Dry Eye & Blepharitis

Understanding Dry Eye

Dry eye is a prevalent condition where the eyes do not receive adequate moisture, resulting in itchiness, redness, and discomfort from dry spots on the eye’s surface. This issue can arise due to insufficient tear production, where the lacrimal glands do not produce enough tears, or a chemical imbalance in the tears, which can affect the eye’s protective layer. Factors such as aging, certain medications, environmental conditions, and prolonged screen time can contribute to the development of dry eye. Treatment options range from using artificial tears, and eye drops to lifestyle changes and medical interventions, depending on the severity of the condition. Regular eye check-ups are essential for managing and mitigating the symptoms effectively.

Symptoms and Diagnosis Of Dry Eye

Individuals with dry eyes often face persistent irritation, which, if untreated, can lead to severe vision problems. Proper eye care is crucial to alleviate symptoms and prevent further complications. Your eye specialist can diagnose dry eye by comprehensively evaluating your eyes and tear production using the TearLab osmolarity testing unit.

TearLab Osmolarity Testing

The TearLab Osmolarity system is the first objective and quantitative test for diagnosing and managing dry eye patients. The literature identifies hyperosmolarity, or increased sodium in tears, as a primary marker of tear film health. During your consultation, your doctor will take a tiny tear sample from both eyes to measure tear osmolarity. Your Osmolarity Number provides significant insights into the health and stability of the protective tear film covering your eye surface. This figure correlates to the severity of the condition. If you are on a Dry Eye Disease Treatment Plan, this number will be monitored to track your progress.

Innovative Dry Eye Testing: InflammaDry®

InflammaDry® is one of our advanced tests for diagnosing dry eye at Eye Associates of South Texas. Often, symptoms lag behind clinical signs of dry eye disease. Inflammation, mainly a molecule called metalloproteinase-9 (MMP-9), is a marker for dry eye disease. InflammaDry detects elevated MMP-9 levels to determine if your dry eye symptoms are due to active inflammation around the eyes.

Significance of MMP-9 Detection

High MMP-9 levels can also be linked to systemic disorders such as Sjogren’s syndrome or other rheumatological conditions. Depending on the results of the InflammaDry test, we may recommend anti-inflammatory treatments, including steroid drops, Restasis®, or Xiidra®. The results from InflammaDry also help us monitor your response to therapy over time.

Discover our dry eye treatment options and schedule your InflammaDry test with us today.

Causes of Dry Eye

Dry eye is a condition that many encounter as they age. It often arises from medications, medical conditions, or injuries. Women, especially those experiencing hormonal changes during pregnancy or menopause, are more frequently affected. The use of oral contraceptives can also alter tear consistency. Dry eye is ubiquitous in individuals over 50. Other contributing factors include:

  • Aging: Natural aging processes can reduce tear production.
  • Medications: Antihistamines, decongestants, blood pressure medications, and antidepressants can all contribute to dry eye.
  • Medical Conditions: Issues such as rheumatoid arthritis, diabetes, and thyroid problems can be culprits.
  • Environmental Factors: Exposure to smoke, wind, air conditioning, and dry climates can exacerbate symptoms.
  • Contact Lens Use: Long-term use can affect tear production.
  • Eye Surgery: Procedures on the eyes can impact tear production.
  • Sun Exposure: UV rays can dry out the eyes.
  • Smoking: Both direct and second-hand smoke can lead to dry eyes.
  • Specific Syndromes: Conditions like Sjogren’s syndrome and thyroid eye disease are known causes.
  • Injuries and Surgeries: Eye injuries and eyelid surgeries can interfere with tear production.
  • Inflammation: Inflammation of the conjunctiva or exposure keratitis may also play a role in this condition.

These factors can impair the quality or quantity of tears, leading to dry eyes. Tears require a balanced chemical composition for effective eye moisturization.

Dry eye occurs when the eyes do not produce adequate tears or lack the right quality. Tear production diminishes with age, affecting women more than men due to hormonal changes.

Dry Eye remains a poorly understood but common eye condition. People often blame weather, eye strain, or allergies for their symptoms, which can worsen dry eye but are not the root causes. Healthy eyes require a continuous layer of tears, known as the “tear film,” composed of three layers: mucin, aqueous, and lipid. Changes in the lacrimal glands can alter tear quality and quantity. The Meibomian glands, which produce oils to prevent tear evaporation, can also be affected. These glandular changes and inflammation compromise the tear film, leading to burning sensations, excessive tearing, blurred vision, redness, and chronic dry eye disease. Without treatment, symptoms can worsen, making conservative therapies less effective.

Our specialists—Drs. Kavanagh, Acosta, Ehiem, Jacob, Hammodeh, and Psolka—are experts in Dry Eye Diseases and offer treatments for both mild and severe cases in San Antonio, New Braunfels, Seguin, and La Vernia, TX.

If you’re experiencing dry eye symptoms, contact The Eye Associates of South Texas for comprehensive testing and tailored treatments to restore your eye health.

Symptoms of Dry Eye

Dry eye can harm the eye’s surface tissues, causing minor abrasions and impaired vision. Fortunately, several treatments can relieve symptoms and promote eye health and clear vision. Dry eye typically affects both eyes and can present with various symptoms:

  • Stinging or Burning Sensation: A common sign of dry eye.
  • Irritation from Smoke or Wind: Environmental factors can worsen symptoms.
  • Scratchy Feeling: Eyes may feel gritty or scratchy.
  • Eye Fatigue: Prolonged reading or screen time can lead to eye fatigue.
  • Light Sensitivity: Bright light can cause discomfort.
  • Difficulty with Contact Lenses: Wearing contact lenses might become uncomfortable.
  • Excessive Tearing: Paradoxically, dry eyes can produce too many tears as a response to irritation.
  • Blurry Vision: Vision can become intermittently blurry.

Complications of Dry Eye

If neglected, persistent dry eye can lead to discomfort, a higher risk of eye infections, and damage to the eye’s surface. Without proper treatment, dry eye may result in various complications, such as:

  • Pain: Chronic discomfort and pain can ensue.
  • Corneal Ulcers or Scars: Severe cases can result in ulcers or scarring on the cornea.
  • Vision Loss: Persistent dry eye can lead to vision impairment.

Comprehensive Treatment for Dry Eye

Dry eye treatment varies based on the underlying cause and severity of the condition and the patient’s overall health and preferences. Non-surgical treatments are often quite effective and may include the following methods:

Non-Surgical Treatments

  • Purposeful Blinking: Regularly blinking consciously can help keep your eyes moist.
  • Increase Humidity: Using a humidifier at home or work to maintain moisture levels.
  • Artificial Tears and Ointments: Over-the-counter products can provide temporary relief.
  • Avoid Smoke: Stop smoking and avoid exposure to second-hand smoke.
  • Minimize Wind Exposure: Try to stay away from air conditioning or windy outdoor conditions.
  • Limit Certain Medications: Avoid using allergy and cold medicines that may dry out your eyes.
  • Dietary Adjustments: Incorporate omega-3 fatty acids through diet or supplements.
  • Autologous Tears: Customized eye drops made from your blood.

If non-surgical methods are not successful, surgical treatments might be necessary.

Surgical Treatments

  • Punctal Plugs: Small plugs are inserted in the corners of the eyes to limit tear drainage.
  • Punctal Cautery: A procedure to permanently close tear drainage holes.
  • Eyelid Surgery: Corrective surgery if an eyelid condition contributes to dry eyes.

Treating the root cause of dry eyes can also alleviate symptoms.

Autologous Tears for Severe Dry Eyes

Autologous tears, created from the patient’s blood, are a standard treatment for severe dry eyes. Unlike artificial tears, these serum tears contain vitamin A, fibronectin, immunoglobulins, and growth factors that promote eye health.

Benefits of Autologous Tears

  • Nutrient-Rich: Contains elements that promote the health of the eye’s surface.
  • Customized Treatment: Explicitly tailored from the patient’s blood.


  • Frequent Blood Draws: Requires regular blood samples, usually every three months.
  • Insurance Coverage: Often not covered by medical insurance.

Prescription Eye Drops: Restasis® and Xiidra

Restasis® Ophthalmic Emulsion

RESTASIS® is a prescription eye drop designed to boost tear production in chronic dry eye patients. Users of RESTASIS® have reported significant enhancements in comparison to alternative treatments.


Like Restasis®, Xiidra is an immunosuppressive medication that decreases inflammation and enhances tear production. While these therapies may take weeks to months to show results, they substantially alleviate dry eye symptoms.

Improving Severe Dry Eyes with Amniotic Membrane

Amniotic Membrane Treatment

A dehydrated amniotic membrane, known as Aril, is placed under a bandage contact lens. This treatment benefits various conditions, including severe dry eyes, corneal abrasions, and herpetic ulcers.

How It Works

  • Healing Properties: The membrane has regenerative and anti-inflammatory properties.
  • Application Duration: Typically stays in the eye for one to two weeks.
  • Enhanced Healing: Promotes quicker regeneration of corneal cells and reduces pain.

While the membrane is in place, you can continue using eye drops. Once the treatment period ends, your ophthalmologist will remove the contact lens.

Treatment Options for Meibomian Gland Disease

LipiFlow® by Johnson and Johnson

If your dry eye condition is linked to glandular issues in the eyelid, you might be a candidate for LipiFlow®. This innovative treatment addresses the root cause of blocked Meibomian glands, a significant factor in evaporative dry eye. By clearing these glands, natural lipid (oil) production necessary for a healthy tear film can resume. Unlike treatments that merely add liquid to tears, LipiFlow® tackles the underlying problem.

During a consultation, your doctor will examine your eyelids and eye surfaces to determine the health of your tear film. If you are deemed a suitable candidate, the LipiFlow® treatment will be performed. The procedure is straightforward: the activator is positioned in a quiet room between the cornea and the external eyelid. This design enables thermal heating to be applied to the back surface of the Meibomian glands. The Thermal Pulsation System then compresses the glands, softening and clearing them. This can restart your body’s natural oil production, which is essential for a healthy tear film. The single-use design and integrated sensors of the activator ensure safe, sterile treatment, potentially alleviating symptoms like burning, redness, and tired, dry eyes.


BlephEx is an in-office procedure designed to treat blepharitis, a common eyelid condition. This painless treatment uses a patented handpiece with disposable tips to clean and exfoliate the eyelid margins, removing debris and scurf with a rotating medical-grade micro-sponge. Performed by one of our eye doctors or certified technicians, the procedure takes about 6-8 minutes.

Keeping the eyelid margins clean is crucial for the meibomian glands to produce the oils that prevent evaporative dry eye. BlephEx is akin to dental cleaning and should be repeated every six months. In between treatments, maintaining nighttime lid hygiene, similar to flossing your teeth, is recommended. This routine will keep your eyelid margins healthy and may reduce the likelihood of developing dry eyes, blepharitis, chalazion, or styles.

IPL by Lumenis M22 with Optimal Pulse Technology (OPT)

Intense Pulsed Light (IPL) therapy is a promising option for those who haven’t found relief with other treatments. Our physicians can help you decide if IPL suits your dry eye condition. IPL therapy significantly improves eye comfort and has been shown to reduce or eliminate dry-eye symptoms, assisting many people to return to everyday life.

Initially used for dermatological purposes such as reducing redness and improving skin appearance, IPL has proven effective in treating dry eye symptoms. During the procedure, one of our board-certified ophthalmologists will direct intense pulsed light bursts at your lower eyelids, cheeks, and entire face width. The blood vessels in these areas absorb light and heat, opening the tear glands. Once opened, the glands can be expressed as clogged secretions, allowing them to function correctly again. This quick 15-minute procedure is usually performed in the clinic, with most patients requiring five treatments in the first six months. Many patients report feeling relief immediately after the first treatment. Maintenance treatments are recommended every 6-12 months.

Preventing Dry Eye

Preventing dry eye symptoms is particularly important for those at higher risk. Simple lifestyle modifications can effectively reduce the frequency and severity of symptoms. For example, wearing protective glasses on windy days and taking regular breaks during reading or other strenuous tasks can make a significant difference.

Your doctor will provide personalized instructions on how to avoid dry eye symptoms based on your specific condition.

Blepharitis: Understanding and Managing Eyelid Inflammation

What is Blepharitis?

Blepharitis is a chronic inflammation or infection of the eyelids and the hair follicles along their edges. This non-contagious condition can affect people of all ages, resulting in redness, swelling, itching, and a gritty eye sensation. Causes include bacterial infections, skin conditions such as dandruff, or issues with the oil glands in the eyelids. While blepharitis can be uncomfortable and sometimes persistent, maintaining proper hygiene and following recommended treatments can help manage symptoms and enhance eye health.

Causes of Blepharitis

Several factors can contribute to the development of blepharitis, including:

  • Seborrheic Dermatitis: A skin condition that causes flaky scales and itchy, red skin.
  • Acne: Skin disorder causing pimples and lumps.
  • Bacterial Infection: Microbial invasion leading to inflammation.
  • Allergic Reaction: Immune response to allergens.
  • Poor Eyelid Hygiene: Inadequate cleansing of the eyelid area.
  • Rosacea: Chronic skin condition causing redness and pimples.

Symptoms of Blepharitis

Common symptoms associated with blepharitis include:

  • Red or Swollen Eyes: Inflammation and redness in the eyes.
  • Red or Swollen Eyelids: Puffy and irritated eyelids.
  • Frequent Tearing: Excessive production of tears.
  • Crusty, Flaky, or Scaly Eyelids: Accumulation of debris around the eyelashes.
  • Sensitivity to Light: Discomfort when exposed to bright light.
  • Blurry Vision: Reduced clarity of vision.
  • Burning Sensation: Feeling of heat or irritation in the eyes.

In more severe cases, removing crusty skin can lead to sores, eyelash loss, eyelid deformation, and spreading infection to the cornea. Additionally, blepharitis can cause styes, chalazions, and issues with the tear film.

Diagnosis of Blepharitis

A doctor can diagnose blepharitis through a comprehensive eye examination, which includes:

  • Eye Examination: Thorough inspection of the eye.
  • Evaluation of Eyelid Margins and Oil Glands: Checking the edges of the eyelids, eyelashes, and oil glands.
  • Review of Medical History: Understanding the patient’s medical background.

Treatment of Blepharitis

Although a definitive cure for blepharitis remains elusive, effective management through diligent hygiene and care is paramount. Essential treatment components include:

  • Eyelid Hygiene: Regular and gentle eyelids, face, and scalp cleaning.
  • Warm Compresses: Apply warm compresses to loosen crust and debris.
  • Gentle Cleansers: Use mild cleansers, such as baby shampoo, to keep the eyelids clean.

In cases where bacterial infection contributes, antibiotics may be prescribed to help control the condition.

Request an Appointment


Explore our wide range of specialized services at Eye Associates of South Texas

From routine exams to advanced treatments, we’re committed to safeguarding your vision.

Routine Eye Care

Get a same-day eye exam with top-notch technology from premier board-certified doctors in South Texas. Simply fill out the form below, and one of our schedulers will contact you to confirm your appointment…

Macular Degeneration

Macular degeneration, often called age-related macular degeneration (AMD), is a prevalent condition among older adults. It is the foremost cause of vision loss and blindness in individuals above 65. This condition impacts the macula, the part of the retina responsible for sharp, detailed vision necessary for activities like reading or driving…


Explore our wide range of specialized services at Eye Associates of South Texas

From routine exams to advanced treatments, we’re committed to safeguarding your vision.

Routine Eye Care

Get a same-day eye exam with top-notch technology from premier board-certified doctors in South Texas. Simply fill out the form below, and one of our schedulers will contact you to confirm your appointment…

Macular Degeneration

Macular degeneration, often called age-related macular degeneration (AMD), is a prevalent condition among older adults. It is the foremost cause of vision loss and blindness in individuals above 65. This condition impacts the macula, the part of the retina responsible for sharp, detailed vision necessary for activities like reading or driving…

Eye Exams

Scheduling an annual eye exam is crucial for maintaining optimal visual health and clarity. Regular check-ups allow eye care professionals to detect early signs of potential issues such as glaucoma or cataracts, ensuring timely intervention. Eye exams can also reveal underlying health conditions, such as diabetes or high blood pressure, making…