Ronald N. Gaster, MD, FACS
19671 Beach Blvd., Suite 400
Huntington Beach, CA 92648
(855) 393-3622
Ronald N. Gaster, MD, FACS
50 N. La Cienega Blvd., Suite 340
Beverly Hills, CA 90211
(855) 393-3621
(310) 425-3938
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What is Dry Eye?

Dry eye syndrome is characterized by a lack of tear production to properly lubricate the eyes. Tears are vital to the healthy functioning of the eye. Dry eye syndrome is medically known as Keratoconjunctivitis Sicca and is defined as inflammation and drying of the Conjunctiva due to a lack of, or inadequate, tear production. Dry eye syndrome may develop for a wide variety of reasons including environment, systemic conditions such as Sjogren's syndrome and even from use of antihistamines. This condition is actually quite common and increases in frequency with age. The most common symptoms include pain from irritation, a sandy feeling, and lack of tolerance when wearing contact lenses. Treatment options for dry eye syndrome include over the counter (OTC)  lubricating drops, a prescription drug known as Restasis®, punctual plugs, Omega 3 Fish Oil supplements, Meibomian Gland Expression, eyelid margin debridement, and LipiFlow treatments. For more information contact us directly.

Dry Eye

Your eyes need to function properly and without the appropriate levels of lubrication, this is simply not possible. The natural tears that are produced in the eyes are what create the moisture required to maintain vision and overall healthy, comfortable eyes. Once an imbalance occurs in tear production, dry eye syndrome sets in and as mentioned previously there are many reasons that this can occur.

Our Treatment Options Include:

Eye Drops

Undoubtedly, the most common type of dry eye treatment is over the counter (OTC) eye drops. This method may not be the best treatment option available and many popular eye drops do nothing to help the dry eye problem; they just soothe the eyes and provide temporary relief. The dry eye drops that are available through Dr. Ronald Gaster are eye drops that have been hand selected by medical doctors and have certain properties that are significant in helping dry eye syndrome.

Punctal Plugs

Punctal PlugDepending on the type of dry eye problem you have, Dr. Gaster may use a different type of punctal plug. The two main types are temporary or permanent punctual plugs. The permanent plugs are made of a silicone substance and the temporary plugs are made of dissolvable collagen. Dr. Gaster may decide to place a temporary plug in your eye prior to selecting a permanent punctal plug. Most patients have no problems with punctal plugs and cannot even feel them in the eyes. If you are concerned about risks associated with punctal plugs, please be sure to ask Dr. Gaster at your examination.

Patients should note that not all punctal plugs are equal in quality. Dr. Gaster  hand selects the best punctual plugs based on results with his patients. When it comes to treating dry eye syndrome, he only uses what works the best. Of course, there are many types of punctal plugs, and for certain individuals some may be better than others.

Eye Vitamins and Omega 3 Fish Oil

Eye vitamins and Omega 3 fish oil pills have gained popularity amongst medical doctors, but not all formulations are valid. It is very possible to supplement your diet with foods that are rich in Omega 3 fatty acids. These foods include walnuts, cod liver oil, flax seed oil, primrose oil, and cold-water fish. Also of note is the importance of vitamin A, which can be found in foods such as eggs or dark green and yellow vegetables. All of these foods can help maintain proper eye moisture.

 

Intense Pulsed Light (IPL) Therapy

Ronald N. Gaster, MD, FACS, is now offering Intense Pulsed Light Therapy for dry eyes, blepharitis and ocular rosacea.

The standard treatment for chronic dry eyes (keratitis sicca) includes frequent artificial tears (non-preserved is best) and lubrication with ointment to nourish the surface of the eyes, warm compresses and lid scrubs, punctal occlusion in some patients, omega-3 fatty acids, humidifiers, Restasis eye drops and/or oral doxycycline for appropriate patients.  If left untreated, chronic dry eyes and blepharitis can lead to scarring in the eyes and possibly loss of vision.  Loss of function of the important Meibomian glands leads to increased evaporation of the tears and worsening of dry eyes.  Once these glands are lost, they do not function again.  However, with early proper treatment, these glands can be saved and restored to normal functioning.  Dry eyes and blepharitis should be adequately treated before any eye surgery, especially cataract surgery or laser refractive surgery such as LASIK or PRK.

The IPL treatment is for patients who want to improve the functioning of their Meibomian glands and thus treat their dry eye disease, blepharitis and Meibomian gland dysfunction, which are often subsets of ocular rosacea.  This condition induces inflammation of the eyelid skin that damages the Meibomian glands resulting in failure to produce enough of the natural oils that slow the evaporation of the tears.  Patients then experience burning, dry, sandy, and gritty sensation in their eyes, redness and blurred vision.  For patients who have failed other dry eye and rosacea treatments or who want to be able to reduce the dry eye treatments they currently perform, IPL may be helpful. 

IPL employs bursts of light directed at the lower eyelids and upper cheek areas which heat the Meibomian glands that are blocked with thick secretions which cannot be evacuated to slow evaporation of the tears.  Once these thickened secretions are warmed and become more liquid, then Dr. Gaster can manually express them more effectively and completely.  Most patients require 4-6 monthly treatments to get best results, but some patients notice mild improvement after the first or second treatment.  Once the full effect is obtained, then maintenance treatments every 3-6 months are recommended to keep the Meibomian glands healthy and functioning.   

Dr. Gaster will administer the IPL treatment in the office.  Eye shields are used to protect the eyes during treatment and a thin layer of cooling gel is applied to the treatment area.  The light treatment is administered by a handpiece attached to the light source to the affected areas of the lower eyelids, upper cheeks and across the nose.  As the pulse of light is administered, there is a tingling sensation that most patients tolerate quite well.  After the IPL therapy, the treated regions may be slightly flushed and red for a short time. 

IPL is not a laser; it is light therapy over a range of wavelengths.  A filter is used to select the proper range of wavelengths for the best treatment to apply the proper amount of heat to warm the skin and close down the abnormal blood vessels associated with ocular rosacea, dry eyes, blepharitis and Meibomian gland dysfunction that cause the abnormal inflammation in the eyelids.  IPL has been used for a long time to treat age spots, sun damage, mottled skin pigmentation, acne, hair removal and irregularities of blood vessels.  Dr. Gaster uses the Lumenis M22, the most advanced IPL machine available. M22's IPL with Optimal Pulse Technology gives users the ability to control the pulse shape and provide reproducible results as well as gentler, more comfortable, patient-friendly treatment.

Patients typically return to normal activities immediately after the treatment.  The use of sunblock is required after the treatment to all treated areas that are exposed to the sun.  After treatment, improved tear function is usually seen after a few months.

 

Meibomian Gland Expression and Eyelid Margin Debridement

Manually expressing the contents of the Meibomian glands helps diagnose Meibomian gland disease (MGD) and is a proven therapy for posterior blepharitis and evaporative tear dysfunction. Small instruments are used to compress the eyelids to squeeze out the contents of the Meibomian glands.

The Meibomian glands of patients with MGD are usually full of stagnant secretions. These poor quality secretions block the gland opening, irritate the eye, fail to lubricate the eye and allow evaporation of the tears. Draining the glands encourages the production of new secretions.

Eyelid margin debridement is a painless method to help open the Meibomian gland ducts at the eyelid margin. Both procedures are done in the office and are pain free.

Restasis® (pharmaceutical product)

This is a pharmaceutical product that helps increase your eyes’ natural ability to produce tears. If you need more tear production, it is likely you are suffering from dry eye syndrome.

Restasis® is a prescription eye drop that Dr. Gaster uses to reduce the inflammatory component of dry eyes. This eye drop is the only FDA approved drop to help increase a person’s tear film production.

Restasis works by reducing chronic inflammation of the tear producing lacrimal glands, improving both the quantity and the quality of tears produced. Because the medication works through a ”turnover” of the cells in the lacrimal glands, its effect has a significant ”inertia." This means that the medication must be used for at least 6-12 weeks before any results will be evident to the patient and the doctor. This inertia also applies when the medication is discontinued (by patients who feel relieved or cured of their dry eye); symptoms will come back several months after the medicine has been discontinued.

Autologous Serum Eye Drops

Autologous serum eye drops contain substances that promote ocular surface health and are non-allergenic because they are derived from the patient’s own blood.  Similar to tears, they contain substances that are nourishing and promote proliferation of ocular surface cells.  Several clinical trials have demonstrated that autologous serum can help dry eye disease as much as or more than artificial tears.  These drops are derived from the patient’s own whole blood and are prepared sterilely by a compounding pharmacy.  Several vials are prepared at one time and the additional serum drops are kept frozen until needed.  The drops are tested for safety prior to dispensing from the pharmacy.  They are usually used for severe dry eyes and ocular surface disease, often with persistent epithelial defects.

LipiFlow Treatment For Dry Eyes

Unlike traditional treatments (e.g., warm compresses, wetting drops and ointments) that address dry eye symptoms, LipiFlow treats the root cause, the obstructed Meibomian glands. If left untreated, dry eye can lead to further ocular deterioration and additional problems. The goal of unblocking the glands is to allow them to resume their natural production of lipids required for a healthy tear film. LipiFlow treatments can only be provided by a licensed physician.

How LipiFlow Works: