Dry Eye Clinic

The Impact of Dry Eye Disease on our Lives

Dry Eye Disease is one of the most under-diagnosed eye diseases, and yet it is the most common reason why patients go see their eye doctor. Dry eye occurs when eyes do not produce the right quantity or quality of tears. Women are more frequently affected than men, and it is often caused by hormonal changes due to aging and menopause or medical conditions. Dry Eye is among the least understood eye conditions that affect large numbers of people. Many people mistake the dry eye symptoms for allergies, climatic conditions or just “eyestrain”. While all of these may aggravate Dry Eye symptoms, they are not the cause.

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 Chan 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!

Tear Osmolarity by TearLab

The TearLab Osmolarity System is the first objective and quantitative test for diagnosing and managing Dry Eye Patients. Hyperosmolarity, or increased sodium in the tears, has been described in the literature as a primary marker of tear film integrity. Your doctor will take a tiny sample of tears from both eyes and measure the Tear Osmolarity. Your Osmolarity Number gives your doctor a meaningful measure of the health and stability of the protective tear film that covers the surface of your eyes. The number correlates with the severity of the disease. If you are placed on a Dry Eye Disease Treatment Plan, your Osmolarity Number will be measured again at certain times to track your progress.


This is one of the tests that we offer at Lake Austin Eye as part of our dry eye exam. Clinical signs of dry eye disease often lag behind symptoms. One of the markers for dry eye disease is inflammation, notably a molecule called metallomatrixproteinase-9 (MMP-9). While other dry eye tests measure tear production or tear film stability, InflammaDry identifies increased levels of MMP-9, which allows us to identify whether your dry eye symptoms are a result of active inflammation around the eye contributing to dry eye symptoms or signs.

Elevated MMP-9 can also be associated with systemic disorders such as Sjogren’s Syndrome or other Rheumatologic diseases. Based on the results of your InflammaDry test, we can recommend anti-inflammatory treatment which may include steroid drops, Restasis®, or Xiidra®. The results of InflammaDry can also help us monitor your response to treatment over time.

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.


TrueTear® is a new state-of-the-art Dry Eye Treatment now available

TrueTear® causes your eyes to produce their own natural tears using tiny pulses of energy. These pulses activate a natural response through a clever technology called neurostimulation.

The TrueTear® tip stimulates a nerve in the nasal cavity with tiny pulses of energy, sending out nerve signals to the brain. The brain then sends nerve signals to the tear glands, and those glands react and temporarily produce new tears.

TrueTear® is a drop-free, drug-free option that puts you in control of your dry eye disease.

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.