2. One of the main reasons for dry eye symptoms and Meibomian gland dysfunction is a build up of microbial flora on the eye lashes and inside the Meibomian glands. This condition is called blepharitis. If lids are quite inflamed ,red and crusty then proper lid hygiene is crucial as the first step at natural dry eye relief. I recommend scrubbing the lids and lid margins with a commercial preparation like occusoft lid scrub foam. This scrubbing will eliminate much of the bacterial flora on the lashes that can clog the Meibomian glands that secrete the crucial outer layer of the tear film. Often times if a patient has a chronic irritated red-eye even after doing lid scrubs with occusoft they may have another condition causing the problem, Another type of blepharitis is related to a small parasite called demodex. Demodex is a small parasite ( mite)that crawls into the hair follicle at night and lays eggs. These eggs will back up on the base of the lash causing a collarette to be seen by the optometrist or ophthalmologist with the bio microscope. The demodex may cause lids to become red, inflamed, crusty , and itch. It is important to wipe the lashes and lid margins with a special pre medicated pad called cliradex right before bed. Cliradex has the demodex killing properties derived from tea tree oil and is extremely effective for the treatment of demodex related blepharitis and secondary dry eyes. Scrub lashes first with occusoft, rinse then rub the Cliradex onto lashes and lids before bed and do not rinse. This combination of lid hygiene will help to eliminate the microbial flora ( staph and demodex) that is blocking the Meibomian glands and causing the dry eyes. Proper lid hygiene is one of the most important steps in dry eye control and Meibomian gland dysfunction.
3. Meibomian glands often times need a jump-start to help them function to their fullest potential and secrete a healthy tear film. Massaging and heating the lid margins is necessary to unclog the Meibomian glands so these glands can secrete the outer lipid layer of tear film. This needs to be done for 10-15 minutes 2 times a day. The use of a warm wash cloth is an inexpensive way to accomplish this but Dr. Lange recommends using the Bruder Mask to heat up the Meibomian glands. This is a mask that is put in microwave for 20 seconds and then Velcro around your face for 10-15 minutes two times a day. While the mask is on the eyes gently massage the lid margins to help un-block the blocked glands. This mask will also help cut inflammation surrounding the eyes. The Bruder eye hydrating mask can last 5-10 years without being replaced. This mask is only $25 and makes the hot compresses a very simple and relaxing task. 4. The use of good preservative free lubricating eye drops are important to use frequently in beginning phases of natural dry eye treatment. Artificial tears that have some hyaluranic acid for dry eye relief is Dr Langes first choice. Dr Lange recommends either Oasis tears plus or Blink to minimize dry eye symptomatology and both have hyaluronic acid in them . Hyaluaronic acid has some anti inflammatory effects and makes these two lubricating eye drops ideal for dry eyes. For the extreme dry eyes and Meibomian gland dysfunction the addition of a special lubricating eye drop called Retain MGD will add additional subjective relief. Retain MGD helps to replenish the outer lipid layer of tear film that may be deficient in Meibomian gland dysfunction . This combination helps to replenish all layers of the tear film.
5. If these first four steps are followed a large percent of dry eye /Meibomian gland dysfunction patients will improve and become asymptomatic. However there will still be patients that have resistance and will still suffer from this condition. This is when punctal occlusion is recommended. This is done by your optometrist or ophthalmologist in the office in less than five minutes. The doctor will take a small custom sized soft medical silicone implant and place it in your drainage duct in your lower eye lids and sometimes in the ducts in the superior eye lid . This is a painless quick procedure that is covered by your insurance. This blocks the duct that the tears drain out of. This procedure keeps the natural tears on the eye much longer bathing the eye in the natural lubricating properties of the human tear. Punctal occlusion therapy is much more effective after patients have been on anti inflammatory omega 3 fish oil, astaxanthin and GLA for a period of two to three months. The anti inflammatory nutrients reduce the inflammatory markers in the tear film which makes punctal occlusion much more effective. 6. Even after following the first five steps you will have patients with moderate to severe dry eye that still have superficial punctate keratitis and significant symptoms. These patients will usually respond extremely well to new generation stem cell therapies. The Lange Eye Institute and Lange Eye Care Centers are now using a cryopreserved amniotic membrane called Prokera to reduce inflammation and promote regenerative healing of the ocular surface in these significant dry eye cases . Prokera is a safe quick in office procedure similar to placing a contact lens on the eye that improves the health of a damaged ocular surface naturally. Lange Eye Care has had some amazing visual recoveries on patients with long-term eye inflammation and pain using these new stem cell enhanced membranes. Dr Michael Lange and the doctors at The Lange Eye Institute are also using a another membrane calle Aril. This is an A cellular allograft amniotic memrane that can be used in place of the prokera for many patients. Some of the benefits of the Aril is it will not compromise your vision while wearing it for the five day period. If you have a corneal problem causing pain or compromised vision come to one of the Lange Eye Care locations and see if you may be a candidate for some of this new generation stem cell enhanced amniotic membranes. After success of the membrane is accomplished patients should continue the first four steps for maximum long term benefit. Patients with moderate to sever dry eye can get significant improvement with these steps. Dr Michael Lange states if the first four steps above are followed carefully most people with dry eye and Meibomian gland problems will improve. Many people will notice improvements in as little as five days but it will take up to four months to gain the full potential for dry eyes. These first 4 steps will in many cases eliminate the need to have more expensive dry eye procedures done. However there will be a percent of patients that will still have a dry eye issue and will need to go to step 5 and step 6. Steps 5 and 6 are still using a natural approach to solve your dry eye problem. Dr Lange states that step 6 , utilization of stem cell enhanced amniotic membranes for severe dry eye has dramatically enhanced a clinicians ability to help patients suffering with severe dry eyes ! Dry eye kits including everything mentioned above in step 1-4 are available at a discounted price at http://www.fortifeye.com. recommend all readers of this see their local optometrist or ophthalmologist if they have any problems with their eyes. This is for educational purposes only. If you are in the Florida area come by one of the 10 Lange Eye Care locations. http://www.langeeyecare.com , http://www.drmichaellange.com