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


  • At Amplify with Dr Wernick I was seeking help for seemingly intractable, probably age-related dryness. I've seen other doctors about it, and that has been helpful, but what he explained to me about it and the careful way he answered all my questions gave me so much more of a clear understanding of what is going on (and is not) that I am more able to implement all his and others' recommendations than I was before. And he gave me additional resources for further follow-up. I am most grateful.

    Cynthia Norton

  • Wow! This is a great Eye Care medical facility. I was thoroughly examined by Dr. Pinkhasov for over 2 hours. She made sure to check my eyes for pretty much everything and patiently explained proper care for my eyes. They definitely know how to provide great care and treat their patients right. Now I know why they have such a great reputation and been around for so long.

    Steve Fay

  • Dr. Kavner is a gifted diagnostician and orthoptic therapist. He treated me several decades ago for a condition similar to dyslexia. I was having migraines five times per week. I worked with him for about a year and I experienced tremendous improvement (down to 3-4 per year) that has lasted.

    Mary K.

  • Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!

    Peter G.

  • Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!

    Kinkie F.



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