Dry Eye Care

Including punctal occlusion


Dry eye syndrome is one of the most common eye problems we treat. Tears are comprised of three layers.  The mucin layer coats the cornea (the clear outer structure in front of the colored), creating the conditions for wettability. Without mucin tears would bead up like a freshly waxed car. The middle layer is the complex aqueous layer. It provides moisture and supplies oxygen and a host of nutrients to the eye.  The outer lipid layer is an oily film which rises to the top of the aqueous layer and prevents the tears from evaporating from the eye. 

There are two main types of dry eye: aqueous deficiency dry eye from reduced watery layer production and evaporative dry eye from deficient or poor quality oils. Some suffer a mixed cause.  During a dry eye evaluation, we will determine which tear layer is the problem. Treatment of dry eyes depends exclusively on the underlying cause.  Artificial tears, prescription eye drops, nutritional support, eyelid hygiene and lifestyle changes are included in the array of treatment options. Other novel procedures, depending on diagnosis and severity, are sometimes considered including IPL (intense pulsed light), intraductal probing and Lipiflow thermal pulsation.

Punctal occlusion can bring great relief to patients with advanced dry eye. The puncta are four tiny openings found in the inside corner of the eyelids toward the nose (one in each lid). These openings lead to an unseen ducts responsible for draining tears in to our nose and throat. This active drainage system is evident to patients who experience the taste of their prescription eye drops.

Those suffering from severe aqueous deficiency often benefit by having their punctal openings painlessly occluded (blocked) to improve tear retension either temporarily with very small inserts or "plugs" made of dissolvable collagen or synthetic materials or semi-permanently with explantable plugs made of silicone or hydrogel. We offer this medically-billable service in our office to our dry eye patients.

If you are struggling with dry eyes, schedule a dry eye evaluation with Dr. Carver to determine the best treatment plan for you!