Dry Eye Specialist


Dry eye disease is a common condition that occurs when your tears aren't able to provide adequate lubrication for your eyes. Tears can be inadequate and unstable for many reasons. For example, dry eyes may occur if you don't produce enough tears or if you produce poor-quality tears. This tear instability leads to inflammation and damage of the eye's surface.

Dry eye disease is known to be multifactorial, with inflammation being a key contributing factor to the vicious dry eye cycle.


A stinging, burning or scratchy sensation in your eyes

Stringy mucus in or around your eyes

Sensitivity to light

Eye redness

A sensation of having something in your eyes

Difficulty wearing contact lenses

Difficulty with nighttime driving

Watery eyes, which is the body's response to the irritation of dry eyes

Blurred vision or eye fatigue

Difficulty wearing contact lenses


Systemic Factors

Autoimmune disease: Rheumatoid arthritis (RA), Lupus, and Sjogren's syndrome (SS).

Autoimmune Conditions and Collagen Vascular Disease


Thyroid-related disorders: Grave’s disease, Hashimoto’s thyroiditis

Sleep disorder: Obstructive sleep apnea

Allergies and asthma

Hormone changes

Graft vs Host Disease

Medication Factors





Hormone Therapy

Oral Contraceptives


Certain pain, cough relievers & many others

Environmental/Anatomical Factors

Reduced/incomplete blink

Prolonged visual tasks

Incomplete lid closure while sleeping

Ceiling fans/air vents/wind exposure

Eyelid deformity/scar

History of ocular surgery or injury

Facial Nerve Palsy

Herpes Zoster/Simplex

Radiation therapy

History of chemical Burn

Extended wear of contact lenses


Dry eye is multifactorial and diagnosis is based on a combination of symptoms and ocular surface evaluation.

Testing includes evaluation of the following:

Staining-Highlights areas of damaged cells due to inflammation

Meibography- Infrared imaging of meibomian glands

Lacrimal Lake Height-quantity and volume of tears

Tear Osmolarity- quality and volume of tears

Lid wiper hygiene and gland expressibility

Tear physiology tests- analyzing natural blink patterns

Tear Breakup time-quality of tears

Inflammation markers- matrix metalloproteinase-9 or decreased lactoferrin


When you blink, a film of tears spreads over the eye. This keeps the eye’s surface smooth and clear. The tear film is important for good vision.

Each layer of the tear film serves a purpose.

The oily layer is the outside of the tear film. It makes the tear surface smooth and keeps tears from drying up too quickly. This layer is made in the eye’s meibomian glands.

The watery layer is the middle of the tear film. It makes up most of what we see as tears. This layer cleans the eye, washing away particles that do not belong in the eye. This layer comes from the lacrimal glands in the eyelids.

The mucus layer is the inner layer of the tear film. This helps spread the watery layer over the eye’s surface, keeping it moist. Without mucus, tears would not stick to the eye. Mucus is made in the conjunctiva. This is the clear tissue covering the white of your eye and inside your eyelids.

What are the treatment options?

Treatment for dry eye usually depends on what’s causing your symptoms. Some of the treatment options include:

Over-the-counter eye. drops. Artificial tears in varying thicknesses can be used to supplement your natural tears.

Lid hygiene and supplements. Lid wipes and supplements can be added to help reduce inflammation.

Prescription medicines. These medications help your eyes make more tears and reduce inflammation. Some of those medications include cyclosporines (Restasis or Cequa) or lifitegrast (Xiidra).

Punctal Plugs. Increases the volume of tears in the tear film.

Gland Expression. Clogged glands cause an unstable tear film.

Blephadex. Procedure that cleans lids and lashes.

Biologic treatments. These therapies use your natural antibodies and growth factors to promote healing.

Surgery. If the thin layer of tissue on the white of your eye is loose, it can cause continuous irritation. Also, the eyelids themselves can be loose and no longer touching the front surface of your eye for protection and wiping fresh tears.

Lifestyle changes. Environmental factors can also play a role in dryness. Some of these modifications include:

Try to avoid smoke, wind, and air conditioning

Use a household humidifier

Limit screen time and take breaks from staring at screens

Wear wraparound sunglasses when you're outside

Drink plenty of water — try for 8 to 10 glasses every day

Get enough sleep — about 7 to 8 hours a night