Dry Eye Disease (DED) is a multifactorial condition characterized by an insufficient ability of tears to adequately moisten the ocular surface. This results in symptoms typically associated with dryness, irritation, and visual disturbance. The condition can stem from quantitative (insufficient tear production) or qualitative (poor tear composition or stability) abnormalities in the tear film.

The tear film, which covers the surface of the eye, is essential for maintaining ocular comfort, clarity of vision, and corneal health. It consists of three layers:

• Mucin Layer is secreted by Goblet cells of the conjunctiva and promotes even distribution of the aqueous layer by converting the hydrophobic surface of the cornea into a hydrophilic one, allowing tears to adhere effectively.
• Aqueous Layer is secreted by main lacrimal gland and accessory lacrimal glands (such as Krause and Wolfring glands) and comprises the bulk of the tear film. Provides moisture, oxygen, and nutrients to the ocular surface and helps flush away debris and pathogens.
• Lipid (oily) Layer is secreted by Meibomian glands located in the eyelids and reduces tear evaporation and enhances tear film stability. Also contributes to the smooth optical surface and lubrication during blinking.

Tear Film Layers

Disruption in any of these layers can lead to tear film instability and ocular surface damage, which underlies the pathophysiology of dry eye disease.

Causes of Dry Eye Disease

• Inflammation of the eyelids (Blepharitis);
• Meibomian Gland Dysfunction (MGD);
• Pathology of periorbital skin (Atopic dermatitis, Seborrheic dermatitis, Rosacea);
• Allergic conditions;
• Decreased blinking frequency, for example, due to prolonged screen time;
• Medication-induced (Antihistamines, Sleeping pills, Painkillers, Diuretics, Oral Contraceptives, Antidepressants, Medications for acne, Antihypertensive drugs and Parkinson’s disease treatment medications);
• Autoimmune diseases such as Sjögren’s syndrome, Rheumatoid arthritis, Systemic lupus erythematosus (SLE), Scleroderma, Autoimmune thyroid disorders;
• Improper contact lens use (e.g., overwearing or poor hygiene) leading to corneal irritation and increased sensitivity;
• Vitamin imbalances (deficiency or excess);
• Hormonal imbalance and hormonal therapy;
• Use of homeopathic medicines;
• Environmental factors such as low humidity, windy conditions, air pollution, smoky or dusty environments, air conditioning;
• Lagophthalmos due to neurological conditions or eyelid surgery.

The mechanisms of blepharitis, meibomian gland dysfunction (MGD), and dry eye disease are so closely interconnected that they form a self-perpetuating “vicious cycle” of ocular surface disease. Meibomian gland dysfunction is characterized by obstruction of the gland ducts and/or qualitative and quantitative alterations in the lipid (meibum) secretion. These changes disrupt the lipid layer of the tear film, compromising its stability and leading to increased tear evaporation. The resulting tear film instability and evaporative dry eye contribute to ocular surface inflammation and irritation. In addition, MGD promotes the accumulation of altered or excess meibum along the eyelid margins and eyelashes. This environment favors the proliferation of skin bacteria, contributing to the development of blepharitis. Dandruff-like deposits (collarettes) may form along the lash line, further irritating the ocular surface. The Demodex mite, a common ectoparasite of human skin, can exacerbate this process. Under favorable conditions (such as poor lid hygiene or increased sebum), Demodex mite may proliferate, leading to blepharitis, a chronic inflammatory condition of the eyelids associated with significant ocular discomfort.

It is important to note that the incidence of dry eye increases with age, particularly in individuals over the age of 50, largely due to a natural decline in tear production and changes in tear film composition. Additionally, women are more frequently affected than men, which is often attributed to hormonal fluctuations that can adversely affect the function of the lacrimal and meibomian glands, contributing to tear film instability and ocular surface inflammation.

Typical symptoms of Dry Eye Disease include:

• Burning, stinging, or foreign body sensation;
• Redness and irritation;
• Itchiness;
• Heaviness or eye strain;
• Mucous discharge;
• Blurred or fluctuated vision;
• Excessive tearing;
• Difficulty wearing contact lenses;
• Increased light sensitivity.

Diagnosing dry eye disease goes beyond basic slit-lamp exams and requires specific diagnostic tests to evaluate tear production, tear film quality, and ocular surface integrity.

• Schirmer’s Test - Filter paper strips are used to measure the tear production under different conditions (without or with anesthesia);
• Diagnostic dyes – for example, Fluorescein to assess ocular surface integrity and tear film stability;
• Optical Coherence Tomography (OCT) – for the aassessment of the epithelial thickness maps.

At Akhali Mzera, we use the IDRA device — a cutting-edge, computer-aided diagnostic device that represents the gold standard for assessing dry eye disease. This innovative and sophisticated device provides a comprehensive evaluation of the ocular surface and tear film in just a few minutes. It offers non-invasive, high-resolution imaging and analysis, allowing clinicians to ensure that patients receive the most accurate diagnosis and the most effective treatment strategies tailored to their specific type of dry eye disease.

Dry eye diagnostic device IDRA

The following examinations can be performed using IDRA device:

• Non-Invasive Tear Film Break-Up Time (NIBUT) - evaluation of tear film stability without the use of fluorescein dye;
• Quantitative and qualitative assessment of the lipid component of the tear film using automated interferometry;
• Meibography - High-resolution imaging of the meibomian glands to evaluate their structure, distribution, and potential dropout—crucial for diagnosing meibomian gland dysfunction (MGD);
• Determination of the tear meniscus height using non-invasive imaging techniques. This parameter reflects the aqueous layer volume and is a reliable indicator of tear production;
• Identification of clinical signs of blepharitis and demodicosis, which are common contributors to ocular surface inflammation and tear film instability.

The results of the examination are presented in a clear and structured format, facilitating effective communication between the doctor and the patient. Based on the analyzed data, the integrated software provides evidence-based treatment recommendations, guided by algorithms developed in collaboration with leading ophthalmologists worldwide. Additionally, the system enables dynamic monitoring of the ocular surface condition through comparative analysis, allowing for ongoing assessment and personalized treatment adjustments over time.

Given that dry eye disease is a multifactorial in nature, its effective management requires a comprehensive, individualized approach.

For the adequate hydration of the ocular surface, lubricating eye drops are commonly used. These drops come in various formulations, but it is generally recommended to choose preservative-free options, especially for frequent or long-term use, to avoid potential irritation or toxicity. In addition to drops, moisturizing eye ointments may be applied, particularly at night; however, they can temporarily blur vision for several minutes after instillation, which should be taken into consideration.

A well-established method for managing dry eye is the use of punctal (lacrimal) plugs. These tiny implants are inserted in the eye’s tear ducts (called puncta) to reduce tear outflow and improve overall tear film stability.

Implantation of lacrimal plugs in the tear ducts

In addition to lubricating the ocular surface, the treatment of meibomian gland dysfunction and blepharitis often requires the use of medications, which should be prescribed by an ophthalmologist with a carefully selected regimen and duration tailored to the patient's condition.

For the past several years, Akhali Mzera has successfully implemented cutting-edge technologies for the treatment of the dry eye disease. We successfully use the Eye-Light device, which combines Intense Pulsed Light (IPL) and Low-Level Light Therapy (LLLT) technologies. This innovative approach offers non-invasive, effective solutions for the management of the dry eye.

Eye-Light device - IPL and LLLT innovative technologies

Intense Pulsed Light (IPL) therapy has been widely used in dermatology for many years, particularly in the treatment of conditions such as acne rosacea. More recently, its effectiveness has been demonstrated in the treatment of dry eye disease. Inflammatory cells often accumulate in damaged blood vessels around the eyelids, contributing to blepharitis and meibomian gland dysfunction (MGD) — two common causes of dry eye. During IPL therapy, controlled pulses of light target these vessels, reducing inflammation and improving gland function. Low-Level Light Therapy (LLLT) complements IPL by using specific wavelengths of light to gently heat the meibomian glands. This helps to liquefy and release the thickened secretions that may be blocking the glands. As a result, the normal flow of meibum is restored, stabilizing the lipid layer of the tear film and enhancing overall eye comfort. Both IPL and LLLT treatments are completely painless, non-invasive, and take only a few minutes to perform. When used together, these advanced technologies provide a powerful and effective solution for improving ocular surface health and managing dry eye symptoms.

Maintaining proper eyelid hygiene is a crucial part of treating ocular surface diseases, especially conditions such as blepharitis and meibomian gland dysfunction (MGD). At Akhali Mzera, we use the AB Max™ device for professional eyelid cleaning, ensuring thorough and effective removal of plaque, scales, and debris that can accumulate along the eyelid margins. The frequency of this painless procedure is tailored to each patient and is determined by the ophthalmologist based on individual needs.

AB Max™ - Professional Eyelid Cleaning Device

It is important to understand that dry eye disease is a chronic condition that requires ongoing care and management. While modern treatments — like IPL, LLLT, and professional eyelid cleaning — are highly effective, their success depends greatly on the patient’s active participation. Strict adherence to the ophthalmologist’s recommendations is essential. This includes following prescribed home care routines, attending scheduled treatments, and maintaining regular follow-up visits. Consistent patient involvement not only improves treatment outcomes but also helps prevent the progression or recurrence of symptoms.

If you are experiencing symptoms of dry eye, eye clinic "Akhali Mzera" offers highly qualified medical care tailored to your individual needs. Using the latest diagnostic technologies, our experienced ophthalmologists will assess the condition of your ocular surface and develop a personalized treatment plan. By combining advanced methods such as IPL, LLLT, and professional eyelid hygiene with AB Max™, we aim to provide effective, long-term relief. At Akhali Mzera, your eye health is our priority. Let us help you restore comfort, clarity, and quality of life.