Dry Eye Clinic

Your eyes need a constant layer of tears- called the “tear film”- to maintain and protect the ocular surface. In Dry Eye, underlying changes to the health of the tear-producing glands can result in a change in the quantity and quality of the tears you make. In addition, there are special glands on the margin of your upper and lower eyelids, the Meibomian glands, that produce lipids (oils) that prevent your tears from evaporating. All of these glandular changes and inflammation result in a tear film that can no longer provide enough nourishment or protection to the surface of your eye. This results in burning, excessive tearing, blurred vision, redness and ultimately becomes a chronic, progressive disease. If left untreated, the changes in your eyes become permanent and difficult to improve.

Drs. Cottle and Dr. Broyles are Dry Eye Disease specialists in Austin, TX. Dr. Cottle was one of the first in her area to offer the LipiFlow® treatment for Evaporative Eye Disease (see below). They are the first doctors in the Austin area to offer the Sjö™ test for early detection of Sjogren’s Syndrome (see below). They also offer comprehensive testing, including Inflammadry® testing, which can detect a major marker of inflammation. It is their mission to try to improve the lives of those suffering from this debilitating disease, and they bring personal experience as well since both doctors are Dry Eye Disease patients themselves!

Lipiscan

LipiScan is a diagnostic tool used to assess the health of meibomian glands in the eyelids, which are crucial for healthy tear film. These glands can dysfunction in conditions like meibomian gland dysfunction (MGD),  a common cause of evaporative dry eye disease. By providing high-definition images of the meibomian glands, LipiScan helps eye care specialists diagnose MGD accurately, enabling them to develop targeted treatment plans.

High-Definition Images:
The device provides high-definition images of the gland structure, allowing for accurate assessment of gland morphology and function.

Fast and Efficient:
The procedure is relatively quick, taking about one minute to image both lower eyelids.

LipiScan and LipiFlow:

• LipiScan is often used in conjunction with LipiFlow, a treatment device that addresses MGD by applying heat and gentle massage to the eyelids.
• While LipiScan helps diagnose MGD, LipiFlow aims to treat it by improving meibomian gland secretions and reducing gland obstruction.

LipiFlow^® by TearScience

If your Dry Eye Disease is determined to have an eyelid glandular component, your may be a candidate for this exciting technology. LipiFlow® is a new procedure designed to treat the root cause of Evaporative Dry Eye, blocked Meibomian glands. Opening and clearing these blocked glands can allow them to resume natural production of lipids (oils) needed for a healthy tear film.

Some treatments attempt to add more liquid to your tears, but without the complex natural oil, tears continue to evaporate faster than produced.

Your doctor will examine your eyelids and ocular surface in the clinic and decide if you have poor Meibomian gland health. If you are a good candidate for this procedure, you will be brought into a quiet room and an eyepiece called the Activator will be gently placed against your inner eyelids. This innovative design allows heat to be placed against the posterior surface of the Meibomian glands, as opposed to the outside of the eyelid. As the contents of the glands are softened, the Thermal Pulsation System compresses the glands which clears the contents. This allows your body to resume the natural production of lipids (oils) needed for your tear film. The Activator’s single-use design and built-in sensors ensure a safe, sterile treatment.

Imagine returning to doing the things you enjoy, without worrying about your eyes. LipiFlow® could be your first step to relief.

IPL for Dry Eyes

Originally used in dermatology, Intense Pulsed Light (IPL) emits various wavelengths of light to target hemoglobin and melanin, which may be overexpressed in inflamed meibomian gland tissues associated with dry eyes. By selectively heating and treating these areas, the goal is to unblock the glands and improve blinking function to restore the eye’s natural lubrication. The procedure involves a series of brief pulses and can feel like the light snapping of rubber band against the skin near the eyes.

A typical treatment regimen involves multiple sessions, about a month apart and spread out over several months. Each session lasts approximately 15 to 20 minutes. During the procedure, you will wear protective eyewear to shield your eyes from the intense light pulses.

The number of treatments needed varies based on the individual’s severity of dry eye symptoms and response to the therapy. Some people report significant improvement after just one or two sessions, while others may require additional treatments to achieve desired results. You may require treatments every 3-6 months to maintain your results.

How it works:
A handheld device emits brief pulses of light around the eyes. The light penetrates abnormal capillaries and dissolves excess oil in the meibomian glands. The glands open up and release more protective oil. The treatment can also reduce or eliminate eyelash mites (demodex) that can cause dry eyes.

RF for Dry Eyes
Radiofrequency (RF) delivers high frequency electrical current to the skin to generate heat and stimulate collagen production. This is a safe and effective in-office treatment for your dry eyes.

The meibomian gland is responsible for producing the oil in your tears. The oil is important because it stops your tear film from evaporating too quickly. If the meibomian gland becomes blocked, you can experience the symptoms of dry eye. This is known as Meibomian Gland Dysfunction (MGD).

The heat from RF helps to melt the thick oil secretions and unclog the meibomian gland, improving the quality of your tears. RF can also reduce inflammation around your eyes that could be contributing to your dry eye symptoms

Autologous Serum Tears

Autologous serum eye drops (ASEDs) are a treatment for dry eye syndrome made from a patient’s own blood serum, offering a more natural and effective approach compared to artificial tears. These drops contain components similar to natural tears, including vitamins, growth factors, and proteins, which can help heal and lubricate the ocular surface.

Here’s a more detailed explanation:

What they are:
ASEDs are customized eye drops made from a patient’s blood serum, which is the straw-colored liquid component of blood remaining after clotting.

How they’re made:
Blood is drawn from the patient, allowed to clot, and then centrifuged to separate the serum. The serum is then diluted with a sterile saline solution and stored in vials, often frozen.

Why they’re used:
ASEDs are used to treat dry eye disease, especially in cases where standard artificial tears are not sufficient or for conditions like Sjogren’s Syndrome, severe dry eye disease, post-refractive surgery dryness, or corneal disease.

Benefits:
They can provide relief from dry eye symptoms by supplementing the eye with natural tear components, potentially promoting healing and reducing inflammation.

Cost and Availability:
ASEDs may not be covered by insurance and can be more expensive than artificial tears, but are generally less than $200 for a 90-day supply.

How to obtain them:
Patients typically need a prescription from an ophthalmologist and will need to go to a specialized pharmacy for preparation and dispensing.  We have a special compounding pharmacy in Austin that we use for our ASED patients.

Dr. Cottle is the first doctor in Austin to offer Sjö™

Sjögren’s (SHOW-grins) Syndrome is a chronic autoimmune disease in which a person’s white blood cells attack their moisture-producing glands.  Today, as many as 4 million Americans are living with this disease.  Although the hallmark symptoms are dry eyes and dry mouth, Sjögren’s also causes serious complications throughout the entire body, resulting in dysfunction of the kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas and the central nervous system.  Patients may also experience extreme fatigue and joint pain and have a higher risk of developing lymphoma.  Nine out of 10 patients are women.

Early diagnosis and proper treatment of Sjögren’s Syndrome is important.  In the past, reaching a diagnosis can often be difficult and has been found to take an average of 4.7 years from the onset of symptoms.  Lip biopsies, which are painful, have often been the only definitive test available.  In the past, testing with bloodwork fails to identify the disease in the early stages.

Now we have advanced diagnostic testing for the early detection of Sjögren’s Syndrome. Often, Dry Eye Disease can be the first sign of Sjögren’s Syndrome.  The advanced diagnostic panel involves the detection of traditional markers combined with three novel, proprietary biomarkers, which allow for earlier detection of the disease.