Dry eyes often have high concentration of solutes in the tear film. When tear osmolarity is checked, it can be elevated in either eye. Not only does this help with diagnosis, but it can be tracked over time to judge the response to treatment. A lower osmolarity makes both the doctor and the patient feel better about the effectiveness of the prescribed treatment plan.
When the eyes are inflamed, there is a marker for inflammation called MMP-9 (matrix metallopeptidase-9) that can be checked. This is done via Inflammadry testing. Special inserts are used to analyze the tear film and it gives a positive or negative result, not unlike a pregnancy test. This can be helpful in our treatment planning, as topical steroids, Restasis or Xiidra may be more helpful in this scenario.
The Lipiview can perform multiple tests and examines the eyelids and blinking phenomena from multiple angles. It looks at the lipid layer thickness, the number of partial blinks in a set time period, and images the meibomian glands showing subtle signs of scarring. This gives an indication as to how severe the dry eyes truly are, as meibomian gland dropout is a sign of permanent damage. If the 30 or so meibomian glands in each lid appear to be intact, but the glands cannot be manually expressed on exam, then they may be clogged. This means the glands should be viable and have the ability to be rehabilitated. If damage is noted, a meibomian gland probing may be necessary to open up glands that are on the cusp of permanent damage.
At the end of the day, these tools are only present to help complement our direct slit-lamp examination. The oil glands are expressed with a Korb evaluator and stains with fluorescein and/or rose bengal are applied to the ocular surface. Values such as tear breakup time, the time it takes for your tear film to start evaporating from the corneal surface, are recorded.
Based on the dry eye questionnaire, dry eye testing and exam findings, your doctor will form a comprehensive treatment plan customized just for you.