Dry eye is a common condition associated with dryness and irritation

After a comfortable journey, we’ll welcome you to our clinic in the heart of Vienna or in Linz. Once you’ve met your treating doctor, we’ll get started. Depending on your needs, the preliminary examination consists of various diagnostic procedures:

• Medical history form for a better understanding of your situation
• High-resolution images of the anterior eye with a slit lamp biomicroscope
• Meibography: Examination of the meibomian glands
• OCT (optical coherence tomography) for the cornea
• Corneal topography for the shape of the cornea
• Measurement of the evaporation rate of tear fluid
• Keratograph: Test of the composition (lipids) of the tear film

All these examinations are neither unpleasant nor do they change your vision.

In your free and non-binding initial consultation, we will check whether you are suitable for treatment from a medical point of view. We can then select the best treatment method and finally put an end to dry eyes.

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• Meibomian gland dysfunction (MDD for short)
• Meibomian gland inflammation (meibomitis)
• Hailstone (chalazion) and sty (hordeolum)
• Can also be used on very sensitive skin

The light pulses are intended to stimulate cell metabolism through increased ATP production in the mitochondria. The body’s defenses are strengthened, reducing oxidative stress in the eye. The meibomian glands can be activated by the irradiation. They can regenerate and improve their function so that the meibomian glands once again release the right amount of lipids to strengthen the tear film. As with IPL therapy, heat also plays an important role.

• Tip: A combination of IPL and LM LLLT is particularly promising for moderate to severe dry eyes!

All you have to do is put on a special mask for around 15 minutes, which shines the light on your closed eyes. No pain – a pleasant feeling as if you were sitting in the sun.

In the case of mild to moderate eye dryness, a single treatment with Light Modulation may be sufficient. As a rule, however, 4 sessions are scheduled one week apart.

Preliminary examination with tear film analysis and meibography: 150 to 250 euros, depending on the effort involved. Treatment session: 300 euros. Package of four sessions for the price of three: 900 euros. Several sessions are usually needed; we discuss how many after the preliminary examination.

“My eyes are so dry today.”

This is a phrase that we often hear or even utter ourselves. Whoever says these words usually blames external factors for dry eyes. For example, heating air in the room is often blamed for dry eyes, and often rightly so. But what many people don’t know is that “dry eyes” also exist as a disease, and it has nothing to do with external influences. The condition is not serious. Nevertheless, it is disturbing, and sometimes very disturbing. This is because it is often difficult for patients to understand that a problem that is supposedly easy to solve is often difficult for the ophthalmologist to treat. To better understand this condition, let’s first look at the surface properties of the human eye, because only then can we understand why “dry eye” can occur in the first place.

The surface of the eye

This consists of the conjunctiva and cornea, which is covered by a thin layer of fluid, the tear film. The eyelids act as cleaners, wiping foreign bodies out of the eye. The tear film protects the eye from drying out – and it is much more complex than you might think. There are three components that make up the tear film. The first is a layer of water containing dissolved salt; the second is the so-called mucin layer, which is produced by mucous glands in the conjunctiva and therefore has a mucous consistency; and the third is a layer of fat that forms at the edge of the eyelid, more precisely in the Meibomian glands.

Each layer has its own function. The aqueous layer serves to moisturize the eye. The mucin layer, on the other hand, ensures that the aqueous layer adheres to the eye at all. And the fatty layer, in turn, ensures that the tear fluid evaporates slowly and can be replenished again and again. Every time we blink, we spread the freshly formed film of fluid over the surface of the eye, which happens on average 12 to 15 times a minute. Excess fluid in the eye drains into the nose via two microscopic openings on the lower and upper eyelid, the so-called lacrimal puncta.

The tear film and its function

The tear film has three tasks. The first is defense. Foreign bodies such as dust, pollen, tiny spores, viruses and bacteria are constantly entering our eyes. The surrounding temperature and any draughts also affect the eye. The tear film intercepts all of these factors and the blinking of the eyelids then washes them away, so to speak. Fluid is also responsible for ensuring that the outermost surface of the eye is as smooth as it is – which in turn ensures the ideal refraction of light. And this means that the optical quality is at its best.

The third function of the tear film is to moisturize and nourish the cornea. Without the film, the blink of the eye would rub directly against the conjunctiva and cornea and damage them over time. The tear film therefore also acts as a lubricant. It also contains nutrients with which it supplies the surface of the eye.

Dry eyes are widespread, and many people suffer day in, day out—more or less—from a lack of tear fluid. The causes vary widely. Particularly common causes of dry eyes are:

• Diseases such as diabetes, rheumatoid arthritis, Sjögren’s syndrome
• Eyelid problems: Disturbance of the eyelid margin structure
• Impaired or absent function of the meibomian glands
• Deficiency of tear fluid components
• Environmental influences: Wind, smoke, dust or dry air
• Working on screens: hours of viewing on smartphone, tablet and PC
• Wearing contact lenses can impair tear formation
• Age: The quality and quantity of the fluid decreases with increasing age
• Hormonal changes, especially in menopausal women
• Medication such as antihistamines, antidepressants or antihypertensives

Depending on the cause, there are different treatment approaches that can help against dry eyes. In many cases, the lack of tear fluid is also due to several of the causes mentioned above. A reliable diagnosis or determination of the cause can only be made by an ophthalmologist.

What causes “dry eye”?

The less tear fluid there is, the higher the concentration of substances present, such as mucus and salts. If this is the case, patients usually experience a feeling of stickiness in the eye or as if there is a foreign body in it. Often there is also a severe stinging or burning sensation. At the same time, the body releases more and more messenger substances that signal to the eye that it is inflamed – the eye then reddens or swells, it often feels hot and sometimes hurts. All this leads to blurred vision. Blinking and eye drops can help.

What sounds absurd is often a symptom: increased tearing of the affected eye. This is the case when the tear film no longer adheres perfectly to the surface of the eye, which is often due to a disruption of the lipid or mucus layer. The tear fluid then runs out, so to speak. Or the dryness has progressed so far that the irritation of the eye becomes very severe and more and more tear fluid is produced as a result. In the worst case scenario, this can all lead to chronic inflammation of the cornea, which in turn causes the uppermost layer to become cloudy.

Yes. Sometimes dry eyes only occur temporarily and go away on their own fairly quickly. This is the case when the cause can be found in temporary (environmental) factors. However, there are also cases in which dry eyes become chronic and do not go away again without suitable treatment. Chronic dry eye is usually due to age-related or hormone-related changes, or systemic diseases.

If dry eyes remain untreated over a longer period of time, further complications can arise. The eye becomes more susceptible to infections and even damage to the cornea is possible.

In principle, yes. However, the medical wisdom applies here: it depends on the individual case. Depending on the severity of the eye dryness and other individual factors, vision correction with a laser is possible despite dry eyes. There are even special procedures that are particularly suitable for people with dry eyes. However, caution is advised, particularly with procedures that can themselves cause dry eyes.

Overall, however, eye dryness is a risk factor in laser eye surgery. Tear fluid plays an important role in protecting the eye and in regeneration after laser eye surgery.

If you suffer from dry eyes yourself and are considering laser vision correction, we invite you to a free suitability test. We specialize in refractive surgery for dry eyes and will find the best possible solution for you.

In addition to the medical treatment options, there are a few tips that can help in everyday life to alleviate or reduce dry eyes:

• Use artificial tears (eye drops)
• Adequate fluid intake through water
• Ventilate regularly and ensure clean air
• Breaks during long periods of screen work
• Maintain eye hygiene and regularly clean the skin around the eyes
• Incorporate more omega-3 fatty acids into your diet
• Wear sunglasses to protect against UV radiation and foreign objects
• Avoid direct air flow, e.g. with air conditioning systems

Diagnosis and treatment of “dry eye”

If there is a wetting disorder, the ophthalmologist can determine this precisely. However, it is important to differentiate this from other eye conditions that have similar symptoms. In this case, the doctor stains the surface of the eye with special substances to determine the sensitivity of the cornea. If this confirms the suspicion of “dry eye”, further examinations are carried out. The amount of tears can be measured using a strip of filter paper inserted into the lower eyelid (the so-called Schirmer test). If necessary, there are other methods to confirm the diagnosis in order to rule out the presence of another form of the disease, which would have to be treated differently.

There are almost always several causes of “dry eye”, which is why there is no one method that always works. Patients need to be aware of this and the ophthalmologist should be open about this from the outset. Sometimes it takes several attempts on the part of the doctor to get the problem under control. Patients should also be made aware that the treatment effect only lasts for a certain period of time. Dry eye is chronic and the symptoms will return at some point. Health insurance companies no longer cover the costs of the treatment. Discussing this with the doctor may be understandable from the patient’s point of view, but it is useless.

“Artificial tears”

These are always the basis for treating dry eye. Artificial tears protect the surface of the eye by forming a lubricating film and also strengthen the tear film that is still present. There are many different types of artificial tears, but they all contain the same components. These are water, salts, sometimes agents for thickening (the tears then adhere better to the surface) and sometimes also preservatives. If these are not included, the artificial tears usually have to be used up within a day.

The effect of these preparations is better the thicker they are. This improves the adhesion of the artificial tears to the surface of the eye and the eye is better moisturized. However, a thicker substance temporarily impairs vision because it covers the eye like a veil. It is not possible for the ophthalmologist to predict how thick the product should be for each patient, as every patient reacts differently. It is therefore necessary to try to find the most suitable preparation through repeated trials. If possible, substances without preservatives should be used, as otherwise allergic reactions may occur. If you wear soft contact lenses, you should always use artificial tears without preservatives. (Anyone who suffers from “dry eye” and wears soft lenses must consult their doctor in detail anyway, as various complications can occur that would go beyond the scope of this article).

How large should the quantity of artificial tears be? The principle of “a lot helps a lot” applies here, and this only helps if they are administered regularly. The good news is that the wetting disorder can almost always be successfully combated with artificial tears.

Eyelid edge care

If inflammation of the eyelid edges is the cause of the wetting disorder, it is important to treat these eyelid edges. The aim is to improve the drainage of the fatty film produced in the Meibomian glands. This is achieved by removing skin exfoliation and crusts from the edges of the eyelids. This detachment is often only possible if an eye ointment is massaged into the corresponding areas. As long as the inflammation on the edges of the eyelids persists, no cosmetic products such as eye shadow etc. should be used on these areas.

Eye drops

There are two variants here: the autologous serum drops and anti-inflammatory drops from the industry. Human blood serum contains a variety of substances that relieve inflammation, which also has a positive effect on diseases on the surface of the eye. In order to utilize these effects, eye drops are obtained from the patient’s own blood. If eye drops from the pharmaceutical industry are used, these must also inhibit inflammation. If the effect is to be short-term, cortisone is almost always included; for longer-term help, only drops without cortisone are suitable.

Contact lenses

Lenses are a problem when patients have “dry eye”, as they often exacerbate the symptoms. However, there are some forms of this condition for which soft and thin lenses paradoxically help. They stabilize the surface of the eye and alleviate the symptoms. Almost always only temporarily, but still.

Close the tear troughs

If the tears run out of the eye too quickly, this is sometimes due to the tear ducts accumulating too much fluid. For a certain period of time, it then helps to close these tear ducts. A type of plug is used for this, which works like a bathtub plug. In rare cases, the closure may be permanently forced by the ophthalmologist. This is done by scarring the puncta.

The diet

As multifaceted as the body is in the production of some substances, it fails when it comes to others. Vitamins, for example, are not produced by the body – these, as well as omega-3 and omega-6 fatty acids, must be obtained from food. The fatty acids have a positive effect on the glands at the edge of the eyelid, on the secretion of tears and on messenger substances that signal inflammation. Omega-3 is rarely found in our food, which is why it is administered through supplements or special foods. Omega-3 fatty acids are found in oily fish or flaxseed oil in particular. Drugs are also available on the market to promote secretion, although these can have serious side effects. This is why they are only ever recommended in severe cases.

When it comes to dry eyes, “normal eye drops” help best. They are similar in composition to natural tear fluid (water, lipids and mucins) and moisturize the eye. You can recognize good eye drops by the fact that they:

• Long-term moisturizing
• The right balance of ingredients includes
• Contain as few preservatives as possible – as many as necessary
• Have the desired viscosity (thick or thin liquid)
• The following may be compatible with the contact lenses
• Free from potentially irritating substances are

If the dry eyes are due to an allergy, there are special anti-allergic eye drops that can relieve symptoms such as itching, redness and swelling. For inflammation, there are antibiotic eye drops – e.g. against conjunctivitis.

Other measures

Surgery is rarely performed in the case of “dry eye” and only if the case is particularly severe.

For example, the eyelid can be sutured to the side. Ophthalmologists must discuss the consequences with patients in great detail.

If the tear fluid evaporates more quickly than it should, special glasses are sometimes prescribed that have a side shield that is anatomically adapted. This is intended to provide protection from the wind.

Incidentally, knowledge about “dry eye” is constantly improving, which means that in future we can expect drugs that work very well and have no side effects.

What patients can also do

In addition to airing the room several times, a room humidifier can be used, especially in winter when there is a lot of heating. Damp cloths over the heating are also always helpful, as is greenery in the room, which creates a good microclimate. In the car, the fan should only be used very sparingly and should not be aimed at the eye area. Rooms in which people smoke should be avoided and the consumption of cigarettes (and alcohol) should be stopped. Plenty of sleep and a balanced diet with lots of vitamins are now just as important as a good supply of water – two liters a day is the minimum.

If you want to swim, you can do so, but swimming goggles are highly recommended. If you work at a monitor, you need to take frequent breaks, and consciously blinking helps to alleviate discomfort. Contact lens wearers are advised to take them out from time to time and to moisten their eyes frequently with the appropriate liquids. Cosmetics should only be used very carefully, and if they are used, then they should be low-irritant products.

However, preparations for cleaning the eyelid are important.

Last but not least, regular examinations by an ophthalmologist are essential.

In ophthalmology, IPL therapy to improve meibomian gland function, low-level laser therapy (LLLT) to promote cell regeneration and reduce inflammation and punctal plugs, which prevent tear drainage, have become established as modern treatment methods for dry eyes. In addition to these measures, eye drops can of course always be used for external moisturization.

LLLT uses low-energy laser light to support cell regeneration on the surface of the eye and the function of the meibomian glands. For example, inflammation can be reduced, which can lead to improved tear production. This can relieve dry eyes without taking a major risk of side effects or complications.

These are “small plugs” that are inserted into the duct through which tear fluid normally drains away. This prevents it from draining too quickly, so moisture stays on the surface of the eye longer. This makes particular sense when the patient simply produces too little tear fluid and other treatments have had little success.

How long or how often you need to be treated depends on the procedure. IPL and LLL therapies are usually carried out in several sessions. This can take several weeks. Many patients report initial progress after just a few applications. Punctal plugs, on the other hand, work immediately after insertion.