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How to Diagnose Dry Eye Syndrome

This is one of the most important initial steps in treating dry eye syndrome correctly. In order to treat dry eye syndrome correctly, the first thing to know is what kind of dry eye syndrome is causing your problem. It is also important to know the severity of the dry eye syndrome. Your eye needs to have the proper amount of each of the three layers of the tear film.

Medical and Eye History

The staff or the eye doctor will take a history at the beginning of your visit. There are many diseases that are associated with dry eye syndrome and it is important to know if any of those are present. If you give a history of any of the symptoms associated with dry eye syndrome, many eye doctors’ offices will have you fill out a SPEED™ form or Standard Patient Evaluation of Eye Dryness or dry eye syndrome questionnaire. How high a person scores on the form can indicate the severity of the dry eye syndrome.

A portion of a complete eye exam includes the eye doctor examining the eyes with a slit lamp microscope to evaluate and examine the eye with high magnification. Several dyes that stain damaged cell walls on the surface of the eye can be used by the doctor to determine if or how much the cells on the surface of the eyes have been damaged and to what extent have they been damaged. As stated before, the cells on the surface of the eye need to have a normal tear film to be healthy. If the tear film diminished and/or abnormal the cells will become unhealthy and can die.

Tear Osmolarity or Salt or Sodium or Na Level in Tear Film

Our bodies are composed of mostly water with the addition chemicals and minerals. The body will maintain the normal level of these substances under normal circumstances. If there is an illness or disease present, it can alter the level these chemicals and/minerals. The tear film also contains these chemicals, enzymes, minerals, and proteins. The TearLab Corporation makes an instrument that can measure the salt or sodium (Na) level in the tear film similar to a blood test that measures the levels in the body. The levels found in the tear film are not directly related to the levels in the body. The tear film is exposed to the air and environment. The levels in the tear film can be dramatically different from the body tissue levels. When there is an increased level of salt in the tear film, it indicates a decrease in the amount of the liquid layer in the tear film and dry eyes. The decreased liquid layer is unable to normalize the normal levels present in the ocular tissues. The tear film osmolarity is a very useful test to follow or monitor the condition of the dry eye syndrome and treatment progress.

RPS InflammaDry Detector

Our bodies are composed of mostly water with the addition chemicals and minerals. The body will maintain the normal level of these substances under normal circumstances. If there is an illness or disease present, it can alter the level these chemicals and/minerals. The tear film also contains these chemicals, enzymes, minerals, and proteins. The TearLab Corporation makes an instrument that can measure the salt or sodium (Na) level in the tear film similar to a blood test that measures the levels in the body. The levels found in the tear film are not directly related to the levels in the body. The tear film is exposed to the air and environment. The levels in the tear film can be dramatically different from the body tissue levels. When there is an increased level of salt in the tear film, it indicates a decrease in the amount of the liquid layer in the tear film and dry eyes. The decreased liquid layer is unable to normalize the normal levels present in the ocular tissues. The tear film osmolarity is a very useful test to follow or monitor the condition of the dry eye syndrome and treatment progress.

How to Diagnose Dry Eye Syndrome
How to Diagnose Dry Eye Syndrome

LipiView

LipiView –Measures Lipid Layer, Images, and Blinking Evaluation

The LipiView instrument is designed to measure the thickness of the outer oily or lipid layer of the tear film. The LipiView contains a high-resolution movie camera and interferometer which is used to examine the tear film.

The instrument produces a high-resolution movie and images of the tear film and surrounding ocular tissue. The motion picture camera in LipiView also evaluates your blinking during the test. The LipiView counts each blink and evaluates each blink during the testing period. During a normal blinking, the upper eyelid comes all the way down and makes contact with the lower eyelid. Secondary to gravity, the tears drop down and pool on the edge of the lower eyelid and the eye. During normal blinking, the upper eyelid makes contact with the lower eyelid where the pooling tears or tear lake reside on the lower eyelid. The upper eyelid lifts back up smoothing and spreading the tears back across the surface of the eye. This spreads the tears across the eye which smooths out the tear film like a windshield wiper clearing the rain off a windshield to provide clear vision. If the blinks are partial or incomplete, the eyelid fails to spread the tears back across the eye which leads to a breakdown in the tear film. The instrument counts how many times the eyes blink and what number of the blinks are partial.

How to Diagnose Dry Eye Syndrome
How to Diagnose Dry Eye Syndrome
How to Diagnose Dry Eye Syndrome

The camera in the LipiView is able to capture 3D like images of the Meibomian glands.  This allows the eye doctor to evaluate the health of the Meibomian glands and number of glands present in the eyelids. In summary, the LipiView provides the eye doctor with the thickness of the lipid layer, number of partial blinks, and images of the Meibomian glands.

Keratograph 5M

Keratograph 5M is an ocular instrument that images and measures many different characteristics of the tear film and the surrounding ocular structures.

How to Diagnose Dry Eye Syndrome

Meibomian Gland 3D Imaging

How to Diagnose Dry Eye Syndrome

The instrument images the Meibomian glands in the eyelids which allow the eye doctor to evaluate the health of the Meibomian glands, size, and the number of glands in the eyelids which secrete the lipid layer of the tear film.

Tear Film Break-Up Time

The Keratograph 5M times, measures, and evaluates the stability and quality of the tear film. The patient is asked not to blink during this test. The instrument times and measures the breakdown or breakup of the tear film without blinking. The tear film breakdowns faster in people with dry eyes or poor tear films than people with a normal tear film. A tear breakup time of lesser than 12 seconds is abnormal.

How to Diagnose Dry Eye Syndrome

Tear Meniscus or Tear Lake Height

Gravity causes the tears pool on the junction between the lower eyelid and the eye between blinks. The instrument measures the amount or height of the tear film that rests on the lower eyelid. This gives the eye doctor information about the quantity of tears present on the surface of the eye.

Tear Film Dynamics

How to Diagnose Dry Eye Syndrome

The Keratograph 5M captures the tear film particle flow characteristics on the surface of the eye and tear film viscosity which evaluates the quality of the tear film.

Advanced Tear Diagnostics (ATD)

ATD manufactures the TearScan 270 MicroAssay System which measures Lactoferrin and IgE in the tear film. Lactoferrin is a protein secreted by the lacrimal gland. Lactoferrin levels are reduced in patients with dry eye syndrome. If IgE levels are increased in the tear film, ocular irritation could also be related to allergies and would need to be addressed. The levels of lactoferrin have a 95% specificity and nearly 75% sensitivity in the tear film. These tests are useful in the diagnosis and monitoring of the dry eye disease and ocular allergies.

How to Diagnose Dry Eye Syndrome

Schirmer’s Test

How to Diagnose Dry Eye Syndrome

The Schirmer’s test has been around for many years and some eye doctors still use the test. New technologies are now available and it is not performed as often as in the past. The test is also known as Basal Secretion Test, Dry Eye Test, and Tearing Test.

The test is performed after the instillation of an anesthetic or numbing eye drop. A special strip of special paper is placed on the edge of each eyelid and is left is place for 5 minutes. The strip of paper is removed and the length of how far along the strip the tears wet the paper is measured. Ten millimeters or more of wetting is normal and anything less is considered abnormal.

How to Diagnose Dry Eye Syndrome
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    Good Afternoon:
    Thought I’d give you a heads-up for a true community service feature.

    James Croley, MD is an eye surgeon located in Cape Coral [Bonita Springs and Lehigh Acres]. He has been serving in Cape Coral for about 30 years and has grown to be world renowned.

    Dr. Croley enjoys a reputation, as a result of his professionalism and accomplishments, that serve to set him apart from any other in a delicate field. He’s a giving, feeling individual, dedicated to making better those things that serve to improve the quality of life in our society.

    Dr. Croley has now authored a fabulous book entitled “Believing is Seeing.” The book is designed to provide insights into how to improve one’s health and welfare in a complicated world….and does just that!

    I believe that a feature focusing on the life and times of this extraordinary man would represent a true community service.
    In line with the Doctor’s giving persona…proceeds from the book sales will be donated towards Missions.

    Happy Easter & God Bless,

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The Cataract & Refractive
Institute of Florida

James E. Croley III, M.D.

Office Hours

  • Monday

    7:30am – 4:00pm
    Dr. Croley sees patients at 7:30am in Cape Coral.

  • Tuesday

    8:00am – 4:00pm
    Dr. Croley performs surgeries on this day.

  • Wednesday

    7:30am – 4:00pm
    Dr. Croley sees patients at 7:30am in Cape Coral.

  • Thursday

    8:00am – 3:30pm
    Dr. Croley sees patients at 8:30am in Lehigh.

  • Friday

    8:00am – 3:30pm
    Dr. Croley alternates also in Bonita & Cape Coral.

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