MUSC Health Storm Eye Institute Expands To Establish Dry Eye Center

Karen Fernandez, M.D.

The MUSC Health Storm Eye Institute has provided years of exceptional eye care to its patients and will continue to do so as it expands to establish a center dedicated to the diagnosis and management of dry eye disease, a condition affecting more than 16 million adults in the United States, with increasing prevalence across all age groups. The Storm Eye Institute Dry Eye Center is located in the new MUSC Health West Ashley Medical Pavilion and offers the most current technology available for the treatment of dry eye.

Karen Fernandez, M.D., an MUSC Health fellowship-trained cornea and dry eye specialist, says dry eye is becoming more rampant, even among younger patients. “Everyone is now at increased risk for dry eye, especially in this age of technology and virtual interactions,” Fernandez says. “People are spending more time in front of screens and doing most activities virtually, and it’s been proven that prolonged visual activities cause decreased blinking rates and increased exposure of the ocular surface and dry eye.” This, in addition to other risk factors like systemic medications, previous eye surgeries and autoimmune disease, all contribute to the increasing prevalence of dry eye disease.

Dry eye is considered a chronic condition. It is multifactorial in origin, making treatment difficult and often frustrating for both clinicians and patients. Because the ocular surface and tear dynamics involve complex and intricate interactions among all of the ocular surface parts, it is important to determine and address the root cause of a patient’s dry eye disease.

The normal tear film is complex and made up of three layers: the mucin layer, the aqueous layer and the lipid layer. Dry eye can be categorized into either deficiency in the aqueous layer, which is more commonly found in patients with autoimmune conditions, or the more common deficiency in the lipid layer in patients with meibomian gland dysfunction (MGD).

Careful external eye and ocular surface examination and imaging are important to distinguish which category of dry eye a patient has in order to tailor and customize their treatment.

The Dry Eye Center houses the newest technology, including an Oculus Keratograph machine which has the ability to objectively analyze the tear film, measure tear height and lipid layer quality and viscosity, and determine tear stability and blink rates. It also can image the meibomian glands by using infrared technology and objectively measures ocular surface hyperemia, which reflects the severity of inflammation in association with dry eye. This has been an invaluable tool for treatment customization for dry eye patients.

“The diagnosis of dry eye is clinical. We examine the surface of the eye to make a diagnosis. However, because external examination also involves subjective measures of severity, it may be challenging to monitor improvement or treatment effect,” Fernandez says. “Having a machine that objectively measures tear film dynamics is extremely helpful in the diagnosis and long-term management of dry eye.”

The mainstay of dry eye treatment is lubrication. There are numerous over-the-counter artificial tears with different active ingredients that all help to heal the ocular surface damage that can occur from dryness. However, treatment takes more than just wetting the surface of the eye. More often than not, patients have concomitant dysfunction of their meibomian glands. These glands along the eyelids produce the lipid layer of the tear film, and when it is deficient, the tear film becomes unstable and quickly evaporates from the ocular surface. MGD is now considered the most common cause of dry eye.

Warm compresses and lid cleansing are the most commonly prescribed treatments for MGD. “These may not always be effective, especially in severe disease,” Fernandez says. The Dry Eye Center is able to offer various in-office treatments for patients with severe MGD, with hopes of improving the patient’s oil gland production. These include intraductal probing of the meibomian glands, thermopulsation treatment, use of a thermal MGD treatment device, cleansing treatment and manual gland expression.

“The idea is to relieve meibomian gland obstruction, liquefy the intraglandular oils with effective heat delivery, expressing these oils out and stimulating the glands to start producing liquid oil,” Fernandez says. “Although this will not eliminate the need to do in-home warm compresses, these in-office treatments have helped patients with MGD get more relief and improvement with their symptoms.”

Autoimmune conditions such as Sjogren’s syndrome can lead to severe underproduction of aqueous tears and severe dry eye. Chronic underproduction of tears leads to profound loss of surface epithelial cells, which creates a risk for secondary bacterial infection and potential sight-threatening complications.

Most of these patients get inadequate relief with conventional dry eye treatments and need to turn to other treatment options. Autologous serum eye drops are among the options. These are derived from the patient’s own blood, taking only the serum portion and making it into eye drops. Although this treatment does not have FDA approval, it is a widely accepted and recommended treatment for moderate to severe dry eye.

A patient’s serum contains proteins, growth factors and anti-inflammatory cells that are found in natural tears and are important in healing. The Storm Eye Institute Dry Eye Center offers this option for patients, with direct delivery of processed autologous serum to their own home.

Dry eye disease is a lifelong disease needing constant monitoring and care. The Storm Eye Institute, with its continued innovation in the form of the Dry Eye Center, hopes to provide the highest level of care and improve quality of life for patients affected by this disease.