Basics - dry eye
The "dry eye" is a wetting disorder of the ocular surface caused by a reduction in the amount of tear or by an altered composition of the tear film. The result is that the eye is no longer ideally moistened.
The tear fluid has a complicated structure and is used for wetting the inside of the lid, the conjunctiva and the cornea. Contrary, a dry eye surface becomes rough, painful, causes visual disturbances and increases the risk of infection. A healthy tear fluid provides the supply and nutrition of the cornea with oxygen and nutrients and additionally protects against infections.
Common subjective symptoms of dry eyes
Reddening of the eye, foreign body sensation, itching, burning, secretion of mucus, swollen eyelids, incompability with contact-lenses, problems working at a computer screen, pain in a smoky or drafty environment, even tears and/or other symptoms can indicate a tear film disorder.
Do you suffer from symtoms of the "dry eye" (Sicca syndrome)?
There are many causes for the problem of the dry eye. This explains, why millions of people are affected:
- Age-related atrophy of the tear tissue
The tear fluid decreases with age. About 75% of the population over the age of 65 suffer from the so-called dry eye.
- Wearing contact lenses
Wearing contact lenses binds tear fluid, which can cause discomfort, infection and / or increased deposit on the contact lens. Examination shows that the dry eye is the main cause of contact lens intolerance.
- Hormonal changes (for women)
Various hormonal changes associated with pregnancy, oral contraceptives or menopause can be the cause of the dry eye problem.
VDU work, people who are exposed to smoke, air pollution, windy, cold or dry climate conditions as well as air-conditioned spaces belong to the risk group.
About 75% of the population over the age of 65 suffer from the so-called dry eye. This causes a wetting disorder of the ocular surface. Part of the tear film is produced by the meibomian glands. They produce the fat layer, the so-called lipid layer. If this is disturbed, it leads to increased evaporation of the tear fluid. The majority of all dry eyes have a malfunction of the meibomian glands.
For diagnosis, we offer you a special program, which we would like to introduce to you. These services of the tear laboratory are not part of the scope of the statutory health insurance.
To record your symptoms, you will first receive a free questionnaire. Based on this, the success of a subsequent therapy can be illustrated.
Slit lamp examination
At the slit lamp the examination of the front eye section takes place. Here, the cornea, conjunctiva and eyelids are examined. Among other things, attention is paid to the irritation and moistening of the conjunctiva, as well as to the position, tension and closure of the eyelids.
Assessment of the secretion of the meibomian glands
The meibomian glands produce the lipid layer of the tear film, with their ducts at the edges of the lid. At the slit lamp we will judge, whether the excretory ducts are free and whether the secretion is changed, with a standardized pressure test (painless).
This test is used to measure eye tear production. For this purpose, a paper strip is suspended in the outer lid angle. The unaesthetized eye (Schirmer I) should be wetted approx. 15 mm. In the case of the Schirmer II, the eye is anaesthetized beforehand, more than 10 mm are considered normal, less than 5 mm in 5 minutes as certainly pathological.
Non-contact measurement of the tear fluid with LipiView
The LipiView allows the measurement of the quality of the lipid layer of the tear fluid, such as that of the eyelid. It provides information about the shape of the dry eye. If the lipid layer is too thin or the eyeblinks are insufficient, this can be the cause of a dry eye. With LipiView a digital recording and analysis of the tear fluid is possible and the thickness of the lipid proportion can be measured (proportion of the outer layer.)
(A) Lipid layer sufficiently thick (predominantly "colored" blue, brown yellow iridescent)
(B) lipid layer too thin (especially gray interference colors)
The treatment options can be varied and depend on the individual cause of the dry eye. Therefore, it is essential for the treatment of the dry eye to diagnose the actual cause individually and then initiate appropriate treatment.
In addition to the application of artificial tears, (depending on the cause) can also help closing the tear drainage, cleaning the eyelid edges, an active eyelid training, the massage of the eyelids or LipiFlow treatment.
Tear substitutes in the form of eye drops, gels or sprays supplement the missing or poor quality components of the natural tear fluid.
The most commonly used ingredients are hyaluronic acid, methyl cellulose or polyvinylpyrrolidone. They are available with and without preservatives. Many companies offer a wide variety of preparations and combinations.
In addition to the supplementation of the natural tear fluid by tear substitutes, the cleaning of the eyelids is of crucial importance. Combined with a light massage, dry secretions and thus germs are removed and the meibomian glands are activated with their excretory ducts.
If a large part of the meibomian glands are blocked, a sufficient proportion of lipids in the tear fluid is missing. Thus, the tear can not be efficiently prevented from evaporating too quickly, the tear fluid ruptures and the ocular surface dries out. In addition, the absence of treatment of a congested meibomian gland can lead to death of the concerned glands, whereat this condition would not be reversible anymore.
LipiFlow is a new procedure that can be used to treat the root cause of evaporative dry eye: meibomian gland dysfunction - MGD.
LipiFlow warms the inside of the eyelid in the area of the meibomian glands. At the same time it provides a gentle massage on the outside of the eyelids to eliminate the congestion of the eyelids and to facilitate the release of lipids. By opening and cleaning the glands, the natural production of the lipids needed for a healthy tear fluid sets in. This precise, clinically proven procedure can be performed with us.
After a few weeks, most patients feel a significant relief of their symptoms. In a clinical study, the LipiFlow system shows a marked improvement in lipid secretion of the lid glands. Four weeks after treatment with LipiFlow, 79% of patients report an improvement in the symptoms of dry eye.
Dry eye with "lack of water" - lacrimal point closure
The teardrop fluid that wets the ocular surface flows down the lacrimal tubules and the lacrimal sac into the nose. Closing of the tear tubules prevents drainage of the tear fluid. Especially with a small amount of tears rapid drying of the eye surface can be reduced very effectively. The closure of the lacrimal points with so-called TP plugs can be compared to a drain plug.
How are the plugs (TP-plugs) implanted?
The TP plugs are made from a soft, flexible silicone similar to the contact lens material. They are inserted into the lacrimal point under the microscope with a special instrument. The front piece folds open like an umbrella, then spreads into the canal and prevents it from slipping back out. The TP plugs come in different sizes - adapted to the width of the tear spot.
Will the complaints be over after the insertion of the plugs?
In many cases of reduced tear production, discomfort can be lessened. However, sometimes tear substitutes are still indicated - but at significantly longer intervals.
In addition to the specific previously mentioned treatment options, the "simple" options of lid-edge care should, of course, not be forgotten. They can be done by most people, independently and at home:
- Warming of the lid
- Massage of the lid
- Cleaning of the lid
Since 2017 we have been using another option to stimulate the meibomian glands to improve the lipid layer of the tear film: "e-eye".
Of course we will also advise you on this.
The individual benefits are calculated and reported on the basis of the official fee schedule for doctors (GOÄ).
Tear fluid analysis- standard (including MGE, LipiView und LipiView II) approx. 145 €
More treatments can be added optionally
Treatment (without diagnostics)
|TP-plugs 2 eyes
|ca. 185 €
|LipiFlow (per eye)
|ca. 465 €
|e-eye (3 treatments)
|ca. 450 €