Dry Eye Treatment in Cape Coral, FL

Dry Eye Syndrome Treatments

The first and most important step in treating dry eye disease is to determine the type of dry eye disease and the severity of the dry eye disease. As stated before there are two major types of dry eye disease which are decreased liquid or aqueous production and evaporative dry eye disease. Once the eye doctor has performed the tests for dry eyes, they can customize a treatment plan for your particular dry eye disease.

Artificial Tears

There are nearly 60 different types and brands of artificial tears on the market. Pharmacies do not have all of them available at all the time. There are watery-like tears, gel-like tears, preservative-free tears and ointment. Artificial tears contain a variety of different lubricates to simulate the natural tear film and has certain components to correct the deficiencies in the tear film. Artificial tears are available in the typical large bottles containing preservatives and preservative free tears in small eye drop dispensers containing 10 to 12 drops. Preservative-free tears are only available in this small size as they could become contaminated if sitting around for a period of time. To begin, the mainstay of treatment is to use artificial tears on a daily basis. One of the main reasons for using artificial tears is to keep the salt levels in the tear film under control. The specific type of tear drop that is best for your dry eye condition will be determined and recommended after your dry eye workup.

HydroEye® Supplement

HydroEye is a patented nutritional supplement that has been shown in scientific studies to provide relief from dry eye syndrome. HydroEye is primarily composed of Omega-6 fatty acid gamma linolenic acid (GLA) from black currant seed oil. It also contains a small amount of fish oil, vitamins, magnesium, and /or nutrient cofactors which increases the efficacy of HydroEye.

How HydroEye® Works

HydroEye works to support a healthy tear film and decrease the inflammation related to chronic dry eyes. HydroEye helps the body produce a chemical called Prostaglandin 1 (PGE1) and Prostaglandin 3 (PGE3), which is an anti-inflammatory chemical that the body produces.

Clinical Study

A randomized double blind or masked study was completed at Baylor University and the University of East Virginia. Dr. Stephen Pflugfelder is one of the world’s leading authorities of dry eye syndrome at Baylor University. Participants were divided into two groups with one receiving a placebo and the other taking HydroEye. Several measurements of the eyes were taken before the study began and at the end of the study 6 months later. Dry eye symptoms, ocular surface inflammation, and corneal surface smoothness were measured.

Findings

The participants taking HydroEye were statistically significantly better that the placebo group. It can take up to 3 to 4 months for the effects of HydroEye to be fully seen. HydroEye taken on a consistent routine basis can provide significant improvement in people suffering from dry eyes. HydroEye is an important component of dry eye treatment.

Fish Oil Omega-3 Fatty Acids

EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are omega-3 fatty acids found in oily fish such as salmon, sardines, and tuna. EPA and DHA has been shown in many studies to have positive health benefits. Omega-3s have shown anti-inflammatory properties. EPA and DHA are found in high concentrations in brain tissue and are requires for maintenance of brain cells. DHA is highly concentrated in the retina of the eye especially in the rods and cones of the retina.

Fish Oil and Dry Eyes

Omega-3 fatty acids have shown in studies to improve the function of the Meibomian glands in the eyelid in producing lipid or oil. Several studies have shown to improve symptoms and dry testing in people that are taking omega-3 fatty acid supplements.

Eating a diet which includes oily fish and/or taking omega-3 fatty acid supplements can improve the symptoms of dry eye syndrome.

LipiFlow

LipiFlow is the only FDA approved treatment for Meibomian gland disease causing dry eyes. The LipiFlow treatment unblocks the obstruction of the Meibomian glands that have been plugged by the sick and inflamed Meibomian glands. The Meibomian glands produce abnormal thick oil which blocks the glands causing them to shut down and atrophy or die. The oil can become so thick that it looks like white cheese that can be expressed from the glands instead a clear oil that looks like olive oil. The LipiFlow uses a combination of localized heat and intermittent pressure. A single-use component of an eye cup and lid warmer is placed in contact with the eyelids. The lid warmer contacts the inner eyelid surface and heats to a controlled temperature of 109 degrees. Once the oil have been heated and made easier to remove from the glands, the flexible bladder intermittently inflates in a precise manner on the outer surface of the eyelid to express the lipid or oil out of the glands. Both eyes can be treated at the same time. The treatment lasts for 12 minutes.

At 4 weeks after treatment, 80% of patients reported improvement of their dry eyes in the FDA study. There is little or no discomfort with the procedure. The indication for the LipiFlow treatment is there is Meibomian gland disease with a decreased lipid layer of the tear film and there are sufficient numbers of Meibomian glands still present that improvement can be expected.

MiBo Thermoflo

The MiBo Thermoflo instrument is a therapeutic medical device that provides a safe and effective treatment for dry eyes secondary to Meibomian gland disease. This treatment is similar to LipiFlow. The instrument uses a proprietary thermoelectric heat pump to maximize the liquefaction of abnormal oils or lipids in the blocked Meibomian glands. The MiBo Thermoflo provides continuous controlled heat device that is applied to the outer surface of the eyelids with the application of ultrasound gel. This provides a comfortable massage of the Meibomian glands. A technician uses the sterling silver plate that heats up to 108 degrees to massage the eyelids. The heat is absorbed deep into the eyelid tissue resulting loosening of the lipids and expression from the glands. The treatment is performed for 12 minutes per eye. The eye doctor may express the Meibomian glands after the procedure to help clean them out. There is a total of 3 separate treatments 2-3 weeks part. You are placed on eye drop medications after the procedure to help with the healing of the Meibomian glands.

Meibomian Gland Probing

A tiny wire probe is inserted into the narrow Meibomian gland opening on the edge of the eyelid while using a microscope. In some cases, chronic inflammation has scarred the Meibomian glands and/or the openings of the glands closed causing a reduction in the lipid layer of the tear film. Opening the scar tissue in the gland and/or its opening can allow the glands to begin to secrete their oil.

Punctal Plugs

There are small openings on the medial side or toward the nose of the upper and lower eyelids called the puncta. The punctal openings lead to the lacrimal drainage duct that drains the tears from the eye into the nose. This is the reason why your nose runs when you get emotionally upset and cry. Many people believe that the tear ducts produce the tears in their eyes but instead the ducts drain the tears away from the eye. The different glands around the eye produce the tear film. Small plugs just like miniature cork can be placed in the punctal opening to block the tears from draining away from the eye resulting in more tears on the surface of the eye.

The best way to know if punctal plugs are going to be beneficial for your dry eye symptoms is to use temporary punctal plugs that dissolve in a few days. During those few days, you can evaluate the effectiveness of the punctal plugs resolving your dry eye symptoms. These types of plugs are made out of collagen. If your symptoms are improved, a permanent punctal plug composed of silicone can be inserted to permanently block the drainage of the tears from the eyes. In the beginning, usually the bottom or lower puncta are plugged. If you are doing well and symptoms have resolved or been significantly reduced, nothing else needs to be done. If your symptoms are not reduced to a comfortable level, then temporary punctal plugs can be inserted into the upper puncta to see they need to be plugged as well. If you get an additional reduction in symptoms, the upper puncta can be plugged as well. There are also temporary plugs that last as long 6 months. If you are having LASIK or other eye surgery and have dry eyes, these longer lasting temporary plugs may be beneficial.

Regener-Eyes^®

Regener-Eyes is a sterile acellular amniotic fluid eye solution containing 777 proteins, cytokines, and growth factors. The science of regenerative medicine primarily focuses on the stimulation of the body’s natural ability to heal and regenerate itself. Regener-Eyes may offer new hope for the treatment of dry eye syndrome. Anti-inflammatory cytokines reduce inflammation associated with dry eye disease. Growth factors help with healing, and regeneration. Hyaluronic acid helps to protect and lubricate the eye. Regener-Eyes helps reduce the pain, irritation, inflammation and stimulate the body’s natural ability to heal, repair, and regenerate.

Regener-Eyes is made with sterile D-MAPPS™ platform technology. It is packaged in sterile human birth fluid eye drop applicators with a 30-day supply. The donor’s medical and social history are screened for HIV, hepatitis, and other communicable diseases in accordance with current United States Public Health Services Recommendations and FDA Federal Regulations and Guidance documents. There have been no reported adverse reactions associated with Regener-Eyes Ophthalmic Solution. Possible adverse reactions are:

Regener-Eyes is a new treatment for people with significant dry eyes.

Autologous Serum

Autologous serum eye drops use serum from your own blood to help treat dry eye disease. Autologous serum has been shown to be useful in treating dry eyes as the serum contains growth factors, vitamins, and other nutrients found in blood. The person donates several vials of blood. The blood is allowed to coagulate, and it is placed in a centrifuge for about 10 minutes to remove the serum from the other components of blood. The blood serum is diluted into bottles of preserved artificial tears. The patient’s blood needs to be tested for communicable diseases such as HIV, and hepatitis to protect the safety of the technicians preparing the autologous serum.

The bottles need to be stored in the freezer except for the current bottle being used which should be stored in the refrigerator. The concentration of the serum tears varies from 20 percent to 100 percent. The most common concentration used is 20 percent since this is believed to closely match in a normal tear film.

The current indications for using autologous serum tear drops is Sjogren’s syndrome and moderate to severe dry eyes. Some of the difficulties with using autologous serum tears is the requirement to refrigerate the drops and the possibility of contamination of the drops. The drops can be difficult to obtain.

Restasis^®</sup<

Indications and Usage

Restasis ophthalmic emulsion is indicated in dry eyes to increase tear production in people with dry eye syndrome, especially those with documented inflammation in their eyes.

Restasis is a immunomodulator that is thought to decrease ocular inflammation by supposedly suppressing ocular inflammation associated with keratoconjunctivitis sicca. There was no increased tear production in people using topical anti-inflammatory medications or who have had punctal plugs inserted. Cyclosporine ophthalmic emulsion 0.05% comes in a single dose or multi-dose sterile eye drop dispenser. The medication is instilled into the eye two times a day. It may take up to 3 to 4 months to achieve the maximum benefit of the medication.

The most common side effect was ocular burning upon instillation of the medication. Other reactions were red eyes or hyperemia, watering or epiphora, eye pain, foreign body sensation, stinging, itching, discharge, and blurred vision.

Administration of Restasis is not detected systemically after topical administration and maternal use is not expected to result in exposure of the fetus to the medication. Restasis should not be used while wearing contact lenses. Patients with dry eyes should be very careful about wearing contacts as this contributes to the development of dry eyes. If contact are being worn, the contacts should not inserted until 15 minutes after instillation of Restasis.

Xiidra®

Indication and Usage

Xiidra is indicated for the treatment for the symptoms and signs of dry eye syndrome.

Side Effects

The three most common side-effects of Xiidra are irritation after instillation of the medication, dysgeusia (unusual taste), and blurred vision for a period of time after instilling the eye drop. Other side-effects are redness, headache, increased tearing, eye discharge, eye discomfort, eye pruritus or itching, and sinusitis. There are clinical studies on use in pregnant women to report any potential risks for its use in pregnant women.

Mechanism of Action

Xiidra or lifitegrast ophthalmic solution 5% binds to the integrin lymphocyte function-associated antigen-1 which is a cell surface protein and blocks the interaction ICAM-1 which is fond to be elevated in the eye related to dry eye syndrome. This is thought to decrease inflammation in the eye secondary to dry eye syndrome.

How Supplied, Storage, and Handling

Xiidra is supplied in a foil container containing 5 polyethylene 0.2mL single use eye drop dispensers. It should be stored at a temperature between 68 to 77 degrees.

Dosage

The medication is instilled into the eye two times a day. It may take as long as 3 to 4 months to obtain the maximum effect of Xiidra in the eyes.

Testosterone Cream or Solution

It has been discovered that there are hormone receptors on the surface of the eye. There are studies that show that women with Sjogren’s syndrome who are androgen deficient have increased Meibomian gland disease, tear film instability, and evaporative dry eye syndrome. It appears that Meibomian glands are regulated by testosterone. Testosterone is present in men and women and the3 levels decrease as we age. Women have lower levels to begin with which may be one reason why women are two to three times more likely to develop dry eyes. Androgens have been found to be involved in regulating the immune system, health of the lacrimal glands, and secretions from the lacrimal glands.

Studies have shown that nearly 70 percent of post-menopausal women on estrogen therapy have dry eyes and 29 percent of women taking estrogen and progesterone. The dry eye disease severity may be related to the strength of the estrogen dose. Exposure to increased estrogen can also come from other sources such as food sources, birth control pills, environmental, and cosmetics.

Post-menopausal women comprise the largest group of dry eye patients. Several studies have shown that in post-menopausal women, application of testosterone cream to the eyelids or solution in the eye has improved the tear film and relieved symptoms of dry eyes in many of those women. The treatment in men has not shown the same results as in women.

Scleral Contact Lenses

A scleral contact lens is a large contact lens that rests on the sclera (white portion of the eye) and not on the cornea as most lenses. The scleral lenses are more stable than gas-permeable conventional that fit on the cornea. They are less likely to dislodge from the eye and tend to be more comfortable that conventional gas-perm contacts. The scleral contact lens vaults over the cornea creating a tear-filled space under the contact lens. There are three types of scleral contact lenses which are based on the size of the lens.

Corneo-scleral lenses or semi-scleral lenses which rest on the junction of the cornea and sclera.

Mini-scleral lenses vault over the whole cornea and rest on the just on the beginning portion of the sclera.

Full-scleral lenses are the largest of the scleral lenses and provide the largest vault and/or space over the cornea. These work best for dry eye patients.

These types of lenses can be used to treat people with dry eye syndrome who are not doing well with more traditional dry eye treatments. The liquid space under the contact lens provides a liquid pool that covers over the cornea. The lenses are made of a permeable polymer that is highly permeable to oxygen for the health of the cornea. These lenses are custom designed to fit the eye precisely to provide the most comfort and best results. Typically, these lenses are more expensive than conventional gas-perm contacts.

Eyewear for Dry Eyes

What is Dry Eye Wear and How Does It Work or Help People With Dry Eyes?

There are two basic categories for eye wear for dry eyes which are daytime wear and nighttime wear.

When Should You Consider Wearing These Types of Eye Wear?

Significant dry symptoms which are not responding to traditional treatments
You have increased symptoms while outdoor such as windy days, riding bicycles or motorcycles, running, and etc..
You are uncomfortable at work where the air-conditioning has the air very dry and/or you work at a computer or do a lot of near work
You have increased symptoms driving as you stare at the road and decrease your blinking and the air-conditioning blowing air on you in the car
You have increase sensitivity to light

Studies have shown that protecting the eyes from the environment can improve dry eye symptoms. There are sunglasses that help protect the eyes. You can wear a wrap-around type sunglass that will help protect the eyes to some extent. There frames the further protect the eyes by sealing them from the environment. In some of the frames you can have your glass prescription added to the frames. Some models use a special foam that seals the eye from the environment and others use a silicone shield to protect the eyes from the environment. The moist around the eye is significantly elevated and the eye is protected from the outside wind and air. Some examples

Nighttime Considerations

You wake up every morning with eye pain and sensitivity
When you get up at night your eyes are very painful
You use a c-pap machine which blows air around your eyes
Your eyes are stuck together when getting up at night or in the mornings
Your eyes don’t completely shut at night either routinely or from eyelids abnormalities

Warm Compresses

Warm compresses can have a significant benefit for dry eye patients especially with Meibomian gland disease and evaporative dry eye syndrome. The warms compresses need to be done in the correct manner to have an effect. The heat needs to be consistent and have a long enough duration to be of benefit. It needs to be warm enough as well to work. The warm compress should be as warm as you feel comfortable with and not so hot to cause a burn.

Applying warm compresses to the eyelids for a minimum of 15 minutes helps bring increased blood flow to the area. This helps keep the Meibomian glands healthier for a better oil layer of the tear film and may delay the progression of Meibomian gland disease.

Methods of Applying Warm Compresses

You can stand at the sink with a wash cloth and apply the warm cloth to your eyes. You have to stay at the sink as the wash cloth cools off very rapidly. This is not very convenient but works.

You can take an old sock and fill it with rice and tie a knot in the sock. You can microwave the sock which will stay warm for a while. The length of time in the microwave will depend on the power of your microwave. You can experiment trying 15 or 20 seconds at a time to get the proper temperature.

You can stand at the sink with a wash cloth and apply the warm cloth to your eyes. You have to stay at the sink as the wash cloth cools off very rapidly. This is not very convenient but works.

You can purchase a variety of heat pads, gel packs, and others at the drug store to use on your eyes.

Tranquileyes™ makes a couple different types of goggles that you place in the microwave to heat. These stay warm for an adequate amount of time.

There are many other heating options available. Just remember to do the warm compresses at good warm temperature for a full 15 minutes once a day.

Amniotic Membrane

Human amniotic membranes are able to treat several diseases involving the surface of the eye. They provide significant benefits in treating different diseases of the conjunctiva and cornea. The amniotic membrane is a fetal membrane that is harvested in a sterile manner from placental tissue during elective C-sections. The donors are screened for transmittable diseases and are treated with antibiotics immediately after obtaining the tissue. The membrane is composed of three layers which are the epithelium, basement membrane, and stroma. The membrane contains several types of collagen which are similar to the collagen present on the eye.

The amniotic membrane promotes healing through epithelial growth, inhibits cell death, reduces inflammation through cytokines, and inhibits fibrovascular growth (scarring).

There are two types of amniotic membranes available which are cryopreserved and dehydrated.

Cryopreserved Amniotic Membrane

With this type of membrane, it is slowly frozen to -80 degrees C using a preservation media which allows for slow freezing without ice formation. ProKera (BioTissue) makes this type of membrane. The amniotic membrane is attached to a ring for placement on the eye. The tissue has to be stored in a freezer and thawed before use. This is inserted onto the eye just like applying a contact lens. It is usually left on the eye for 1 week and is removed. The tissue usually melts or is absorbed within the week and just the ring is left.

Dehydrated Amniotic Membrane

The membrane is dried using low temperature heat in a vacuum which retains the cellular components. This tissue can be stored at room temperature and needs to be rehydrated when applied onto the surface of the eye. A bandage contact lens is place over the membrane. It is usually left on the eye for 1 week and any remaining tissue and the contact lens are removed. Manufacturers of this type of membrane are AmbioDisk, BioDOptix, and Seed Biotech.

The vision will be blurred during the time the tissue is on the eye. People tolerate the membrane well. Some people may complain of some mild discomfort with the ring on the eye. People with severe dry eye disease that have not achieved results with other treatments are good candidates for the application of an amniotic membrane.

Poor Blinking

You normally blink your eyes 12 to 15 times a minute. This is to keep your tear film smooth and have the proper levels of the different portion of your tear film. There are diseases such as Parkinson’s which diminishes the number of blinks per minute and these people can have terrible dry eye problems secondary to not blinking. Poor or incomplete blinking can a significant effect on dry eyes as well. The tear pool on the lower lid due to gravity. When you blink, the upper eyelid comes down and touches the lower eyelid. The upper eyelid pulls the tears back up over the surface of the eye. The LipiView instrument monitors your eyes during the test and counts the number of blinks and whether they are complete or incomplete blinks. If you have poor blinking or incomplete blinking, it can greatly exacerbate the dry eye syndrome. There are exercises to help improve blinking.

Blink exercises require frequency. They must be done every 10 to 12 minutes for 30 days to be effective. Use an audible signal such as an egg timer or smart phone to remind you, especially during tasks requiring sustained focus.
Close both eyes normally, pause 2 seconds and open. The, close the eyes normally again, pause 2 seconds and aggressively squeeze the lids together for 2 seconds. Open both eyes. Repeat every 10-12 minutes.
Hold your fingers at the corners of your eyes and blink. When you are blinking correctly, you should feel no movement under your fingers. If you feel anything, you are using your defense muscles that run along the side of your head. Your blinking muscles are on top of your lids.
Blinking is very task-dependent and the blink rate decreases with sustained visual activity. Examples are reading, watching TV, looking at a computer or flat screen, and/or driving a car. You might want to put a note on your computer or TV to remind you about blinking exercises.
If you are having difficulty remembering the blinking exercises, do the exercises during TV commercials, every time after you use your phone, or look at a computer. Post a note if necessary.

TrueTear™ Intranasal Tear Stimulator

The TrueTear stimulator provides a temporary increase in tear production during neurostimulation in adult patients. The device produces small electrical pulses to stimulate production of the liquid portion of the tear film. The electrical pulses are delivered by a disposable tip attached to the True Tear device that you place in your nose for a short period of time. Patients may respond differently to the treatment.

Potential Complications with Using TrueTear

Precautions

Should not use if:

A cardiac pacemaker implanted or wearable defibrillator
Other implanted metallic or electrical device in the head or neck
Chronic or recurrent nose bleeds
Bleeding disorders
A known sensitivity to the ultrasound gel used to lubricate the device

Tacrolimus

Tacrolimus is used in the treatment of preventing rejections in organ transplants in its systemic form. In eye care it has been used in treating uveitis (ocular inflammation inside the eye) and blepharitis. There are some new studies with its use in dry eye syndrome. It is believed to help dry eye patients by decreasing inflammation. Topical 0.02% Tacrolimus is used twice a day. Most patients complained of irritation for 30 minutes after instillation. Still, most patients chose to continue the treatment secondary to their improved dry eye symptoms. It is still too early to tell whether this will become a mainstream treatment. As of now it is only available through a compounding pharmacy and is available as a drop or ointment.

Other Factors or Diseases Associated with Dry Eye Disease

Blepharitis

Blepharitis is a disease of the eyelids in the area around the edge of lid where the eyelashes are located. This can be due to a variety of causes but the most common cause is the growth of Staph bacteria around the base of the eyelashes. The inflammation from blepharitis can cause meibomianitis or infection and/or inflammation of the Meibomian glands. This can also cause scarring of the Meibomian gland openings. This leads to a decrease in the lipid layer of the tear film. Treatment of blepharitis is important in treating and controlling dry eye disease.

Allergies

Many people believe that they have allergies because their eyes or eyelids itch. Dry eye disease can cause the same symptoms of itchy eyes as can allergies. So the symptoms do not always indicate the problem that you are having with your eyes. Many people are taking allergy medications because they believe they have allergies without knowing what they really have. Essentially, all allergy medications dry out the eyes.

People are making their dry eyes worse while they think they are treating allergies. Nearly one half of people with dry eye disease are allergic to at least one thing in their environment. It is important to get tested for any environmental allergies in the area that you live in. If you do have allergies, then you want to treat the allergy in the appropriate way that will do the least to exacerbate your dry eye disease. The results of the allergy tests will guide you to the proper treatment of your specific allergies. If you have dry eyes it is important not to use allergy medications without knowing if you have allergies and then treat it in the best way considering your dry eye problem.

Auto-Immune Diseases

Auto-immune diseases are associated with dry eye disease in many cases. The combination of dry eyes, dry mouth, and rheumatoid arthritis is called Sjogren’s syndrome. Follow your doctor’s treatment regime for your auto-immune disease as it can help your dry eye disease as well.

Which is the Best Treatment?

There is no best treatment for dry eye disease. The best treatment is one that is based on the diagnostic testing done prior to beginning treatment. Your treatment should be customized to the type and severity of your dry eye disease. If you are not producing enough of the liquid layer of your tear film, the treatment should be based on improving that layer of the tear film. If the lipid layer of the tear film is deficient, then the treatment should be geared to the improvement of the lipid layer of your tear film. If there is inflammation present, the inflammation needs to be addressed as well. The eye doctor should begin with a baseline level of treatment for your particular type of dry eye disease. Additional treatments are added until you have reached the maximum benefit and relief of symptoms. It may take a few months to get the results that you need depending on the severity of the dry eye disease.

Summary

Dry eye disease is the most common eye disease in America and is increasing in prevalence. In today’s society, adults and children are hours a day staring at a flat screen device such as a smart phone, iPad, computer, and/or TV. As they rate continually stare at that flat screen, their blinking diminishes, and the tear film begins to break down and evaporate from the eye. The salt or Na level increases in the tear film resulting inflammation of the surface tissues of the eye. This inflammation may be low grade and not felt in the beginning, but over time these verity of the inflammation will increase. The increase salt levels also burns the nerve endings on the surface tissues of the eye which diminishes the sensation of the eye. Many people may not sense or develop severe symptoms until the disease has caused significant damage. Dry eye disease is a chronic progressive disease. If you have dry eye disease, you will need to keep working at treating it for the rest of your life. There is no magic pill that will make it go away.

The key to treatment is proper diagnosis. Again, the treatment of dry eye disease based on the type of dry eye disease. Just putting a few artificial tear drops in your eyes is not going to be enough in the long run. If you have children, limit their time on any of the flat screen devices. Protect your eyes from the sun and environment by always wearing sunglasses. Wrap-around sunglasses are better. If you are having any of the symptoms of dry eyes see an eye doctor. You need to get your eyes tested to know the condition of your dry eye disease. Proper treatment early on is important. It is much easier to prevent dry eye disease damage to the eyes verses trying to reverse the damage. Some of the damage can be irreversible.

JAMES E. CROLEY III, M.D.

Dr. James E. Croley III is a board-certified ophthalmologist and the founder of the Cataract & Refractive Institute of Florida. He graduated magna cum laude from Cumberland College before attending medical school at the University of Miami and completing his residency at the University of Alabama Eye Foundation Hospital. Additionally, he studied at Stanford University where he gained further education in advanced ophthalmology techniques. Dr. Croley is a member of the American Academy of Ophthalmology and the Florida Society of Ophthalmology.