The Meibomian Glands and Dry Eye

These images show the meibomian glands, which exist within the lining of our eyelids. These glands produce the oils that coat the surface of our eyes and keep the watery portion of our tears from evaporating (drying out). Together, the watery component and the oily layer make up the tear film. The first image, above, shows an eye with a healthy distribution of meibomian glands. The other images show eyes with varying degrees of meibomian gland drop out. Meibomian gland drop out is a major cause of dry eyes and ocular surface disease. Once these glands are compromised they do not grow back or regenerate. There are a number of technologies that enable us to manage dry eye disease including many over the counter lubricating drops as well as a number of prescription medications. I have found that a well designed and fit scleral lens is a technology can allow many patients with dry eye disease to regain ocular comfort once again as well as providing so many patients with clear vision.



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Scleral Lens Shells Used to Help with Sleep

Scleral lens shells used to help patient sleep through the night

The patient pictured here was unable to close his eye completely especially during sleep due to multiple eyelid surgeries.. Due to the need to wake up every 2 hours to use lubricating drops, he was unable to achieve a complete night’s sleep. When we met this patient he was unable to sleep throughout the night for 2 years. We fit both eyes with specially designed scleral lens shells for him to use during sleep. With these lenses this patient is now able to sleep throughout the night for the first time in years. The scleral lenses that we designed for this patient were
designed for use during sleep only.

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Autologous Serum for Dry Eyes

There are many patients suffering from chronic dry eyes due to prior surgeries, medications and autoimmune disease. Many of these patients will not be able to obtain relief from over the counter lubricating eye drops. A well designed and fit scleral lens will provide great relief to this very “high need” patient population. This is because a scleral lens will keep the front surface of the eye in a moist environment. Occasionally however, a scleral lens will not provide the level of comfort that the dry eyed patient is seeking.

With this group of patients, autologous blood serum tears (serum tears for short) have been known to provide significant improvement in patients’ symptoms. Serum tears are made from the patient’s own blood and are composed of a complex mix of growth factors, proteins, antioxidents and lipids. Because the serum tears are made from the patient’s own blood, they
will closely mimic their own natural tears. Many of our patients suffering from ocular surface disease, are wearing scleral lenses and using blood serum tears when not wearing their lenses.

The following three images use a special dye to highlight defects on the cornea. Each of these eyes might benefit from autologous serum



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Dry Eyes Protected with GVR Scleral Lens

Three years ago, the young woman in this photo developed painfully dry eyes . The cause of her dry eyes is undetermined and not well understood. For the past three years both eyes have been painful with constant burning and itching. Last week we fit this patient with GVR Scleral lenses. These unique lenses vault over her dry corneas and keep the front surface of the eye in a liquid (sterile unpreserved saline) environment. When this patient returned home after a weeks stay in Miami, she was seeing clearly and comfortably once again. The pain, the burning and the itching were gone. Upon leaving to return home, she presented us with an awesome strawberry chocolate cake. It’s moments like this that give my professional life extra meaning. Over the next few months we will be seeing this young woman again several times for follow-up visits to make sure that her eyes remain clear and healthy.

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Lasik in 2002 with Severe Dry Eyes, now 20/20 with GVR Scleral Lens

This patient underwent LASIK surgery in 2002. For 2 years his vision was clear and sharp even though he suffered from severe dry eyes. In 2004 his vision started to deteriorate slowly until 2010 when he was diagnosed with post-LASIK ectasia. Multiple eyeglasses and contact lenses were prescribed but the end result was blurred, distorted vision which could not be corrected with conventional lens technologies. In 2013 he was fit with GVR Scleral lenses which are providing him with clear (20/20), comfortable vision without visual distortions and all day comfort.

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FAQ For Dry Eyes and Scleral Lenses

I suffer from chronically dry eyes due to arthritis and the multiple medications that I need to take to address other health issues. Every time that I blink, it feels like there is sandpaper rubbing against my eyes. Can scleral lenses help me with my eye comfort?

The answer to this question is yes. In addition to providing clearer vision, a scleral lens serves as a therapeutic device. The lens acts as a buffer between the dry, compromised cornea (the front surface of the eye) and the eyelids. When you blink, the eyelids will no longer be rubbing against the irritated, dry cornea but against the outside surface of the scleral lens. In addition, the scleral lens does not touch the cornea. Instead, the scleral lens vaults over the cornea and comes to rest on the white portion of the eye (the sclera). Pure, unpreserved saline solution acts as a liquid reservoir between the back surface of the scleral lens and the front surface of the cornea. In many cases, the irritated cornea will heal due to the protective nature of the scleral lens. Comfort and vision in almost all cases is excellent.

I was diagnosed with dry eyes and have difficulties wearing soft lenses. I have tried gas permeable lenses but can only tolerate them for a very short period of time. Will scleral lenses help me?

Yes. Almost all patients who have been diagnosed with dry eyes have issues with the tear film coating the cornea and protecting the cornea from the environment and the blinking action of the eyelids. All soft lenses act as sponges by soaking up the tear film on the corneal surface making your dry eyes even drier. Scleral lenses vault over the compromised cornea and come to rest on the white portion of the eye known as the sclera. The space between the back surface of the scleral lens and the front surface of the cornea is filled with sterile, unpreserved saline solution. In other words, your dry corneas are always in a liquid environment. The very special scleral lenses that we design serve 3 purposes: 1. Vision. Visual acuity with scleral lenses is almost always excellent and stable both during the day and at night. 2. Therapeutic. Because the corneas are always in a moist environment, the dry, irritated corneas have the opportunity to regain a much healthier appearance. 3. Protection. Most eyes that have been diagnosed as dry have a corneal surface that is irritated and compromised. Scleral lenses do not move on the corneal surface like a gas permeable lens does. In addition, the scleral lens protects the cornea from the environment and the blinking action of the eyelids.

I have read about dry eyes and how it can impact contact lens wear. Can you elaborate on this? Can scleral lenses address this issue?

The majority of contact lens problems, including intolerance and limited wearing time are related to the tear film lying over the cornea. These difficulties are caused by disruption of the tear film and increased evaporation of the tear film caused by the contact lens. In addition to contact lenses affecting the tear film, there are other causative factors including medications used by the patient, and medical conditions that may be affecting a patient’s tear film. In the strictest sense, scleral lenses are not really contact lenses in that there is no “contact” with the cornea. Because the scleral lens does not touch the cornea, there is no disruption to the tear film. In addition, because of the liquid reservoir between the back surface of the scleral lens and the front surface of the cornea, the cornea is always in a moist environment. One other factor to be considered by those suffering from dry eyes: Many corneas are not spherical or smooth but may be very irregular. The blinking action of the eyelids over an irregular corneal surface can create additional comfort issues for patients suffering from a dry eye. Scleral lenses have smooth surfaces. The blinking action of the eyelids over a scleral lens will not add to any corneal irritation already there. To the contrary, the scleral lenses will actually protect the dry cornea from the environment and the blinking action of the eyelids.

My eyes are always dry even at night. Can I wear scleral lenses while sleeping?

Scleral lenses have a therapeutic effect on a dry eye. Remember, scleral lenses do not touch your cornea but come to rest on the white portion of your eye known as the sclera. The space between the back surface of the scleral lens and the front surface of the cornea is filled with unpreserved sterile saline solution. In other words your corneas are always in a dry environment and your corneas are also protected from the blinking action of your eyelids. I prefer that my patients not sleep with their lenses overnight. However, if you wish to take a short nap with the lenses for about an hour, that will be OK to do.

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Dry Eye and the Scleral Lens

There are millions of people throughout North America who suffer from chronic dry eyes. Many of these people are suffering from
dry eyes due to ocular surface disease. Others have dry eyes due to the medications that they are taking. Dry eyes are also a symptom of systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjorgren’s Syndrome ( a triad of dry eyes, dry mouth and rheumatoid artritis).

Millions of post-refractive surgical patients who underwent ocular surgeries such as LASIK and Radial Keratotomy are suffering from dry eyes. One of the reasons for this surge in dry eyes in this particular population is the irregular compromised ocular surface caused by these surgical procedures. Many of these patients still have open corneal wounds which never healed completely. Needless to say, many of these patients have suffered significant pain which resulted in severe depression and the many ramifications of severe depression. These include loss of work, inability to study, family strife and so on. In addition, the vision in this population is not stable even with eyeglasses or contact lenses. Conventional contact lenses may provide clear vision for a very short period of time but significant discomfort and pain will set in after a very short period of time.

Over the years our specialty practice has treated thousands of patients who have suffered for years with chronic dry eyes caused by a host of diseases, dystrophies, medications and ocular surgeries. Almost all of these patients are now functioning on a much higher level because of GVR Scleral lenses. This particular scleral lens design protects the ocular surface from the environment and the blinking action of the eyelids. These lenses do not touch the compromised, dry ocular surface. Instead, the lenses vault over the front surface of the eye (the cornea) and come to rest on the white portion of the eye (the sclera). A liquid reservoir exists between the back surface of the lens and the front surface of the eye. In other words, the ocular surface is always in
a moist environment. Many of the compromised corneas that we have seen have undergone a healing effect after having worn these unique lenses. Dry irritated ocular tissues often have a more robust appearance when viewed under our ocular microscope. Of course, the comfort with the GVR Scleral lenses is excellent. Most patients will have virtually no sensation or awareness of a lens on the eye.

In addition to the therapeutic benefits of the GVR Scleral lens, the vision provided by this unique technology is almost always excellent. The compromised irregular cornea is replaced as an optical surface by this lens. In addition to clear vision, the improved vision will not fluctuate but will be stable. Almost all patients wearing GVR Scleral lenses are able to wear their lenses for of their waking hours. Because of these lenses, thousands of patients over the years have avoided undergoing corneal transplant surgery.

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Dry Eye Videos

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