how well treatment is working.
• A close look at your eyelids, your cornea and the surface of your eye, using dyes that highlight dry spots.

Treatment

Most people do best with a combination of treatments, and it can take a few weeks to feel the full effect.

At home

• preservative-free artificial tears, used regularly rather than only when your eyes hurt
• warm compresses and eyelid cleaning, to open blocked oil glands
• blinking breaks during screen time: every 20 minutes, look at something 20 feet away for 20 seconds
• a humidifier, and keeping fans and car vents from blowing at your face
• wraparound sunglasses outdoors, especially in wind

In the office

• Prescription anti-inflammatory drops, such as cyclosporine or lifitegrast, which help your eyes make healthier tears.
• Punctal plugs: tiny plugs placed in the tear drains of your eyelids, so your own tears stay on the eye longer. Putting them in takes a few minutes, in the office.
• Amniotic membranes: a thin, natural tissue placed on the eye like a contact lens, which helps a damaged eye surface heal. They're used for more severe dry eye.
• Treating the eyelids for blepharitis and blocked oil glands.

Dry eye questions

Why do my eyes water if they're dry?

When the surface of the eye is irritated, it sets off reflex tearing. Those watery tears don't have the right balance of oil and mucus to stay on the eye, so they run off without fixing the dryness.

Are over-the-counter eye drops OK?

Artificial tears are fine. If you use them more than four times a day, choose preservative-free ones. Be careful with drops that promise to take the red out: used often, they can make redness worse.

Is dry eye serious?

Mild dry eye is mostly uncomfortable. Severe dry eye that isn't treated can damage the cornea and affect your vision, so it's worth getting checked if drops aren't helping. Why your eye might hurt when you blink.

Can I have LASIK if I have dry eye?

Often, once the dry eye is treated. LASIK can make dryness worse for a while, so we check for dry eye at every LASIK consultation. LASIK with dry eyes.