Dry Eye Syndrome and Guide to Nighttime Therapy

Jul 15, 2015
14 min read

Dry eye disease is one of the most common ocular morbidities, and a leading cause of visits to eyecare professionals today.1,2

Common signs and symptoms of dry eye syndrome (DES) include:

  • dryness
  • redness
  • stinging
  • foreign body sensation
  • reduced vision
  • excessive tearing

These symptoms can often be exacerbated by environment, medical conditions, medications, prolonged use of electronics, as well as various ocular conditions and anatomy.

It's time to think differently.

“For those considering new ways to manage dry eye syndrome, it might be time to think holistically. A company based out of Temecula, California called Eye Eco, has worked extremely hard to develop various products that can be used during this critical time period. - Dr. Matt Geller”

Here’s a 36 page guide on understanding dry eye and meibomian gland dysfunction. Learn how you can treat MGD using LipiFlow, and how to bring this technology to your practice.

Exposure Keratopathy

Symptoms: Irritation, burning, foreign body sensation (FBS), redness, usually worse in the morning.

Clinical Signs: Inadequate blinking or closure of eyelids leading to corneal desiccation. Punctate epithelial defects in the lower third of the cornea, commonly as a horizontal band. Conjunctival injection, chemosis or eyelid deformity.


Image Source: University of Iowa Health Care

Potential Etiologies: CN VII palsy,  Bells palsy, Eyelid deformity, Nocturnal Lagophthalmos, Proptosis.

Workup: Case history. Evaluate eyelid closure and corneal exposure. Check corneal sensation. Look at tear film and corneal integrity with flourescein dye.

Product Recommendation - Onyix™/ Quartz™ Shield

  • Suggested Treatment Duration: overnight, beginning before bed and finishing upon waking up


  • Dr. Geller's Notes: I utilize the Onyix™ and Quartz™ shields particularly for patients with exposure keratopathy because of their ability to create a moisture chamber to halt tear evaporation. I use the Eye Eco Onyix™ shield, which is black for patients who prefer a dark sleep mask, and the Quartz™ shield for patients who'd rather be able to see out of the shield. They just released a new hand made head strap designed specifically for use with a C-PAP machine used for sleep apnea. My patients report that the shield shelters eyes from excess tear evaporation, while also fogging up, creating a moisture rich environment for the eyes. The new strap features a soft cotton/Lycra fabric covering sewn over elastic, so it stays in place and provides great comfort. The mask is nice because it rests inside the orbit for a lower profile. These are often preferred by smaller faces and those that want to use it on the airplane. Coincidentally, I am writing this as I am on a flight from San Diego, CA to Jacksonville, FL and my eyes are feeling extremely dry!

Product Recommendation - Tranquileyes™ XL


  • Dr. Geller's Notes: I utilize Tranquileyes™ XL as a first line therapy for my patients with exposure keratopathy. Practicing in California, many of our patients appreciate a holistic remedy for their dry eye, and so Tranquileyes™ is easily adopted. Tranquileyes™ provides maximum coverage for eyes and surrounding tissue, helping to keep lids closed. Coverage not only replenishes moisture to the patient's eyes, but also to the skin around the eyes. I find that most patients with exposure keratopathy have concomitant meibomian gland disease. Tranquileyes™ ensures eyelid closure and also provides the right level of heat and humidity to treat the MGD comfortably and effectively. Tranquileyes™ is the only system on the market that controls heat and humidity beyond 10 minutes, and can sustain required temperatures and humidity up to 25 minutes. No other product on the market can achieve this, and as we know, relative to MGD, humidity helps open the glands and promotes circulation and healing.

Traditional Treatment: Prevention is key. Artificial tears can be used throughout the day, as well as lubricating ointment at night. Eyelid taping or patching at nighttime can also be helpful. Surgical repair of eyelids can also be used as a last resort.

Floppy Eyelid Syndrome

Symptoms: Irritation, redness, mucous discharge, usually upon waking up in the morning.

Clinical Signs: Lids are extremely easily everted, superficial punctate keratitis.