Dry Eye Disease

Dry eyes are caused by a lack of adequate tears. Your tears are a complex mixture of water, fatty oils and mucus. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eyes from infection.

For some people, the cause of dry eyes is decreased tear production. For others it's increased tear
evaporation and an imbalance in the makeup of your tears.

Meibomian gland dysfunction (MGD) is
blockage or other abnormality of the
meibomian glands so they don't secrete
enough oil into the tears. This lipid layer
covers the watery part of the tears,
preventing them from evaporating. MGD is
a leading cause of dry eye syndrome, made
worse by numerous risk factors (listed
below). If left blocked, these glands can atrophy over time, rendering them inactive.

Signs/Symptoms of Dry Eye

  • A stinging, burning or scratchy sensation in your eyes
  • Stringy mucus in or around your eyes
  • Sensitivity to light
  • Eye redness
  • A sensation of having something in your eyes
  • Difficulty wearing contact lenses
  • Difficulty with night time driving
  • Watery eyes (which is the body's response to the irritation of dry eyes)
  • Blurred vision or eye fatigue

Risk Factors

  • Medications such as antihistamines,
    Decongestants, birth control, antidepressants,
    and others
  • Age (dry eye is more common in people age50
    or older)
  • Windy, smoky, and dry environments
  • Seasonal Allergies
  • More than 1 hour of screen time per day on
    computers, tablets, smartphones, etc.
  • Eating a diet low in vitamin A or Omega-3
  • fatty acids
  • Wearing contact lenses

Dry Eye Treatment

Consequence of Struggling

step 1

Over time the glands that supply the lipid component to the tears (essential in preventing evaporation) can develop blockages (See figure 3}. These blockages are usually a result of dried lipid (Meibum) in or around the gland. The purpose of any lid heating treatment is to open the gland orifice and soften or partially melt the Meibum within these glands. Research has shown that continuous heat needs to be applied for 6-10 minutes to the upper & lower lids to be effective. There are three methods (listed below) that can be used to accomplish this.

  1. Bruder mask (or generic equivalent): These beaded masks are available at most pharmacies. The great thing about these masks is how well they retain heat. Most masks will retain heat for the required 6-10 minutes with only one re-heating. The down side is this method requires a microwave to heat the mask. Instructions for heating will be on the box. This is my favorite method because of its simplicity.
  2. Warm Compress: A washcloth and VERY warm water should be applied directly to the top and bottom lids. Research has shown the temperature of the water needs to be greater than 104°F (40°C) to be effective. Just make sure it is not so hot that it irritates or scolds the skin. You will need to reheat the washcloth approximately every 2 minutes to keep the temperature from dropping below the required level.
  3. The Bundle Method: Dampen 4-5 washcloths with room-temperature water. Squeeze out the excess water. Fold the towels into long rectangles. Wrap the first towel into a tight cylinder then continue wrapping the remaining towels around that one until you have a large bundle. Place the towels in a container and cover with a lid. Microwave on high for 1 minute, 50 seconds. Allow towels to cool for 1- 3 minutes until desired temperature is reached. Take out the first (outside) towel for use on eyelids and place the cover back on the container. Once two minutes of treatment is finished, replace the washcloth with another from the container. Continue until all washcloths have been used. The point of this is to not have a ‘gap’ in applied heat by always having a hot washcloth available.

Massage the top and bottom lids

step 2

Now that the tear glands have been heated much of the material inside the glands will have liquefied, and the gland opening will be enlarged. This is the optimal time to flush some of that material out of the gland. We accomplish this with lid massage.

On the top lids, massage downwards toward the lid margin putting mild pressure with the ball of your finger toward the globe (ball) of the eye. Your stroke should start on the upper portion of the eyelid and end where you feel the base of the eyelashes-this is the lid margin. Massage 5-6 times on the upper lid (approximately 20 seconds per lid). Repeat on the bottom lid, massaging upward toward the lid margin. This is always done to both eyes.

Cleaning the lid surface

step 3

lf you have done a good job, some of the dried Meibomian oil should now be on the lid surface. (It is too small to see with the naked eye.) We do not want it to stay there and have an opportunity to fall back down into the enlarged gland opening you just created with the hot compress. Clean the surface by diluting Baby shampoo and a Q tip or use Lid Scrub pads that can be found at the local pharmacy. Gently move the Q tip or Lid Scrub pad back and forth over the lower and upper lid margin (by the lash base) for 3-4 swipes. Be sure to wipe along the lid margin itself and not to touch the very sensitive front of the eye (the cornea).

Cleaning the lid surface

step 4


Vision therapy is well worth the response, time and effort. Our Son had a hard time focusing and writing neatly. After vision therapy Seth could complete a task in half the time if previously took. His abilities to focus improved greatly and so did his handwriting.

Also, he was better at listening. As a parent, we wanted learning to be fun for our Son, and vision therapy made this possible.

Amanda T.

Vision Therapy is well worth the expense, time and effort. Our son had a hard time focusing handwriting neatly. After vision therapy Seth could complete a task in half the time it previously took his abilities to focus and improved greatly and so did his handwriting.

Also, he was better at listening. As a parent you wanted learning to be fun for our son and vision therapy made this possible.

Alexa H.

Vision Therapy has given or son the tools he needs to be able to scan and read the written word more effectively and efficiently.

He love working with John and these working sessions give him the motivation to gladly work on his homework assignments.

It amazed us to see the difference in the tracking of his eyes and along a line of it's from the beginning to the end of the treatment.

Dr. McBryar , Kristen and John  are all marvelous and we would recommend them to anyone I only wish that we would have found them sooner!

Charlotte M.

Prior to coming to the institute for vision development my son complained of daily headaches. Therapy has eliminated his headaches completely. I love knowing my son is able to learn pain-free for the rest of his life because of the work that has been done over just a few weeks in this office. He he absolutely loved coming that didn't even feel like going to a doctor or therapy. We are grateful for the relief he was able to find by coming here.

Thank you!

Olivia C.

Seems much less frustrated with life

Reads non-stop and fast

Spelling abilities have been hugely improved

Seems much more confident

Thank You!!!

Kelly O.

When we first came to the practice, my son did not have huge issues, but lots of small ones- trouble with reading, sports (hitting the baseball consistently), coordination, etc- that were not easily detectable,but when put together presented issues. The staff here were all very professional and loving towards him. While I was concerned in the reading, my son was concerned with the athletic side. Seeing improvement night off the bat gave him confidence that i have nor seen in him and made him want to not only Come to therapy, but also made him want to work hard. He has surpassed his grade level and above in reading and hit his first home run this year! Thank you!!!

Alice M.
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