Procedures and Devices for Chronic Dry Eye

Reviewed by: HU Medical Review Board

Dry eye disease is complex and can be challenging to treat. Various devices and procedures may help treat the symptoms of dry eye. Understanding the importance of your tears, parts of the eye, and ways chronic dry eye is sometimes managed will help you know more about the treatment options you may have.

What is the tear film?

Every time you blink, your eyes are coated with a thin layer of tears. This layer of tears is known as a tear film. This film has 3 layers, all with different functions:1

  • Oily (lipid) layer – This is the outside layer of the tear film. This layer helps to keep the tears from drying out too quickly. This layer is made by the meibomian glands, which are located at the edges of your eyelid.
  • Watery (aqueous) layer – This is a watery layer that makes up most of what we see as tears. Its purpose is to clean, protect, and lubricate the eye.
  • Mucus (mucin) layer – This is the inner layer of the tear film. This layer helps to spread the watery layer evenly over the eye surface. This layer is made up of mucin, a protein secreted by goblet cells. It helps keep the eyes moist and free from particles. Without this layer, the tears could not properly coat the eye.

Meibomian gland dysfunction

Under normal conditions, your eye and tear film are in balance. The balance of oil, water, and mucus from the tear film protects and lubricates your eye. When something throws off this balance, dry eye can occur.2

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Meibomian gland dysfunction (MGD) condition where the glands are not secreting enough oil or when the oil they secrete is of poor quality. MGD causes the tears to dry out too quickly and can lead to chronic dry eye.3

Intense pulsed light therapy

Some devices or procedures offer drug-free symptom relief for MGD. Intense pulsed light therapy (IPL) is a procedure that can be performed to treat MGD. IPL uses light energy to warm the meibomian glands, helping to express the oil from the glands.4,5

Tiny blood vessels in the eye may become red and irritated due to chronic dry eye. IPL therapy helps to destroy the vessels that cause irritation. This can decrease overall inflammation. IPL also improves the function of cells on the surface of the eye and balances the number of particles found in the tear film. Some IPL devices include:5

  • OptiLight

Devices and procedures for MGD

Other procedures apply heat and pressure to the eyelids to help with oil flow to improve dry eye symptoms. Some of these devices or techniques include:5-8

  • LipiFlow®
  • MiBo Thermoflo
  • TearCare® system

These are not all the devices and procedures available for managing dry eyes due to MGD. Talk to your doctor about your treatment options.

Additional procedures for chronic dry eye

Tear conservation procedures may be another option for treating chronic dry eye. These procedures save your natural tears.

Punctal occlusion is considered a minor surgical procedure and can be performed in a doctor’s office. This procedure involves “blocking” the duct that drains your tears, either by inserting plugs or using cautery. Cautery is a procedure that uses heat to close off part of the system that normally drains tears. If you need this procedure, your doctor will make sure to use drugs that help decrease any discomfort.9,10

Meibomian gland expression may help those with MGD. Your doctor will apply anesthetic (numbing) eye drops, then use special instruments to apply pressure to the meibomian glands. This may help with oil flow from the glands, relieving dry eye linked to MGD.11

Talk to your doctor about your treatment choices. Some devices and procedures may not be right for you.

Before beginning treatment for chronic dry eye, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.