A dry eye center, how we diagnose the cause of your symptoms

Dry eye can have a variety of causes, which impacts how it is treated. In diagnosing dry eye, determining the cause is vital.

A dry eye center, how we diagnose the cause of your symptoms in Olympia

Dr. Levi Zurcher cartoon

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American Family Vision Clinic

Determining the cause of your dry eye symptoms is as important as diagnosing the problem’s existence in the first place. At our dry eye center, we consider this our primary task when patients come in seeking help for their dry eye.

Diagnosis Procedures

The first step in the diagnosis process is speaking with our doctor. The doctor will ask you about your symptoms, and how severe they are. You may also be asked to fill out a questionnaire, to provide additional information about the symptoms you are experiencing, to help the doctor better understand your situation and determine what course of treatment to pursue.
However, some things, like the cause of your dry eye, are difficult to determine without proper diagnostic techniques.
There are several types of tests you can expect.

Comprehensive Eye Exam

A comprehensive eye exam is far more than just reading a vision chart. It includes a full examination of your eye health and health overall, including any past issues which may be related to eye health.

Diagnosis Procedures
Tear Volume Tests

Tear Volume Tests

If you aren’t producing enough tears, that can cause dry eye, and help the doctor narrow down the list of possible causes. There are a couple of different tests designed for this purpose, such as the Schirmer test, in which strips of paper are placed under your eyelid to measure tear production, and the phenol red test, in which a thread with pH-sensitive dye (which will change color when exposed to tears) is placed over the lower eyelid and wetted with tears for a short period to check tear volume.

Tear Volume Tests

Tear Quality Tests

Dry eye can also be caused by a problem with the quality of your tears. These problems typically mean that your dry eye is caused by a different problem compared to those who have dry eye due to low tear production. There are tests to check this, such as the osmolarity test, which measures the composition of your tears.

Ocular Health Tests

The doctor may also perform a test, such as a stain test using specialized dyes to check for damage to the surface of the eye, which can be causing dry eye through irritation due to the damage. Seeing how quickly the tears evaporate can also provide additional information on the nature of your dry eye

Meibomian Gland Evaluation

Meibomian gland dysfunction is another common cause of dry eye, as it causes disruption in the production and secretion of oil that is a key component of the tear film. The doctor can physically check for signs of a problem using advanced imaging to scan the meibomian glands.

Diagnosis Procedures
Tear Volume Tests

What Comes Next?

Following the diagnostic tests and discussion with you, the doctor should have a good idea of what the cause of your dry eye is, and will be able to recommend to you a treatment plan specifically tailored to your unique situation.

Common Questions

Normally we have tear ducts located in the inner corners of our eyes that help to drain our tears out of the eye into the nose; but if your tear drainage system is blocked (lacrimal stenosis) and/or not functioning properly it may cause overly watery eyes (epiphora). Additionally, if you’re experiencing excessive tearing, this may sound counter-intuitive, but it may mean that your eyes are dry. When our eyes are dry, they feel irritated and uncomfortable, which stimulates the lacrimal gland to produce so many tears that this then overwhelms the eye’s natural drainage system, causing our tears to roll down our face instead of through our tear ducts. Allergies, and irritants can also cause excessive tearing. Infections can also cause overly watery eyes because part of your body’s response to an eye infection is to produce excess tears in order to keep the eye lubricated and wash away any germs or discharge.
There are ways to alter your environment in order to prevent dry eyes. For instance, avoid air blowing in your eyes such as a fan, air conditioner, hair dryers, or car heaters. Also consider adding a humidifier to add moisture to dry indoor air, which is especially useful when the heaters are on in the winter. Also, when you go outside the wind and dry air can cause your eyes to tear and be dry, so to prevent this and to protect your eyes it’s important to wear sunglasses or other protective eyewear when you go outside. Furthermore, if you are working with your digital device it’s important to take breaks and follow the 20/20/20 rule, which is every 20 minutes look 20 feet away for 20 seconds. Additionally, sometimes your eye doctor may notice early signs of dry eyes before you experience symptoms, so you can prophylactically treat dry eyes by applying warm compresses over your eyes and doing lid massage, as well as using artificial tears to keep the front surface of your eyes lubricated.
When you have dry eyes this sends out a signal to your lacrimal gland to produce more tears, but then this results in an overproduction of tears causing tearing/watery eyes. The overproduction of tears is called reflex tearing. Your body is trying to counteract your dry eyes, so it then starts to produce more tears, but then it ends up flooding your eyes with too much tears, resulting in a vicious cycle of dry and then teary eyes. That is why it’s important to deal with the root of the cause of the tearing, which is your dry eyes, to stop this sequence of events from happening. But it’s important to also note that watery eyes can be caused by other conditions as well, so be sure to get a thorough evaluation by your eye doctor to determine the proper diagnosis and treatment.
Typically first your eye doctor would take a thorough case history reviewing your symptoms and the severity of the symptoms. (Some symptoms of dry eyes include burning, itching, excessive tearing, gritty/foreign body sensation, eye discomfort, inflammation, or blurry vision.) Your eye doctor will also review your medical history, any medications you’re taking, your day to day activities, as these can all contribute to dry eyes as well. Then a thorough dry eye evaluation will be conducted. Your eye doctor will look at your eyes under a microscope where they will assess your meibomian glands on your upper and lower lid margin. To get a better image of the inside of your meibomian/oil glands your doctor may also take an image of them using a Lipiscan/Meibography. If any of your oil glands are capped, truncated or atrophied this may indicate you have dry eyes. Also your tear layer will be assessed, typically a sodium fluorescein dye would be used. Here we can examine your tear break up time (TBUT), tear meniscus height, and blink rate. Various other tests can be used to detect dry eyes such as Lissamine green and Rose Bengal dye, Schirmer test 1 and 2, and Phenol red thread test. For the Schirmer Test your eye doctor will place a strip of medical paper inside of your lower eyelids, and the paper will then absorb your tears, which will show us the amount of tears you have. For the phenol red test it’s the same concept as the Schirmer test but instead a thin red thread string is placed inside your lower eyelids to determine the volume of your tears. If any of these values are below normal this can also help us detect dry eyes.
There are various treatments used to help people who suffer from dry eyes. The type of treatment depends on the severity and type of dry eyes (aqueous or evaporative). One treatment option is to apply warm compresses 2x a day for 10 minutes over your eyes with lid massage and lid scrubs. Also using over the counter artificial tears 2-4x a day can reduce your dryness. If your dry eyes are more severe, you can also add a gel drop or ointment at night, and/or add prescription eye drops for dry eyes, such as Restasis or Xiidra. Dry eye is a multifactorial disease of the ocular surface, and one component that causes dry eyes is ocular surface inflammation and damage; so Xiidra and Restasis work by regulating the inflammatory processes in the eye that can affect tear production. Another treatment for dry eyes is to have your eye doctor insert punctal plugs in the inner corners of your eyes, which partially closes one of your tear ducts to allow your tears to stay longer on the front surface of your eyes and keep your eyes lubricated. There are also other in-office devices such as LipiFlow, iLUX, TearCare, Intense Pulsed Light, or Blephex that your eye doctor can use to treat your symptoms of dryness. Furthermore, changing your environment can also help reduce your dry eyes, such as adding a humidifier to your room or taking frequent breaks from your digital devices.
Dry eyes can be detected by your eye doctor first reviewing your symptoms and the severity. Some symptoms of dry eyes include burning, itching, excessive tearing, gritty/foreign body sensation, eye discomfort, inflammation, or blurry vision. Then a thorough dry eye evaluation will be conducted. Your doctor will look at your eyes under a microscope where they will assess your meibomian glands on your upper and lower lid margin. To get a better image of the inside of your meibomian/oil glands your doctor may also take an image of them using a Lipiscan/Meibography. If any of your oil glands are capped, truncated or atrophied this may indicate you have dry eyes. Also your tear layer will be assessed, typically a sodium fluorescein dye would be used. Here we can examine your tear break up time (TBUT), tear meniscus height, and blink rate. Various other tests can be used to detect dry eyes such as Lissamine green and Rose Bengal dye, Schirmer test 1 and 2, and Phenol red test. For the Schirmer Test your eye doctor will place a strip of medical paper inside of your lower eyelids, and the paper will then absorb your tears, which will show us the amount of tears you have. For the phenol red test it’s the same concept as the Schirmer test but instead a thin red thread string is placed inside your lower eyelids to determine the volume of your tears. If any of these values are below normal this can also help us detect dry eyes.
You may have dry eyes if your eyes are feeling gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or if you’re experiencing light sensitivity. Dry eyes can also cause blurred vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up after going in and out of focus due to an unstable ocular surface caused by dry eyes.
If you’re experiencing any symptoms of dry eyes you should see your optometrist to get a thorough dry eye evaluation to determine the severity of your dry eyes and then have the proper course of treatment. Some symptoms of dry eyes are if your eyes feel gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or you may experience light sensitivity. Other symptoms may include blurry vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up, after going in and out of focus, due to an unstable ocular surface. Since symptoms of dry eyes can also be similar to symptoms caused by other eye conditions, it’s best to not just take care of the problem by yourself, and it’s important to visit your eye doctor so that you can get the proper diagnosis and treatment. Additionally, there are instances when sometimes signs of dry eyes can be detected by your eye doctor before you even experience any symptoms. So, in that case your eye doctor may also provide some sort of treatment to prevent you from starting to feel symptoms of dry eyes in the future. Thus, if you don’t experience any symptoms of dry eyes it is still important to get your eyes examined at least once per year.
Dr. Zurcher cartoon

Summary

We have several methods through which to diagnose the causes of your dry eye, and through careful checks, we will be able to use that information to best help you get started with treatment. If you have additional questions, or wish to schedule an appointment for us to determine the nature of your dry eye, you can contact American Family Vision Clinic at (360) 491-2121.

 

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