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SYLMAR, CA 91342
(818) 367-1015

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Dr. Forbes

Dr. Stevens

Dry Eyes have been an ever increasing problem as people live longer and our environment changes. Until recently, we did not have a true understanding of the causes and treatment methods were unsatisfactory at best.

New technology has finally found the main cause of Dry Eyes; Meibomian Gland Dysfunction (MGD). (See below). For many years, we believed a reduction in tear volume was the main cause of dry eyes, but this was never a well-accepted answer. The only treatment was eye drops with very limited effect and warm compresses which were found to have almost no effect at all.
dry eye
However, treatment methods were slow to respond and many
eye care professionals continued to use ineffective eye drops.

There has to be a better way!
THERE IS A BETTER WAY! A major part of our new treatments began with Avenova, a liquid used to kill bacteria that seemed to have no side effects.

It is a compound the cells in your blood used to attack bacteria. This alone proved to have great results. But there was more to the problem and now we know there are a series of steps needed to truly help dry eyes patients.

Please continue reading, but note that our protocols are updating at a rapid rate and changes in usage are often on an individual basis. Please call the office for an appointment and mention you may have a dry eyes problem.
dry eye 

The great majority of Dry Eye problems comes from Meibomian Gland Dysfunction and the accompanying inflammatory condition called Meibomitis or Blepharitis.

Blepharitis, the most general of the terms, describes inflammation of the eyelid as a whole. Marginal blepharitis is inflammation of the lid margin and comprises both anterior and posterior blepharitis.

Anterior blepharitis refers to inflammation of the front lid margin, concentrated around the lashes. It may be accompanied by collarettes around the lashes, and inflammation may spill onto the posterior lid margin. This often has a bacterial origin.

Posterior blepharitis is an inflammatory condition of the rear lid margin. It has a variety of causes, including MGD, conjunctival inflammation (allergic or infectious) or other conditions, such as acne rosacea.

MGD is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by blockage of the ducts and changes in the glandular secretion. This will result in alteration of the tear film, symptoms of eye irritation, inflammation, and ocular surface disease, all commonly associated with “Dry Eyes”. The Meibomian Glands are located in a row across your eyelids.
 The protocol discussed below is for Dry Eyes caused by MGD or Meibomian Gland Dysfunction.

Research has found that well over 80% of all dry eyes and eyelid problems are caused by MGD.

It is commonly found in women after menopause although it can be found at any age in either sex.
dry eye

Dry Eye Protocol 
Phase 1
Step 1
The eye and lids are relieved of inflammation with an eye drop you use for about 2 weeks. Removing inflammation allows the MGD treatments to function correctly. Insurance usually covers this… ($0 – $30) This step is necessary in about 60% of our patients.

Step 2
Warm to hot and wet compresses applied to the closed eyes 3 – 5 times per day for 5 – 15 minutes each. This seems to have limited to no help, but does temporarily increase comfort levels. The new Bruder Mask (see below) has been introduced to help keep the eyes moist at night.
Phase 2
Step 1 (usually begins after the 2 weeks of steroid use)
The standard for MGD care used to be Doxycycline, a tablet that is a mild anti-inflammatory and mild antibiotic. Recently, due to a shortage and dramatically increased cost, we usually replace Doxycycline with another antibiotic, often used for only 4 - 5 days. Insurance usually covers this… ($0 – $30)

Step 2
Avenova is a new prescription “medication” used 2 times a day for three months or more. This product has proven to be invaluable in our protocol. Avenova is a non-toxic liquid (antibiotic) that removes almost all bacteria from the lids and lashes. This is best applied with make-up removal pads. Use a new pad for each eye. No Insurance coverage. ($35)

Step 3
Omega 3 specifically for dry eyes and MGD in pill form. We have found the PRN brand to be superior to all others in purity and effectiveness. Usually, you will take 3 – 4 PRN Omega 3 pills per day, with meals, for at least 4 months. ($48 - $52)

Step 4
A) We have been working with a Bruder Mask, part of a chronic dry eye hydrating kit which can be effective in keeping eyes moist during sleep. This new device is inexpensive and may also be used for stys etc. The patient reports have been excellent.

B) A new lid cleansing device, BlephEx, allows us to thouroughly clean scales, dry skin and hardened mucous from the lids. This may be repeated at 2 month intervals if needed. ($80) (Seldom necessary).

C) Vitamin D has recently been mentioned as a necessary addition to this protocol. The correct dosage seems to be 1500 – 3000 IU per day. PRN Omega 3 (Dry Eye Omega) has 1000 IU in a 4 pill dose. We believe an extra 1000 - 1500 IU per day could help many patients.

D) Eye drops may be used during the day with limited effect. Systane Balance seems to be one lubricating drop where patients have found some temporary relief.    

Sylmar Vision Center 12737-3 Glenoaks Blvd. Sylmar, CA 91342 Phone: (818) 367-1015

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