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What Are The Types of Dry Eye?

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A female student in a park experiencing dry eyes, scratching her itchy eyes

Dry eye disease is an irritating condition resulting from dysfunction in your tear film. It can negatively affect your vision, make it difficult to wear contact lenses, and significantly impact your life.

If your optometrist diagnoses you with dry eye disease, their diagnosis will fall into two types: aqueous dry eye and evaporative dry eye (Meibomian gland dysfunction).

What Is Dry Eye?

When your tears can’t properly lubricate your eyes, it can result in symptoms of dry eye disease. Whether caused by decreased tear production or increased tear evaporation, your eyes will feel stripped of hydration, causing discomfort.

Symptoms of Dry Eye

You can identify dry eye disease and problems in your tear film when you experience specific symptoms, such as:

  • Feeling like there’s a foreign object in your eye
  • Gritty sensation
  • Light sensitivity
  • Mucus discharge
  • Overwatering of the eyes
  • Blurred vision
  • Discomfort when wearing contact lenses
  • Eye fatigue

What is the Tear Film? 

The tear film has 3 layers, and problems with any of them can cause symptoms of dry eye on a scale of severity.

  • Top oil layer: the top layer of the tear mixture consists of oil that helps smooth the tear surface and slow tear evaporation
  • Middle water layer: the thickest layer of the tear mixture, the middle layer is composed of water and salt that help wash away irritants and particles, such as dust or debris
  • Inner mucus layer: the inner layer of the mixture is made of mucus that helps evenly spread the tears over the eyes 

Types of Dry Eye

Dysfunction in any layer of the tear film can disrupt the balance of your tears and lead to dry eye symptoms. Dry eye can be classified into two types.

Aqueous Dry Eye

When your lacrimal gland, in the corner of your eye, has difficulty producing enough tears, it can contribute to dry eye. The lacrimal gland makes the second, watery layer of your tear mixture which helps wash away debris and irritants from the eyes.

This type of dry eye can result from aging, or autoimmune conditions such as Sjogren’s syndrome, rheumatoid arthritis, and lupus, as they can damage the lacrimal glands. Hormone changes, such as during menopause, can be a risk factor for this type of dry eye disease.

A close-up of a man with Blepharitis is touching the lower part of his eye

Evaporative Dry Eye or Meibomian Gland Dysfunction (MGD)

Evaporative dry eye results from meibomian gland dysfunction, which occurs in over 85% of dry eye disease cases. This type of dry eye affects the tear mixture’s top oil layer. Oil produced by the Meibomian gland helps slow evaporation and stabilize the balance of tears.

When the glands are blocked or damaged from debris in the eyelids, computer and screen usage, or makeup buildup, dry eye symptoms can emerge. It’s common in those with eyelid inflammation, called blepharitis, or skin conditions such as rosacea.

Other Causes of Dry Eye

Additional factors can also contribute to dry eye disease, including:

  • The environment, including wind, smoke, pollution
  • Medications including birth control, some antidepressants, Accutane, hormone replacement therapy
  • Refractive eye surgeries, such as LASIK

Treatments for Dry Eye Disease

With advancing technology, treatment options now extend far beyond using artificial tears. Modern treatments target the cause of your dry eye rather than simply managing the symptoms.

In-Office Dry Eye Treatments 

Several treatment options at our clinic can help restore your well-being and ease your dry eye difficulties.

  • OptiLight by Lumenis is the only FDA-approved intense pulsed light (IPL) treatment. In 3 to 4 sessions over 75 days, non-invasive, carefully calibrated light energy pulses will help liquefy and free hardened oils that may be blocking your eye glands.
  • LipiFlow therapy uses a uniquely designed device that covers your eyes and gently warms and melts blockages in your eye glands, then gently massages debris from your eyelids.
  • Oasis punctal plugs prevent tears from draining out of your eye too quickly by inserting tiny plugs into your tear ducts. They’re a safe dry eye management system.
  • TearCare is a heat therapy system that treats evaporative dry eye disease due to meibomian gland dysfunction (when used with manual expression of the meibomian glands).

At-Home Remedies

Your optometrist can also offer you treatments to help relieve dry eye in the comfort of your own home.

  • Omega-3 supplements derived from salmon, halibut, nuts, seeds, and oils can reduce existing symptoms of dry eye and prevent future dry eye symptoms
  • Applying a warm compress to your eyelids can help soften oil blockages and soothe irritation or redness.

Find Dry Eye Relief

Whether you have persistent dry eye symptoms or you’re noticing signs of the condition for the first time, book an appointment to get relief for your eyes.

Dr. Charlie Bittel

Written by Dr. Charles F. Bittel, III

Dr. Charles F. Bittel III (also known as Dr. Charlie or Dr. Bittel Junior) was introduced to the world of optometry in 1983 at his father’s graduation from optometry school. He is a graduate of Servite High School in Anaheim and received his degree in psychology from UCLA. Dr. Charlie Bittel graduated summa cum laude from the Southern California College of Optometry in 2006 and was the class salutatorian.

Dr. Charlie Bittel, owner and primary optometrist at Charles Bittel III, OD, enjoys all aspects of family eye care and is happy to see patients anywhere from 4–104 years old. In the last few years, Dr. Charlie has developed a passion in dry eye disease and myopia management and has embraced the challenge of incorporating these areas of interest into his family practice. He has also had the honor of being a part of Johnson & Johnson Vision Care’s Professional Affairs Consulting team and Speaker’s Bureau. And, most recently, he has partnered with their LipiFlow team to help fellow optometrists incorporate dry eye clinics into their practices.

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