Subtypes of Dry Eye Syndrome:

There are two subtypes of Dry Eye Syndrome: Evaporative and Aqueous Deficient.

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Evaporative Dry Eye Syndrome:

Evaporative Dry Eye Syndrome, the most common subtype, is often caused by “Meibomian Gland Dysfunction” (or MGD), which is affected by the incomplete and infrequent blinks in our modern lifestyle (i.e. digital device use when reading for long periods, searching the internet, and/or watching TV, movies, and video games). Studies have proven when we concentrate on a screen that we don’t blink completely and only blink half as often as other times. This becomes a very real problem because other studies have shown that the oil glands that secrete a vital component of our tear film do not “pump” or release their oils without repetitive physical contact between the upper and lower eyelids: AKA frequent, complete blinks.

 

When these oil glands are not working correctly they become congested, as the oil becomes thicker and cloudier causing the glands to become backed-up and plugged. If they remain clogged for too long of a period they eventually atrophy. It was originally thought that this “death” of the oil glands was a product of increasing age, however, there are an increasing numbers of children and young adults who have already lost a significant number of their oil glands due to growing up with lengthy periods of digital device use. This common disease is a chronic, progressive condition that cannot be cured, but it can be managed using heat treatments to “melt and loosen” the clogged oils, followed by massage of the eyelids to extract the oils (just like when pushing toothpaste out of the tube).

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Aqueous Deficent Dry Eye Syndrome:​

A different cause of Dry Eye Syndrome is from a lack of proper function of the “lacrimal” gland behind our upper lid, which secretes the watery portion of our tear layer known as the aqueous layer. A lack of proper hydration and nutrients from this watery layer leads to inflammation, and eventually can cause physical damage to the eye surface itself. This subtype is known as Aqueous Deficient Dry Eye Syndrome, and can be treated with prescription antiinflammatory eye drops, which work by either increasing production from the lacrimal gland, or by healing the signs and symptoms of Dry Eye. Improvement may occur quickly or can take several months, and results will vary​.

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Other Contributing Factors:​

Other contributing factors include gender, age, smoking status, number of hours of near work, blowing vents and fans, CPAP use, history of eye surgeries, contact lens use, allergies, medications, and hormone balance to name a few. Dehydration aggravates ocular surface disease, and can happen not only from lack of adequate water consumption, but also from the diuretic effects of alcohol and caffeine. In addition, ocular surface disease can also be associated with systemic problems such as Sjogren’s Syndrome, Lupus, Rheumatoid Arthritis, Diabetes, Thyroid Disease, Rosacea, Vitamin A Deficiency, etc​.

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What causes Dry Eye Syndrome?

Dry Eye Syndrome, more appropriately called Ocular Surface Disease (OSD), is a complicated disease process involving tear layer instability, increased saltiness of the tears, and inflammation of the ocular surface with potential damage to the cornea. These disease aspects relate to each other in a vicious cycle typically starting with tear film instability and evaporation of the tears causing an increased tear osmolarity. This increased saltiness of the tears then leads to cell damage and eventually cell death, which stimulates less-protected nerve endings to begin triggering an inflammatory cascade and release of inflammatory mediators. These mediators contribute to gland disease with changes seen in the oil within the glands. The increased gland dysfunction contributes to further tear film instability - starting the cycle all over again. This cycle explains why a large proportion of patients with OSD have both subtypes of Dry Eye Syndrome.

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Treatments:

Treatment recommendations defer between Aqueous Deficient Dry Eye Syndrome and Evaporative Dry Eye Syndrome, and are focused mainly on the cause of the specific sub-type. Due to the cyclical nature of dry eye disease, most patients develop both sub-types or basically a mixed presentation, which is why most patients receive similar treatment options.

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The first step in the treatment and management of dry eye disease is lifestyle modifications that eliminate offending agents or causative factors. As previously mentioned, our modern lifestyle has led to spending ever increasing amounts of time viewing screens/monitors, which leads to blinking less and causes dry eye disease and increases meibomian gland dysfunction. Therefore, one of the most important changes you can make in your daily life is to consciously make a point of doing complete, frequent, full blinks, especially when you are busy with any focused activity, whether you are reading, using a computer, tablet, or phone, or even watching TV. Special blinking exercises may provide long-term training and short-term benefit. Additionally, use the “20/20/20” rule: every 20 minutes, take a 20 second break and look at things at least 20 feet away.

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Other Recommendations for Lifestyle Changes for Improvement:

Reduce the use of fans, even while sleeping, or at least set the direction of the fan so air is circulated away from your eyes. Even with closed eyelids, moisture is “wicked” up and away through the crease of our lids causing dryness. Avoid air ducts.

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Place computer monitors below eye level, even if it means raising your chair and finding a small platform for your feet. While keeping your head level, this creates a downward gaze of the eyes, allowing the eyelids to cover more of the eye surface, reducing evaporation. In addition, it’s important for your neck and back to keep the head level and only drop the eyes.

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Reduce or simplify eye makeup use or at least consider hypoallergenic makeup. Avoid waterproof mascara.

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Use a humidifier, especially during the winter

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Wear wrap-around, sports sunglasses or prescription eyewear outdoors to create a barrier from dust and wind.

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Avoid tobacco smoke as it is an eye irritant that also reduces air quality.

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Minimize caffeine and alcohol intake as they are both diuretics that result in dehydration.

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Drink more water. Recommend 64 oz (8 cups) everyday. Staying hydrated leads to better tear production.

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Increase Omega-3 fatty acids in your diet. They are important for producing the oily part of your tear film. These can be found in: 1) Oily fish such as mackerel and salmon, especially wild-caught 2) Other seafood like oysters and shrimp 3) Seeds such as flax and chia seeds 4) Beans like soybeans and kidney beans 5) Nuts like pecans and walnuts 6) Other sources like avocados. If you cannot get enough dietary Omega-3 fatty acids, consider an Omega-3 supplement, preferably high in EPA and DHA. Recommended daily dose is 2000-4000 mg

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Find substitutes for medications. Talk to your primary care doctor about alternatives to medications that may be causing dry eyes such as:

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1) Antihistamines (Most allergy pills dry up secretions: good for your nose, but bad for your eyes)

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2) Nasal Decongestants (These pills work by drying-up secretions: good for your nose, but bad for your eyes)

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3) Pure estrogen such as Premarin

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4) Select high blood pressure medications (i.e. beta blockers)

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5) Medications for anxiety, depression

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6) Select acne medications (i.e. Accutane)

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Contacts and Ocular Surface Disease:

The front of the eye has a clear dome that acts as the window to the eye, and this structure is called the cornea. This clear cornea contains no blood vessels, so the only way it receives oxygen and nutrients is through the air and the tear flow across the eye. During the day, the cornea naturally receives plenty of oxygen and nutrients during each blink. When the eyelids close, they wipe away the existing tear film along with any contaminants. The action of them squeezing against each other creates a pumping action to release vital oils from our oil glands. Finally, when the lids open they smooth down the next tear layer. However, while sleeping none of these beneficial actions occur, which puts stress on the cornea.

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What happens when you wear contact lenses? First, the contact lens introduces a barrier between the eyelid and the eye’s surface, which can interfere with wiping away the tear film and laying down new tear film. Second, a contact lens works like a filter, allowing a certain amount of oxygen and tear components to pass through the material, but the cornea still receives reduced oxygen and nutrients than what it is used to. If the contact lens is allowed to become old or dirty, or if it is simply worn too many hours a day, then contact lens “filter” can become “plugged up,” blocking oxygen and tear flow, and eventually this can “suffocate” the cornea.

 

Contact Lens solutions can clean the surface of a lens, but the “porous” material deep within the contact lens material are very difficult to keep clean. A lens with a clean surface can still feel comfortable, but if the material within the lens becomes too “plugged up,” this can gradually lead to more and more problems with irritations, allergies, or reduced wearing time. If the lenses are not worn carefully, stress on the cornea can lead to Dry Eye Syndrome, cloudy opacities, eye infections, blood vessels growing onto the cornea, or even ulcers on the cornea that can leave permanent scars.

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We want you to successfully wear contact lenses many years into the future, and the better you take care of your contacts now, the fewer problems you will have later. Below are some recommendations to help your eyes remain healthy for many years to come:

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1) Have a set of eyewear you are willing to wear: choose frames you enjoy and update your prescription frequently.

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2) Wear your eyewear three hours a day to make sure the contact lenses are off the eye’s surface for three hours of awake time: this allows time to restore normal oxygen and tear flow (which does not occur while sleeping.)

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3) At the first sign of irritated eyes, remove your contacts and wear your other eyewear for several days. This lets your immune system fight the problem without the interference of contact lenses reducing oxygen and tear flow.

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4) Don’t sleep in your contacts, unless specifically instructed to do so by your doctor (only a few types of contacts are healthy enough to sleep in, and even these act as “filters”). With overnight use, follow your doctor’s instructions exactly due to the higher risk of health problems.

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5) Use only the solution system recommended to you, and follow the instructions exactly as written.

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6) Every morning, empty the case and let it air-dry. Replace the case every month (many solutions come with a new case) because a “bio-film” gradually builds up in the bottom of the case creating a habitat for germs to hide in and grow.

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One alternative option to your current contact lenses that your doctor can recommend to help minimize dry eye effects is wearing daily lenses. Replacing your lenses daily eliminates a lot of the “plugged up filter” effect. At the very least, you should replace your contacts at their recommended interval, as over-wearing your contacts can cause significant problems as discussed above.​

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Another alternative is to be fit with “scleral” contact lenses. These custom lenses create a space between the eye surface and the contact lens, which is filled with fluid, acting as a therapeutic, healing “bathtub” for the eye surface. Insertion and removal can be the biggest obstacle, however, comfort, vision, and durability are usually excellent.

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Finally, consider “Orthokeratology” contact lenses. These custom rigid lenses are worn while sleeping, and reshape the cornea to a point that when you take them out in the morning you do not need to wear contact lenses (or glasses) during the day. Some people may not be candidates due to their prescription, but if you are a candidate it may provide a nice alternative to wearing soft contact lenses during the day.

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Maintaining the Health of Our Eyes​

As touched on above, our eyelids, eyelashes, and oil glands within the lids are important to maintaining the health of our eyes and can be affected by a variety of diseases. As you may or may not know, we all have bacteria and other invaders such as “Demodex” that naturally inhabit the skin, oil glands, and eyelashes around our eyes, but for some people the levels of these invaders become too high and cause problems including redness, itching, or crusting along the lashes.

 

In addition, if the oil glands that open up near the eyelashes become plugged up, this can result in Meibomian Gland Dysfunction, painful styes, painless lumps called Chalazia, or poor tear quality. These eyelid diseases can affect people of all ages, and once they begin they usually become chronic problems that can be more difficult to treat if not addressed right away. One inflammatory skin disorder, Rosacea, has been found to have higher evidence of “Demodex”, bacteria, and Meibomian Gland Dysfunction. Thus, if you have chronic rosy red cheeks, forehead, chin, or nose then your eyelid problems may be related to this condition, and you should consider seeing a Dermatologist.

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Whether your eyelid disease is from Rosacea or from too much computer use/poor blinking it can be difficult to treat if not maintained properly. Meibomian Gland Dysfunction is like the gum disease of eye care. Prevention of gum disease and cavities is typically done through daily maintenance techniques, regular examinations with imaging, and in-office treatments. Preventing MGD and Evaporative Dry Eye Syndrome can best be done in a similar fashion. See the comparison below.​​​

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​Brushing and flossing your teeth takes just a couple of minutes. Cleaning your eyelids takes even less time, but it is an essential part of hygiene, which most of us don’t do. Why? Because most of us are not aware of the impact that cleaning your eyelids has on our vision and eye health. Depending on the type of chronic eyelid problem, your eye doctor may recommend certain methods for treating the eyelids. The two most common home-based eyelid routines are lid scrubs (remove dust, debris, germs, and other invaders) and warm compresses (soften thick, congested, and trapped oil secretions). Below are instructions for how to perform each one.

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Lid Scrubs [Once daily/Twice daily]:

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1) Products Offered (choose one):

 

Acuicyn Hypochlorous Acid Based Eyelid and Eyelash Cleanser (requires prescription)

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TranquilEyes Tea Tree Eyelid and Facial Cleanser

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Ocusoft Lid Scrub Original Eyelid Cleanser

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Ocusoft Lid Scrub Plus Eyelid Cleanser

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2) Moisten a cotton swab or gauze pad with appropriate cleaning solution (unless using a pre- moistened cleansing wipe).

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3) Next clean the upper lids. Lightly close the eyes, grasp the upper lid, and rub where the lashes go into the edges of the eyelid. Visually divide the lid into three sections and gently scrub each section approximately 5 times.

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4) Then clean the lower lids. Look up toward the sky, pull the lower lid down away from your eye, and repeat as above.

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5) Finally, after cleaning the lids, rinse them with warm water, but do not wash the eyes (keep the lids closed).

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Warm Compresses [Once daily/Twice daily]

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1) Products to Use (choose one):

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Tranquil Eyes Goggles (eyeeco.com)

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Bruder Mask (bruder.com)

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2) Heat the product according to instructions (i.e. for goggles and masks with gels or beads, typically one minute in micr owave produces at least ten minutes of therapeutic heat).

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3) Close eyelids and apply the product for at least 10 MINUTES (A hot washcloth is not recommended because it cools down after a minute, and would need to be re-heated ten times per session).

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Alternatives to daily regimes listed above:

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​As an advanced alternative to these time consuming daily regimens, a clinic-based procedure (LipiFlow) can be performed once every one to three years using specialized equipment that applies precisely targeted heat and deep, repetitive massage to the eyelids. This procedure is extremely effective (hence the ability to wait more than a year before the next procedure), very comfortable, and very safe. Like most dental work, this procedure is often necessary to prevent even bigger long term problems (i.e. disappearance of the meibomian glands from the eyelids), but it does not fully replace daily maintenance, and it is not covered by either medical health insurance or routine vision insurance.​​

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LipiFlow is the only FDA approved treatment of Meibomian Gland Dysfunction, and is the best treatment option for the majority of Evaporative Dry Eye Syndrome patients. This treatment is designed to restore the natural oil flow to the tear film that covers the eye’s surface. In-office debridement/scaling is often performed by an eye care professional prior to insertion of LipiFlow activators. The activators are specifically designed to be placed under and over the eyelids and are contoured above the cornea, so that the activators themselves avoid contact with the eye’s surface. The placement of the activators on the eyes and treatment is a simple process that is done with minimal discomfort. This unique combination of patented vectored heat and gentle adaptive pressure safely removes gland obstruction or old gland content. The entire treatment takes 12 minutes and restores normal gland function with maximum results usually experienced 6-8 weeks after treatment.

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Other supplemental or alternative treatment for Meibomian Gland Dysfunction and Evaporative Dry Eye may include topical or oral antibiotics. Topical antibiotic drops or gels can remove some of the bacterial load on the eyelids and eyelashes, which may improve gland functioning and increase eye comfort. Oral antibiotics like Doxycycline (or Azithromycin) can greatly benefit many of our patients, whether they suffer from MGD, Rosacea or chronic styes. There are three ways that Doxycycline helps:

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1) decreasing the eyelashes colonization of bacteria and “Demodex”

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2) inhibiting vasodilation that contributes to redness and telangiectasia 

 

3) activating certain anti-inflammatory properties.

 

Doxycycline does have some unfortunate, but manageable side effects you need to know:

 

1) skin photosensitivity (avoid direct sunlight)

 

2) gastrointestinal disturbances (take with food)

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3) interference with anticoagulant medications (don’t take with Warfarin/Coumadin or other blood thinners) and

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4) contraindicated in children, geriatrics, and pregnant women.

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Drops to Treat Dry Eye Syndrome:

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Treatment for either subtype of Dry Eye Syndrome along with most ocular surface irritations and diseases will typically begin with the use of an artificial tear lubricant that coats the surface of the eyes and replenishes the tear layer. There are several options, brands, and formulas, which makes shopping for artificial tears confusing and difficult. Many people may find themselves purchasing a low cost generic or name brand that is familiar (such as Visine), however, the ingredients for artificial tears are vastly different between generics and their brand name counterparts. Also, while Visine does “get the red out”, the effect is short term leading to rebound redness. This well known drop doesn’t treat the problem (dry eye), but rather just masks it (removes redness), so often times the problem worsens. If you want to minimize redness, try Lumify instead. When first starting a new artificial tear, use regular “eye drop” formulas at least four to six times a day, or use “gel” formulas two to four times a day, and continue this schedule for at least two weeks. After the first two weeks, you can try adjusting how often you use the drops based upon how much relief your eyes need, but since eye drops drain away from the eye within 30 minutes, you will need to use the eye drops several times daily. For overnight lubrication, use either the “gel” (in bottles) or the thicker “ointment” (in tubes) formulas at bedtime. Below is a list of approved artificial tears:

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Refresh Optive, Refresh Optive Advanced, Refresh Optive Omega 3, Refresh Plus, Refresh Tears, Refresh Repair, Refresh Celluvisc, Refresh Optive Gel, Refresh Liquigel, Refresh PM, Refresh Lacrilube, Refresh Contacts, FreshKote, Systane Complete, Systane Ultra, Systane Balance, Systane Gel, Systane Nighttime, Blink Tears, Blink Gel Tears, Blink-N-Clean Lens Drops, Blink Contacts, TheraTears, TheraTears Extra, TheraTears Nighttime Liquid Gel, TheraTears Contact Lens, GenTeal Tears Drops, GenTeal Tears Gel, GenTeal Tears Ointment, Soothe Hydration, Soothe XP, Soothe Nighttime, Retaine MGD, Rohto Digi-Eye, Rohto Dry Aid, Rohto Ice, Rohto Cool, Rohto Cool Max

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The thicker the artificial tear, typically the longer the effects last. Thickness of artificial tears increases from “eye drop” formulas to “gel” formulas to “ointment“ formulas. The thicker the artificial tear, the more the blurriness they can cause, which can really bother some people, especially those that wear contact lenses. If you are one of these contact lens users, consider one of the “contact lens” specific options, as they are thinner and made specifically for contact lens use. Additionally, dry eye patients suffering from meibomian gland dysfunction should consider “lipid-based” formulas to replace deficient oil levels in their tears. Meanwhile, if you suffer from Fuchs’ corneal dystrophy (an age-related corneal dystrophy causing blurred vision especially in the morning), you should consider FreshKote to provide additional benefit beyond dry eye treatment.

 

Finally, when considering your choices, remember that preservatives have negative side effects, so consider preservative-free options that may provide the best treatment. If you find yourself using your artificial tears almost continuously or if you don’t like the inconvenience of using artificial tears multiple times a day, you may want to talk to your doctor about Lacrisert, which is a dissolvable insert placed in the lower cul-de-sac of the eye once daily, and that acts like a slow-release, preservative-free artificial tear that lasts longer than 14 hours.

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If you are looking to purchase some of the products listed previously, you can get 10% off at DryEye Rescue by using code DRDRAAYER10. Click the link below.

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Punctal Plugs​

As you may or may not know, near the inner corner of each eyelid is an opening that serves as a “drainage duct” for your tear flow. For many dry eye patients, closing or “plugging” this duct may keep both natural and artificial tears on the eye longer, which may reduce the need for eye drops. “Punctal plugs” work much like the drain stopper in a bathtub. Closure of this “puncta” can be accomplished with either temporary dissolvable “punctal plugs”, semipermanent removable “punctal plugs” or with permanent cauterization of the puncta. To determine how much benefit “punctal plugs” can provide our patients, a temporary collagen plug that dissolves within 1 week is usually fit first. After a successful trial, the patient can choose (with our recommendations) between a short term synthetic dissolvable plug that lasts 3-6 months or a semi-permanent silicone plug that lasts until it is removed or falls out. To achieve permanent punctal occlusion, cauterization of the puncta can be done via a quick, in-office procedure using only local anesthesia (performed by an oculoplastics surgeon).

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All three options have their advantages and disadvantages. The semi-permanent plugs are inserted just into the puncta so they can still be seen and mechanically removed if necessary. However, the visible part of the plug can sometimes rub against the eye or eyelid causing irritation. Simply rubbing the eyes can cause these type of plugs to dislodge and fall out of the puncta. Meanwhile, the dissolvable synthetic plugs, while only lasting 3-6 months go all the way into the puncta, and don’t risk falling out. On the other hand, permanent cauterization is just that, “permanent”, which can be both good and bad. Excessive tearing and watery eyes can occur if the punctal occlusion does its job too well. If you chose cauterization, you may be forced to live with this unfortunate side effect. However, if you opted for one of the “punctal plug” options, you may need to visit your eye doctor for removal of the plug or replacement with a different type to better control the amount of tears on your eye(s). Usually, punctal plug insertion is uneventful and rarely involves serious side effects or problems, but additional side effects can occur including eye infections, allergic reactions, and increased ocular inflammation. Although all of these are very rare, if they do occur, they may make removing the plugs necessary. If removal is considered necessary, your eye doctor may use forceps to grasp and extract the plug or try flushing with saline solution, which forces the punctal plug to exit into the nose or throat where the tear ducts drain. Other than some slight initial discomfort, once the punctal plugs are in their proper place, you should not feel them. Immediately after the procedure, you should be able to drive yourself home and resume normal activities.

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Patient selection is an extremely important part of treatment success with punctual plugs. In my experience, patients that typically do well with plugs are those with autoimmune diseases (Rheumatoid Arthritis, Lupus, Sjogren’s), thyroid patients, contact lens wearers, and avid computer users. Additionally, patients who do not fully blink, who have lagophthalmos, or who have an inadequate nocturnal lid seal (determined by Korb-Blackie Lid Light Test) may also benefit because the plugs aid in increasing the volume of tears on the ocular surface. Some patients you may want to hold off on treating with punctal plugs are those with a significant meibomian gland problem (determined by Lipiscan and other testing) and those with significant ocular surface inflammation (determined by InflammaDry Test). In both cases, the plugs keep these patients’ unhealthy tears sitting on the ocular surface causing irritation. Once inflammation has been tamed in these patients, Punctal Occlusion can be considered with much better results.

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Inflamation and use of Steriod Drops

The signs and symptoms of inflammation are well known: redness, heat, pain, and swelling. Does this sound familiar? As you may recall, one of the main parts of the dry eye cycle is inflammation, which is typically worse in Aqueous Deficient Dry Eye patients than in Evaporative Dry Eye patients. Several systemic inflammatory conditions can cause Ocular Surface Disease, such as Sjogren’s Syndrome, Rheumatoid Arthritis, Lupus, etc., and the majority of these patients have Aqueous Deficient Dry Eye Syndrome. Topical anti-inflammatory options include either fastacting, short term steroid drops or slow-acting, long term cyclosporine/lifitegrast drops. The steroid drops are only used short term because they have some fairly serious side effects when used long term such as elevated eye pressure and cataract development. The long term anti-inflammatory drops’ (Restasis (cyclopsorine) and Xiidra (lifitegrast)) most common side effects are eye irritation, discomfort, and blurred vision. Xiidra can also cause an unusual taste sensation, but seems to work faster (maximum affect at ~6 wks) than Restasis (maximum affect at ~6 months). The two types of drops are complimentary, and are often prescribed together. This leads to a quicker treatment affect by using the steroid drops, while providing long term benefits by using either Restasis or Xiidra.

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​Here are some examples of steroid drops that may be prescribed (each medication is designated to the level of inflammation it is best used to treat — mild, moderate, and severe):

 

Difluprednate 0.05% (Durezol)

 

Prednisolone acetate 1% (Pred Forte or Econopred Plus)***### or 0.125% (Pred Mild or Econopred)

 

Prednisolone sodium phosphate 1% (Inflamase Forte) or 0.125% (Inflamase Mild)

 

Dexamethasone sodium phosphate 0.1%***### (Maxidex)

 

Loteprednol etabonate 0.5% (Lotemax)***###^^^ or 0.2% (Alrex)

 

Fluorometholone alcohol 0.1% (FML)*** or acetate (Flarex)

 

***available in an ointment

^^^available in a gel

###available in a antibiotic/steroid combination

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​One of best steroid drops for dry eye patients is the Lotemax 0.5% ophthalmic gel. Loteprednol has a lower incidence of IOP spikes, plus the gel is found to be more soothing than most of the suspension drops. The one downside is that sometimes this medication isn’t well covered by insurance companies, and a more cost-friendly alternative may be needed.

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Unconventional Solutions​

Dry eye treatment, typically, begins with the easiest and cheapest options before more complex and expensive options are pursued. However, every pair of eyes are different, and thus treatment will often be very different. Complex cases will often require very different management techniques then mild cases. For complex cases, unconventional approaches may be required such as autologous serum eye drops or amniotic membrane tissue bandages. Autologous means that the donor and the recipient are the same person. These special eye drops are made from your own blood (after the red blood cells and clotting factors are removed). The collected blood serum is diluted with a sterile, preservative-free solution to produce a tear substitute that is unique to the patient, and contains many important growth factors and nutrients normally found in healthy tears. These ingredients revitalize unhealthy corneas, which is why they work so well for advanced dry eye patients. Additionally, since blood and tears have an almost identical salinity and pH, there is no issue of burning or stinging upon instillation. Because they are non-preserved, the drops are stored in the freezer until you need them.

 

Amniotic membrane tissues are extracted from the placenta of consenting mothers after cesarean section births. It is the tissue closest to the baby throughout development in the womb. Amniotic membranes protects the baby from any harm and have natural therapeutic actions which help the baby develop. The amniotic membrane tissues isolated from the placenta are either cryopreserved or dehydrated as implantable discs. These round tissue bandages have natural properties that can help damaged eye surfaces heal faster with less scarring and inflammation. Additionally, they provide pain relief and reduce corneal haze making these especially useful for ocular surface disease patients. However, they can cause some mild discomfort and blurred vision when inserted, which is why one eye is typically done at a time.

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