Dry Eye Care

Expert Dry Eye Diagnosis & Treatment in Chattanooga

senior woman having her eye inspected by opthalmologistExperiencing chronic dry eyes can have a significant impact on your comfort and your quality of life. At Pomerance Eye Center, PC, we understand the complexity of this condition and provide precise diagnosis and treatment.

Our office is located on Gunbarrel Road near the Erlanger East Hospital. We offer advanced diagnosis and treatment of dry eye to our Chattanooga, Southeast Tennessee, Northwest Georgia, and Northeast Alabama communities. Call our friendly and experienced team to schedule your consultation today!


What Causes Dry Eye?

Natural tears bathe the surface of the eye to wash away dust and debris and provide moisture. A balanced tear film layer is essential to maintaining optimal function and keep your eyes healthy. Tears contain three critical components: oily (lipids), watery (aqueous), and mucous-like (mucin).

close up of human eyeEach plays a vital role in maintaining lubrication, preventing evaporation, and providing nutrition for the cornea. There are two types of dry eye conditions corresponding to abnormality of the various component of the tear film.

  • Evaporative Dry Eye - not enough oil
  • Aqueous Deficiency Dry Eye – not enough water
  • Mixed Dry Eye – not enough water and oil

Often, defective tear glands are thought of as causing dry eye. Actually, the tear glands, also called lacrimal glands, located above the eye in the upper outer part of the orbit, are primarily responsible for reflex tearing, such as that occurring when the eye is suddenly irritated. The baseline tears don't come from the lacrimal glands but rather from both the eyelid (the mucinous oily component produced by the meibomian glands) and the surface of the eye itself (the aqueous component produced by the goblet cells of the conjunctiva or clear covering over the white of the eye).

Most cases of dry eye are related to dysfunction of the meibomian glands (located in both the upper and lower eyelid where the oily lipids are produced). These glands can become clogged or stop working correctly, resulting in a highly evaporative tear loss. This condition is more prominent among seniors, especially women.

Dry eye can also be caused by chronic bacterial or inflammatory disease of the eyelids called blepharitis. The association between blepharitis and dry eye cannot be understated. Treatment is often directed at both simultaneously.

If you have diabetes, autoimmune conditions, thyroid disease, allergies, exposure to environmental or occupational stressors, or use certain medications, the risk for developing dry eye increases. You can temporarily suffer from dry eye after having LASIK surgery. Certain over-the-counter and prescribed medications can cause dry eyes, so you must inform our ophthalmologists which ones you are taking.

Symptoms of Dry Eye

It is critical to see our ophthalmologists if you experience any symptoms to help you avoid more severe forms of the disease. Indications you may be experiencing dry eye include:

  • Irritated or scratchy eyes
  • Burning or stinging
  • Excessive tearing when reading or driving
  • Problems wearing contact lenses
  • Blurred or decreased vision
  • Stringy mucus around or in the eyes
  • Sensitivity to light
  • Fatigued or heavy eyes

What makes dry eye so aggravating is the inflammation it causes. Lack of lubrication causes friction, heat, and discomfort. If not addressed, permanent damage to the ocular surface's delicate structures can occur in late stages. In dry eye, certain inflammatory chemicals secreted by those with dry eyes increase the potential for damage and discomfort. Treatment is often directed at suppressing these modulators.

Types of Treatments for Dry Eye

At Pomerance Eye Center, PC, we will start with a complete and thorough exam and diagnosis. Although a cure for dry eyes is elusive, treatment can afford relief and improve function. Many treatments have been tried – here are a few:

Artificial Tears: The main therapy for dry eye is, of course, tear replacement therapy. Although called artificial tears, they are not replicas of the natural tear but rather substitutes. The purpose of these is to increase the fluid on the ocular surface, thereby reducing the friction. Ingredients often provide some stabilization of the tear film to inhibit evaporation. We specifically recommend a brand of tear replacement containing glycerin from flaxseed oil. This product lingers longer on the surface of the eye, prolonging its beneficial effect. Lacrisert®, a small lubrication-infused device, can be placed between the lower eyelid and the eye itself to provide continuous lubrication. Some people, due to laxity in the eyelid musculature, have trouble retaining Lacrisert. They are tiny and somewhat difficult to handle.

Anti-Inflammatory Medications: We can also provide prescriptions for anti-inflammatory medications such as Restasis®, Xiidra®, Cequa, and steroids. These will suppress the inflammatory reaction caused by chronic dry eye. These are especially useful in the early stages of corneal breakdown. Although covered by many insurance plans, there are notable lapses in coverage, making some out of reach for many patients.

Punctal Plugs: A punctual plug is a small device inserted into the tear duct(s) to prevent tears from draining too quickly from the eye. These were developed before extensive knowledge of tear physiology was known. The plug allows the tear film to remain in place on the surface of the eye longer and was supposed to eliminate symptoms. However, allowing defective tears laden with inflammatory modulators to stay on the eye longer was soon found to be counter-productive in some people. Infections resulted, and symptoms sometimes worsened, so these have fallen out of favor except in certain circumstances.

LipiFlow® Thermal Pulsation System: This treatment, and others like it, aim at thinning the oily component of the tear. An automated system, LipiFlow warms the oils to their anticipated melting point, followed by expression of the oils by compression of the glands. Only somewhat effective, the equipment for this procedure is expensive, and treatment is costly for the patient. We decided not to offer this therapy.

BlephEx®: Using this handheld device, exfoliation of the eyelid at the lash line to remove debris and bacteria that can contribute to dry eyes is performed. The procedure is not painful and can be completed in 10 minutes or less. Its purpose is to remove the "biofilm" of inflammatory products physically. Unfortunately, the biofilm will recur, so this is, at best, a temporary measure and is ineffective over time when used alone. We do not offer this treatment due to its limited effectiveness.

Intense Pulsed Light treatment (ILP): Visible light and infrared therapy liquify hardened oils that are clogging the Meibomian openings. IPL has a variable effect and often requires other modalities to achieve a successful resolution of symptoms.

LLLT (Low Level Light Therapy): Bio-modulation therapy is the newest treatment for dry eye associated with eyelid infection/irritation. Low-level light has been found to change the function of the mitochondria in inflammatory cells. Mitochondria are the controllers of metabolism in the cell. LLLT appears to re-regulate the mitochondria to suppress blepharitis and associated dry eye effectively.

Amniotic Membranes (AMG): If the surface of the eye becomes damaged due to excessive inflammation, Amniotic membranes, configured like a contact lens, can be placed in the eye. A bandage contact lens is often used to hold AMGs in place. They contain a rich supply of natural growth hormones and anti-inflammatories that promote healing of the ocular surface. The membrane effectively sacrifices itself to permit the repair of the cornea. There is short-term interference with the vision, but these afford tremendous relief for those with severe disease.

Autologous Tears: The human body has its own defense and healing properties. If there is intense dry eye, a small quantity of the patient's blood can be separated into its component parts in a laboratory. The serum, containing concentrated reparative proteins, antibodies, and enzymes, can be formulated to create a tear substitute. Although the product cannot be stored for a long time, autologous tears have been helpful to many with severe dry eye.

These treatments and therapies are just some ways to eliminate the symptoms of dry eye and encourage healing. Our objective is to find the cause of the problem and match it to the most effective therapy.

Advanced Dry Eye Care in Chattanooga

woman pointing at her eyeAt Pomerance Eye Center, PC, you will benefit from the latest technology and advanced treatment options for dry eye and other vision problems. One-on-one consultations with our recognized leaders in ophthalmology provide you with personalized care and confidence in your treatment.

If you are one of the many who suffer from debilitating symptoms related to dry eyes, you can count on Dr. Glenn N. Pomerance and our skilled team. We are dedicated to promoting optimal vision health with premium dry eye diagnosis and treatment in Chattanooga. Call today to schedule your appointment!


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