Dry Eye Service

Dry eye is a common chronic disease that can range from mild to seriously debilitating. It arises when a patient either doesn’t produce enough tears, or more commonly, doesn’t produce tears of the quality needed to keep their eyes lubricated. 

Up to 50 per cent of Canadians suffer from dry eye disease. This number is rising as the population ages, since dry eye is more common in middle-aged and older people. However, younger people – even children – can also suffer from dry eye. Digital screen use has been associated with an increase in symptomatic dry eye disease in younger patients.

Certain medical conditions, such as Sjögren's syndrome, autoimmune diseases, diabetes, rosacea and many more, can make a person more likely to suffer from moderate or advanced stages of dry eye disease. 

Learn more about dry eye

While an optometrist may be able to diagnose dry eye through a regular comprehensive eye exam, higher-tech methods are useful to assess patients with moderate to severe dry eye.

Specialized dry eye testing can help to provide precise data from the ocular surface. This specialized dry eye testing is at an extra cost, but it can help your optometrist stage dry eye disease more accurately and help to develop personalized treatment plans as well as track progress over time.

Dry eye testing available at the Waterloo Eye Institute

Tear film and ocular surface evaluation

• Tear osmolarity testing – Measures tear film stability. Tear osmolarity is a measure of how much salt is in your tears. A high salt content indicates dry eye disease.

• Non-invasive tear break-up time testing – Assesses tear film evaporation rate and tear film instability.

• Meibography – High-resolution imaging to evaluate meibomian gland dropout and dysfunction. Meibomian glands produce the oil that makes up an important part of tears, preventing them from drying too quickly.

Advanced corneal and conjunctival imaging

• Tear meniscus height measurement – Evaluates tear reservoir capacity.
• Anterion – Provides high-resolution imaging of abnormalities in the corneal epithelium (the layer of cells that protects the very front of the eye) and conjunctiva (the mucus membrane that covers the white of the eye and the inside of the eyelid).
• Corneal topography – Imaging that maps the cornea (the clear structure that domes over the iris and pupil) in 3D.

If your dry eye is mild, treatment is likely to start with eyelid hygiene, including hot compresses, lid cleaning and over-the-counter artificial tears.

For people with moderate to severe dry eye, our Dry Eye Service offers a range of treatment options unusual in Canada due to our suite of state-of-the-art equipment. Treatments may include:

Personalized at-home treatment plans

A thorough assessment will help the optometrist and patient to develop a tailored at-home treatment plan that might include:

• Environment adjustments and nutritional supplementation
• Eyelid cleaners and artificial tear drops
• Short-term or long-term dry eye pharmaceutical treatments  (e.g. topical steroid, topical cyclosporine, oral doxycycline, Xiidra)
• Plasma-based artificial tears (autologous serum)
• Moisture chamber glasses (available through the Optical Dispensary, these eyeglasses cup over your eyes to keep moisture in and wind out.)

In-office treatments

• Meibomian gland expression – Unclogging the oil-producing meibomian glands in your eyelids. Can be manual or instrument-assisted (after warming).

• Intense pulsed light (IPL) therapy – Reduces inflammation and improves oil flow in tears.

• Thermal pulsation treatment (iLux) – Heat and massage to unblock meibomian glands.

• Blepharoexfoliation – Manually removing biofilm and debris from eyelid margins using ZEST (Zocular Eyelid System Treatment), an antimicrobial, anti-inflammatory gel cleaner.

• Punctal Plugs – Increase tear retention by blocking drainage of the tear film.

• Scleral Lenses – Hydrate the cornea for severe dry eye cases.

• Amniotic membrane insertion – Sterilized and processed amniotic membrane is used for repairing ocular tissue.

We can also provide coordination for surgical procedures when required.