DRY EYE Management: Raised to a SCIENCE!
DRY EYE Management: Raised to a SCIENCE!
As a world resource to dry eye patients and surgeons alike, Dr. Gulani teaches Dry Eye as a Specific entity with a Specific cause which warrants a Specific treatment.
Using this dedicated methodology, he has successfully helped people suffering from all levels of dry eyes who travel to our institute from all over the world.
He explains that the tear film is actually about 7microns thick and is made up of three layers:
The Innermost, Mucin Layer (produced by the Conjunctival Goblet cells on the surface of the eye) and this layer makes the tear film “Stick” to the eyeball.
The Middle, Aqueous Layer (produced by the Lacrimal glands which are located on the upper and outer side of your eye socket). This is the real Tear Film if you may and contains all of the chemicals and nutrients that are needed for the ocular health and safety.
The Outermost, Lipid layer (produced by the Meibomian glands which are arranged along the eyelid margins vertically in rows like “Tooth Paste Tubes” with their “Mouths” opening at the lid margin close to the eye lashes. This layer actually provides surface tension to the tear film and hence maintains its vertical distribution on the eye despite gravity.
Dr. Gulani classifies Dry eyes at various levels for eye care practitioners based on severity, symptomatology and vision impact.
Essentially though he explains that there are two basic kinds:
I. Quantitative (Decreased Quantity)
1. Decreased production
2. Increased Loss
II. Qualitative (Decreased quality / altered chemical content of either one or all three layers despite good quantity)
Some Pearls:
The tear film is actually dependant on the nerve sensation of the cornea (that is why people have Dry eyes following a certain kind of Lasik surgery where the nerves get cut during surgery) and inflammatory cycles related to allergy, infections etc. It can also be associated with certain diseases like arthritis, hypothyroidism etc.
Finally, the tear film leaves the eye via tear ducts (in each lid) and goes into the nose on a normal basis (remember how some eye drops taste nasty).
The above explanation is Dr. Gulani’s way of simplifying the dry eye concept for all his patients and then he gets to work further investigating the root cause of dry eye and planning an effective treatment regimen.
So lets say someone has a decreased production but good quality of tears, they can have punctual plugs inserted into their tear ducts and thereby “Retain” whatever little tears they produce (a Plumbing issue- Block the drain since the tap is producing less water so the water remains in the sink for a longer time).
This can further be augmented by tear producing eye drops like Restasis.
If the quantity is good but the quality of tears is bad then he addresses the abnormal layer effectively with appropriate eye drops, medications and even techniques.
FIRST in North East Florida:
For example, if the Lipid layer is affected because of the Meibomian glands being blocked by repeated inflammation and allergy, he can actually open these glands with a brief, in-office procedure using a new technology that he has introduced for the First Time in North East Florida.
Using MGD probes, he can actually open the closed mouths of the glands (remember the ones like toothpaste tubes) and allow for free flow of the lipid layer again.
In certain cases based on their seriousness, Dr. Gulani performs “No-Stitch” human placenta surgery, transplants etc.
Thus we can see how approaching the dry eye complaint in a systematic manner can actually make sense of the situation, rule out any associated diseases and effectively plan for a customized solution for each individual eye.