Dry Eye Clinic – Dry Eye Treatment in Mumbai






What is dry eye?

Normally, the eye constantly bathes itself in tears. The tears lubricate the eye, maintain nutrition, and provide oxygen to eye structures, acts as a refractive component, and helps remove debris from the surface of the eye.

Dry eye is an extremely common condition, which affects most people at some stage in their lives. Dry eye is a disorder of the tear film which occurs due to tear deficiency or excessive tear evaporation; it causes damage to the surface of the eye and is associated with a variety of symptoms reflecting ocular discomfort.

Dry eye symptoms may be a manifestation of a systemic disease, therefore timely detection may lead to recognition of a systemic disorder. Additionally, patients with dry eyes are prone to potentially blinding infections, and also at an increased risk of complications following common procedures such as laser refractive surgery.


What are the symptoms of dry eye?

The usual symptoms include

  • Stinging or burning eyes,
  • Scratchiness,
  • Stringy mucus in or around the eyes,
  • Excessive eye irritation from smoke or wind,
  • Blurred vision,
  • Eye pain,
  • Eye fatigue,
  • Sensitivity to light,
  • Excessive tearing, and
  • Discomfort when wearing contact lenses.
Dry Eye

Excessive tearing from “dry eye” may sound illogical, but is actually the eye’s response to discomfort. If the tears responsible for maintaining lubrication do not keep the eye wet enough, the eye becomes irritated. Eye irritation prompts the gland that makes tears (called the lacrimal glands) to release a large volume of tears, overwhelming the tear drainage system. These excess tears then overflow from your eye.


What is the tear film?

What Is The Tear Film

When you blink, a film of tears spreads over the eye making the surface of the eye smooth and clear. Without this tear film, clear vision would not be possible. The tear film consists of three layers:

The tear film consists of three layers:

  • An oily layer
  • A watery layer
  • A layer of mucus

The oily layer, produced by the meibomian glands (oil glands), forms the outermost surface of the tear film. Its main purpose is to smoothen the tear surface and reduce the evaporation of tears. The middle watery layer makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal glands in the eyelids, cleans the eye and washes away foreign particles or irritants.
The inner layer consists of mucus produced by the conjunctiva. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain moist. Without the mucus, tears would not stick to the eye.


What causes dry eye?

Dry eye may develop due to

  • Inflammatory disease, such as allergies, autoimmune diseases such as Rheumatoid Arthritis, Sjogren’s syndrome,
  • Environmental conditions such as allergens, cigarette smoke, dry climate, high temperature, air pollution), excessive computer use,
  • Hormonal imbalance, such as perimenopausal and post-menopausal women and patients under hormone replacement therapy,
  • Contact lens wear.,
  • Systemic disorders, such as diabetes mellitus, deficiency of vitamin D, vitamin A and thyroid disease
  • Many systemic medications, such as diuretics, antihistamines, antidepressants, psychotropics, cholesterol lowering agents, beta-blockers and oral contraceptives
Causes of Dry Eye


How is dry eye diagnosed?

As dry eyes may be associated with a variety of causes, it is important to perform a comprehensive evaluation before proceeding to treatment. At Arohi Eye Hospital, a systematic stepwise examination leads to the diagnosis of dry eyes, and the severity of it.


  • Thorough History: A careful and thorough history is obtained with particular attention to diabetes, thyroid disease, connective tissue disorders, contact lens wear, previous ocular surgery, and relevant drug history. Taking a thorough history helps us to identify when and how your dry eye started. It may also help us to reach the diagnosis.
  • Ocular Surface Disease Index (OSDI) questionnaire: This questionnaire is used in assessing patients with dry eye symptoms which helps to quantify the symptoms and eradicate the severity of the disease.
  • Slit Lamp Examination: A careful slit-lamp biomicroscopic examination (a high magnification microscopic examination) is done to look for any abnormalities in the front part of the eye. This is where we look at the ocular surface and diagnose meibomian gland dysfunction, blepharitis, or any other lid abnormalities.
  • Break-up time test (TBUT): Tear film stability can be assessed with the fluorescein tear break-up time test (TBUT). TBUT less than 17 seconds is indicative of evaporative dry eye.
  • Schirmer test: Another clinical method for assessing the severity of dry eye is ocular surface dye staining and the Schirmer test. Schirmer test measures aqueous tear (the watery part of the eye) production. It involves placing filter-paper strips under the lower eyelid to measure the rate of tear production
  • Meibography: This is a no-touch, fast infrared imaging to see whether the meibomian glands (structure producing an oily layer of tear film) are structurally normal, dilated, shortened, or atrophied. With this advanced testing, we can also grade the level of meibomian gland dysfunction


How is dry eye treated?

After the diagnosis of dry eye disease, the best treatment for the patient must be selected based on the grade of the disease.

A. Level 1 Treatment: The treatment mostly includes the following:

  • A.Lifestyle changes:
    1. Avoid dusty and smoky environment, adopt humidification of room
    2. Actively blink using the 20-20-20 rule
    3. Avoid smoking
    4. Have Omega 3 fatty acid supplementation from foods such as oily fishes (salmon, sardines, and anchovies) and flax seeds
    5. Have Calcium and Vit A rich diet
    6. Reduce contact lens usage
    7. Keep your eyelids clean
    8. Remove your eye makeup thoroughly at the end of the day
    9. Use good quality shades and sunglasses
  • Clinical Treatment:
    1. Avoid offending medication if any
    2. Treat systemic disorders
    3. Use lubricating agents or artificial tears substitutes in the form of drops and ointment called artificial tears, which are similar to your own tears. They lubricate the eyes and help maintain moisture. Artificial tears are available without a prescription. There are many brands in the market, so your doctor may suggest the one that suits you best.
    4. Use preservative-free eye drops for people who are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands are recommended. You can use artificial tears as often as necessary-once or twice a day or as often as several times an hour. Some people with dry eyes complain of scratchy eyes when they wake up. This symptom can be treated by using an artificial tear ointment or thick eye drops at bedtime.
    5. Take mild steroids eye drops or cyclosporine eye drops medications as prescribed by your specialist doctor

B. Level 2 Treatment: Level 2 disease requires the lifestyle changes of Level 1 and the following:

  • Oral Steroids or Oral Immunosuppressants
  • Oral treatment for Meimbomitis with Antibiotics, Omega 3 fatty acids, Vitamin D & Calcium supplementation
  • Autologous Serum
  • Topical Acetylcysteine
  • Therapeutic contact lenses
  • Meibomian gland expression: Gentle heat is applied to closed eyelids before expression to open the oil-secreting glands. Then each gland is gently squeezed to express the blocked material. After the treatment, you may be given some medical treatment and home exercises to keep the oil glands functioning well.
  • Punctal Plugs: Conserving your eye’s own tears is another approach to keeping the eyes moist. Tears drain out of the eye through a small channel into the nose (which is why your nose runs when you cry). Your ophthalmologist may close these channels either temporarily or permanently. The closure conserves your own tears and makes artificial tears last longer.
  • E-Eye: This device generates polychromatic pulsed light using new technology IRPL (Intense Regulated Pulsed Light) to treat dry eyes. Non-invasive, fast, accurate, and totally painless procedure. It delivers very short and specific flashes of cold light to stimulate meibomian gland function in complete safety. In response to this stimulation, the oil glands resume normal secretion. The effects achieved appear very rapidly after each session and their persistence over time increases with the number of sessions conducted.

C. Level 3 Treatment: The various surgical options available in the Level 3 treatment are the following:

  • Permanent punctual occlusion
  • Amniotic Membrane Transplantation
  • Tarsorraphy
  • Surgical management of lid abnormalities

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