Aqueous Deficient Dry Eye vs Evaporative Dry Eye Syndrome

 

Aqueous Deficient Dry Eye 

Aqueous deficient can be broken down into Sjogren's Syndrome and Non-Sjogren's Syndrome. Sjogren's Syndrome is an autoimmune condition where your immune system is attacking the salivary glands in the mouth and the lacrimal gland in the eye.

Your excretions from these glands will be lessened or non-existent, which will create an extremely dry mouth and dry eye. 

As with any autoimmune condition, diet usually plays a crucial role, but may not explain the whole story. 

Non-Sjogren's Aqueous Definifiect Dry Eye is where the lacrimal gland is affected, but not due to an autoimmune response, but rather due to something else.  Systemic drugs, a reflex block, lacrimal gland duct obstruction and lacrimal deficiency are examples of this. 

Treatment for aqueous deficiency is all about finding the underlying cause of the problem in the first place.  Restasis has been shown to increase tear production so it can be helpful for symptom relief. 

Evaporative Dry Eye Syndrome

Evaporative dry eye can be broken down into two categories as well. 

Extrinsic, meaning coming from the outside is usually caused by vitamin A deficiency, contact lens wear, preservatives in eye drops, and ocular surface disease like an allergy. 

Intrinsic, meaning coming from inside, is usually caused by meibomian gland dysfunction, vitamin A overdose (e.g. Accutane), lid disorders, low blink rate (e.g. which occurs during digital device use). 

Treatments for evaporative dry eye include

One Love,

Dr. Travis Zigler

Dr. Travis Zigler

SeeEO of Eye Love

 

 

 

Video Transcription

So, in this video I wanted to go over what Aqueous Deficient Dry Eye is versus Evaporative Dry Eye and looking at this picture right here you need to understand the different layers of the tear film. And so, you have here oily layer right here. That’s what comes from the meibomian glands and they produce meibom, which is oil. Your watery layer is right here, which comes from your lacrimal gland and then the mucin layer comes from the goblet cells of the cornea and the conjunctival.  So, understanding these three layers is how we treat dry eye.

Let me move on to the next slide and we’ll go over the definition of evaporative versus aqueous deficient dry eye. You can see dry eye is broken down into two different sections, aqueous-deficient and evaporative. The most common we’ve seen in our practice is evaporative, and we’ll get into that secondly, but first let’s go over aqueous-deficient. Aqueous deficient can then be broken down to Sjogren and Non-Sjogren. And so Sjogren Syndrome is an auto immune condition where your immune system actually attacks the salivary glands in the mouth,  and then the lacrimal gland in the eye. And so, it makes it so you don’t have any excretions from those glands and so it creates an extremely dry environment and this usually has a cause and just figuring out what the cause of Sjogren Syndrome is will help with that. I’m not an expert with Sjogren, but diet usually has a lot to do with that, and so exploring different diet avenues could help with that.  Non-Sjogren is where the lacrimal gland is affected. So we don’t know what’s causing it. It could be systemic drugs, a reflex block, lacrimal gland duct obstruction and lacrimal deficiency. So, the lacrimal gland sits right up here, towards your ear on the upper eye lid. What that does, is it secretes the watery layer that we talked about. So that’s the middle layer. Let me go back a couple of slides and show that watery layer right there. So, Sjogrens affects the watery layer and so does any problem with the lacrimal gland affect the water layer. So that’s Aqueous Deficient. I don’t see that as often. Treatment for Aqueous Deficiency is a little of tough. It’s kinda finding the underlying cause. So, if Sjogrens is cause find out what’s causing Sjogrens. If it's any of these other things, you got to figure out what’s causing it. So restasis has been shown to increase tear production. How effective it is, it’s still up in the air. Some people think it works really well, others don’t.

So, let’s move on to the evaporative side of things. With evaporative dry eye it could be cause from an external factor. Vitamin A deficiency. We always stress the importance of vitamin A. The two reason, or we have two supplements that do not have vitamin A in it because vitamin A has also been shown to increase the risk for lung cancer in those who smoke, so we took it out. That being said studies were done with synthetic vitamin A and not whole food vitamin A. So an easy way to get whole food vitamin A is diet and carrots are good for your eye. Beta-carotene, and so just eat those carrots and that will keep you from vitamin A deficiency. Then your leafy green vegetables kale, spinach. You guys have heard us talked about this before. Other extrinsic factors that affect evaporative dry eye are contact lenses. So contact lenses mess up that tear film, because let’s go back a couple of slides, you could imagine putting a contact lens right in the middle of this tear film, its going to mess it up. So, a contact lens messes with it and causes more evaporative dry eye. It also causes physical trauma on the meibomian glands that could cause it as well. Allergies and other ocular surface diseases of course could cause it as well. And then, preservatives in all your drops. That’s why we always stress non-preserved drops because preservatives could be toxic and depending on who you are just depends on what preservatives you might be allergic to. I like to think of it like preservatives in your food. Preserved food are worse for you than natural food. Anything in a box, I try to avoid and I try to eat fresh produce. So, that’s one other thing I’d like to add in extrinsic evaporative dry eye, is lasik. So, if you’ve had lasik, you’re kind of messing with it, that can also be classified as non-sjogren dry eye. It’s kind of, we don’t know much about post lasik dry eye. We just know it’s bother some and we think it’s just because you’re cutting the nerves and you’re killing tissue with the laser and therefore causing some problems there.

The intrinsic side is what we talk about in this community a lot and that’s meibomian gland dysfunction. So, the meibomian gland is a gland in the upper and lower eyelid. And you can see all the arrows that I made. This points it out, so you have this whole thing right here being the meibomian gland and all these little pockets right here are oil factories. So what happens these oil factories produce the oil or the meibom, it puts it out into this gland, or the duct, and then it goes all the way down to the end and every time you blink this muscle pushes that oil out of the eyelid. Now, what we see when we see meibomian gland dysfunction is when the oil hardens right here at the end obstructing the duct. And so when the oil hardens and obstructs that duct the oil can’t get out. And so again going back a couple slides to this, if the oil can’t get out you have no oily layer. So that’s why it’s called evaporative dry eye. The oily layer is responsible for keeping these tears in tact and so if you lose that oily layer your tears break up. The most common question I get or the most common symptom I get in my clinic is my eyes run water or my eyes water a lot. Reason that is, is because the oil layer is not there. Your eye gets affected by feeling like there’s something in it because it’s dry and then your eye produces more watery tears because that’s what your brain think it needs. So it produces more watery tears from the lacrimal gland. So no oil leads to more watery tears. Which we know isn’t good.

So how we treat the evaporative dry eye is through warm compresses, an omega-3 supplement, and like I talked about in the past an omega-3 has a couple of other vitamins and minerals that have been shown to help with dry eye. Then doing that warm compress with the massage afterwards seems to help with evaporative dry eye pretty well. You guys have heard of Lipiflow and all those other treatments that we’ve discussed here as well. That’s all going to help with the treatment of evaporative dry eye. Also, making sure you eat vitamin A, avoiding preservatives, contact lenses, if you could avoid them that’s best, or a scleral lens is better. Then diseases such as allergies affected as well.

If you have any questions leave them below. If you wanna check out our dry eye supplements, you can use the code FXDRYEYE, so fix dry eye without the i at the beginning. So that’s FXDRYEYE at eyelovethesun.com (that’s e-y-e-l-o-v-e-t-h-e-s-u-n.com)

 

 

[0:00:01] So, in this video I wanted to go over what Aqueous Deficient Dry Eye is versus Evaporative Dry Eye and looking at this picture right here you need to understand the different layers of the tear film.

[0:00:13] And so, you have here oily layer right here. That’s what comes from the meibomian glands and they produce meibom, which is oil. Your watery layer is right here, which comes from your lacrimal gland and then the mucin layer comes from the goblet cells of the cornea and the conjunctival.

[0:00:33] So, understanding these three layers is how we treat dry eye. Let me move on to the next slide and we’ll go over the definition of evaporative versus aqueous deficient dry eye.

[0:00:46] You can see dry eye is broken down into two different sections, aqueous-deficient and evaporative. The most common we’ve seen in our practice is evaporative, and we’ll get into that secondly, but first let’s go over aqueous-deficient.

[0:00:58] Aqueous deficient can then be broken down to Sjogren and Non-Sjogren.
And so Sjogren Syndrome is an auto immune condition where your immune system actually attacks the salivary glands in the mouth,
and then the lacrimal gland in the eye.

[0:01:16] And so, it makes it so you don’t have any excretions from those glands and so it creates an extremely dry environment and this usually has a cause and just figuring out what the cause of Sjogren Syndrome is will help with that.

[0:01:30] I’m not an expert with Sjogren, but diet usually has a lot to do with that, and so
exploring different diet avenues could help with that. Non-Sjogren is where the lacrimal gland is affected.

[0:01:41] So we don’t know what’s causing it. It could be systemic drugs, a reflex block,
lacrimal gland duct obstruction and lacrimal deficiency. So, the lacrimal gland sits right up here, towards your ear on the upper eye lid.

[0:01:56] What that does is it secretes the watery layer that we talked about. So that’s the middle layer. Let me go back a couple of slides and show that watery layer right there. So, Sjogrens affects the watery layer and so does any problems with the lacrimal gland affect the water layer.

[0:02:13] So that’s Aqueous Deficient. I don’t see that as often. Treatment for Aqueous Deficiency is a little of tough. It’s kinda finding the underlying cause. So, if Sjogrens is cause find out what’s causing Sjogrens.

[0:02:25] If it's any of these other things, you got to figure out what’s causing it. So restasis has been shown to increase tear production. How effective it is, it’s still up in the
air.

[0:02:36] Some people think it works really well, others don’t. So, let’s move on to the evaporative side of things. With evaporative dry eye it could be cause from an external factor. Vitamin A deficiency.

[0:02:49] We always stress the importance of vitamin A. The two reason, or we have two supplements that do not have vitamin A in it because vitamin A has also been shown to increase the risk for lung cancer in those who smoke, so we
took it out.

[0:03:04] That being said studies were done with synthetic vitamin A and not whole food vitamin A. So an easy way to get whole food vitamin A is diet and carrots are good for your eye.

[0:03:16] Beta-carotene, and so just eat those carrots and that will keep you from vitamin A deficiency. Then your leafy green vegetables kale, spinach. You guys have heard us talked about this before.

[0:03:27] Other extrinsic factors that affect evaporative dry eye are contact lenses. So contact lenses mess up that tear film, because let’s go back a couple of slides,
you could imagine putting a contact lens right in the middle of this tear film, its going
to mess it up.

[0:03:43] So, a contact lens messes with it and causes more evaporative dry eye. It also causes physical trauma on the meibomian glands that could cause it as well.
Allergies and other ocular surface diseases of course could cause it as well.

[0:03:57] And then, preservatives in all your drops. That’s why we always stress non-preserved drops because preservatives could be toxic and depending on who you are just depends on what preservatives you might be allergic to.

[0:04:10] I like to think of it like preservatives in your food. Preserved food are worse for you than natural food. Anything in a box, I try to avoid and I try to eat fresh produce.

[0:04:20] So, that’s one other thing I’d like to add in extrinsic evaporative dry eye, is lasik.
So, if you’ve had lasik, you’re kind of messing with it, that can also be classified
as non-sjogren dry eye. It’s kind of, we don’t know much about post lasik dry eye.

[0:04:37] We just know it’s bother some and we think it’s just because you’re cutting the nerves and you’re killing tissue with the laser and therefore causing some problems there.

[0:04:48] The intrinsic side is what we talk about on this community a lot and that’s meibomian gland dysfunction. So, the meibomian gland is a gland in the
upper and lower eyelid. And you can see all the arrows that I made. This points it out, so you have this whole thing right here being the meibomian gland and all these little pockets right here are oil factories.

[0:05:14] So what happens these oil factories produce the oil or the meibom, it puts it out into this gland, or the duct, and then it goes all the way down to the end and every time you blink this muscle pushes that oil out of the eyelid.

[0:05:29] Now, what we see when we see meibomian gland dysfunction is when the oil hardens right here at the end obstructing the duct. And so when the oil hardens and obstructs that duct the oil can’t get out.

[0:05:41] And so again going back a couple slides to this, if the oil can’t get out you have
no oily layer. So that’s why it’s called evaporative dry eye.

[0:05:49] The oily layer is responsible for keeping these tears in tact and so if you lose that oily layer your tears break up. The most common question I get or the most
common symptom I get in my clinic is my eyes run water or my eyes water a lot.

[0:06:06] Reason that is because the oil layer is not there. Your eye gets affected by feeling like there’s something in it because it’s dry and then your eye produces more watery tears because that’s what your brain think it needs.

[0:06:20] So it produces more watery tears from the lacrimal gland. So no oil leads to more watery tears. Which we know isn’t good. So how we treat the evaporative dry eye is through warm compresses, an omega-3 supplement, and like I talked about in the past an omega-3 has a couple of other vitamins and minerals that have been shown to help with dry eye.

[0:06:44] Then doing that warm compress with the massage afterwards seems to help with evaporative dry eye pretty well. You guys have heard of Lipiflow and all those
other treatments that we’ve discussed here as well.

[0:06:59] That’s all going to help with the treatment of evaporative dry eye. Also, making sure you eat vitamin A, avoiding preservatives, contact lenses, if you could avoid them that’s best, or a scleral lens is better.

[0:07:13] Then diseases such as allergies, affect it as well. If you have any questions leave them below. If you wanna check out our dry eye supplements, you can use the code FXDRYEYE at eyelovethesun.com 

 

1 comment

Doroty Weikel

Where can I get this?

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